Tobacco Use and Trends
- In 2022, an estimated 10.5 million people (6.0 million males and 4.5 million females) aged 15 years and older were tobacco product users in Italy. This positions the country as the 19th globally and the 5th in the WHO European Region in terms of number of tobacco users.1,2
For comparison, according to the Attitudes of Europeans Towards Tobacco and Electronic Cigarettes survey in 2020, 23% adults in Italy (29% male and 18% female) aged 15 years and over were currently smoking tobacco products (cigarettes, cigars, cigarillos or pipe). Tobacco smoke was more prevalent in the 25-39 age group with 30%, followed by the 40-54 age group with 29%, the youngest 15-24 age group with 20%, and the oldest age group 55 years and over with 17%.
Among those tobacco smokers, 81% were daily cigarettes and 5% were daily hand-rolled cigarettes smokers.
In 2019, 32% of youths (31% boys and 34% girls) aged 15-16 years were current cigarette smokers.
Demand for cigarettes per capita reduced a notable 44% in Italy from 92 packs in 2002 to 52 packs in 2021. The demand for per capita fine-cut tobacco (e.g. roll your own) has been consistently increasing in Italy by 4-fold from 0.3 packs of 20gr weight in 2002 to 4.5 packs of 20gr weight in 2021 (Figure 1).
Figure 1 Cigarette and Fine Cut Tobacco Consumption in Italy 2002-2021
Source: European Commission, Releases for consumption of cigarettes and fine cut tobacco (2002-2022)
Nicotine Alternatives
In 2020, 12% of respondents (14% male and 9% female) said they at least tried e-cigarettes.
The “at least tried out” category, the rate was the highest among the 25-39 age group with 17%, followed by the 40-54 age group with 14%, then the youngest 15-24 age group with 10%, and the 55 years old and older group with 8%.
1% of adults were current e-cigarettes users.
In 2020, 10% of respondents (12% male and 8% female) said they at least tried heated tobacco products (HTPs).
The “at least tried out” category, the rate was more prevalent among the 25-39 age group with 14%, followed by the 40-54 age group with 12%, then youngest 15-24 age group with 10%, and the 55 and over age group with 7%.
Current HTP prevalence was 3%.
In 2020, 75% of respondents said they had either quit or attempted to quit without any assistance.
Approximately 9% utilized Nicotine Replacement Products (NRTs), 8% sought medical support, while 12% and 8% utilized e-cigarettes and HTPs respectively. Only 4% opted for HTPs or oral, chewing, nasal tobacco products in their quitting journey.
In 2019, 13% of youths (15% boys and 12% girls) aged 15-16 years in Italy were current e-cigarette users.
Health and Economic Burden From Tobacco Use
In 2021, it was estimated that tobacco was the 2nd highest risk factor driving the most deaths and disability combined in Italy.
Tobacco was responsible for an estimated 61.4 thousand deaths, which is about 18.6% of total deaths.
Of tobacco-related deaths, 56.6 thousand or 92.3% were due to smoking, and 6.2 thousand or 10.1% were due to secondhand smoke.
In 2021, the top 10 causes of the most deaths in Italy included Ischemic Heart Disease (IHD) ranking 1st, Stroke ranking 4th, Lung Cancer ranking 5th and Chronic Obstructive Pulmonary Disease (COPD) ranking 7th.
Tobacco was responsible for an estimated 9.8 thousand or 13.3% of all IHD deaths, 4.1 thousand or 8.7% of all Stroke deaths, 21.4 thousand or 75.6% of all Lung Cancer deaths, and 8.8 thousand or 53.0% of all COPD deaths.
In 2021, tobacco use caused an estimated loss of 1.5 million disability-adjusted life years (DALYs), which was about 21.2% of total DALYs. Tobacco accounts for 196.4 thousand DALYs for IHD, 85.3 thousand DALYs for Stroke, 439.7 thousand DALYs for Lung Cancer, and 164.9 thousand DALYs for COPD.
Regulatory Environment and Economics
Public Health Commitment
Italy ratified the WHO Framework Convention on Tobacco Control (FCTC) in 2008.
Italy adopted graphical health warnings (GHWs) on combustible cigarettes (CCs) in 2016, covering 65% of the front and 65% of the back of the packages.
Diverse Tobacco Market
HTPs and e-cigarettes with and without nicotine content are available. HTPs are classified as “smokeless tobacco”. Key points include:
The flavor ban is imposed on HTPs while e-cigarettes have no flavor restrictions.
Product restrictions for e-cigarettes include a maximum nicotine concentration to 20mg/ml, the tank capacity not exceeding 2ml, and refill containers limited to a maximum 10ml.
Text health warnings cover 30% of both surfaces for HTPs and e-cigarettes.
Taxation Policy
In 2022, total tax rate on retail prices of a pack of cigarette was 76.7%.
In 2023, HTPs are subject to an ad valorem excise of 36.5% with the excise base being the duty on the equivalent quantity of cigarettes. That is, Italy uniquely sets the excise base by comparing the consumption time of heated tobacco sticks and cigarettes. Consequently, Heated Tobacco brands can have various excise liability based on the consumption time of their sticks compared with cigarettes.
In 2022, e-cigarettes are levied differential specific excise tax for nicotine (EUR 0.132/ml) and without nicotine (EUR 0.088/ml) content.
By the definition of tax application, a differential excise tax policy is applied between CCs and HTPs. The excise value for HTPs is ERU 1.13/pack, with its share (22.6%) on the retail price (EUR 5.00/pack) in 2023. The excise value of CCs is EUR 3.89/pack, with its share (64.91%) on retail selling price (EUR 6.00/pack) in 2023.
Smoking and Advertising Bans3
- Weak smoking bans with unknown level of compliance, and moderate advertising bans with complete level of compliance were enforced in Italy in 2022.
Age Restrictions
- Tobacco products and e-cigs with nicotine cannot be sold to individuals younger than 18 years of age.
Illicit Cigarette Trade
- Estimated figures indicate that illicit cigarette trade in Italy remained consistently below 10% over the years with 2.6% in 2008, reaching 6.7% in 2020 and maintaining the same level until 2022.
- In 2021, an estimated 1.4 billion counterfeit & contraband (C&C) cigarettes were consumed in Italy. The market share of C&C was approximately 2.2% of the total cigarette market, costing the government an estimated EUR 272 million in total tax revenue.
Tobacco Production and Diversification
In 2022, Italy produced about 30.9 thousand tons of unmanufactured tobacco, accounting for approximately 0.5% of the global production of 5.8 million tons. This positioned Italy as the 21st largest tobacco producer in the world.
When compared to 2010, when Italy produced about 89.1 thousand tons of unmanufactured tobacco, there was a 65.4% decrease by 2022.
In 2022, Italy utilized approximately 11.0 thousand hectares of land for tobacco cultivation, reflecting a 60.6% decrease compared 2010. (FAOSTAT [accessed January 2024])
