by Vera Martinella
Australia, New Zealand, the United States and France are successful examples: with laws and price increases they have achieved important goals. Our country has been at a standstill for 10 years
Prevent children from starting to smoke and reduce the number of smokers of all ages as much as possible. How to do? In Europe as in the rest of the world, the most used strategies, often combined with each other, are three: purchase bans for minors, price increases and more effective information campaigns, starting from school desks. British Prime Minister Rishi Sunak’s intention to insist on the law: on Wednesday 4 October, during the annual conference of the Conservative Party, he expressed his desire to prevent teenagers from lighting their first cigarette. To achieve this goal he wants to raise the age of the ban on the purchase of tobacco year after year, now set in the UK as in Italy at 18 years.
England’s proposal
If Parliament were to approve Sunak’s proposal (valid only for England, not Scotland, Wales and Northern Ireland), therefore, from 2024 it would be prohibited to sell cigarettes to 19-year-olds, from 2025 to under-20s and so on. Until, practically, the ban will affect the entire population. The prime minister also has electronic cigarettes and vaping products in his sights, the consumption of which among English teenagers has tripled in the last three years (despite the fact that their sale to minors is prohibited) and for which he wants to introduce new restrictions. Perhaps following the example of the United States, where in 2020 the Government banned the sale of the most popular aromas among adolescents in small cartridges, most widespread among young people: fruit, sweets or various caramelized flavors and mint (menthol In Europe, menthol is already prohibited both in liquids for electronic devices and in classic cigarettes, because it has been shown that it increases the ability of nicotine to create addiction).
Winning examples
Will it work? Yes, if you look at those who have already tried. The first country to have already introduced this law was New Zealand, which prohibits the sale of tobacco products to all those born after January 1, 2009 – says Silvano Gallus, head of the Lifestyle Research Laboratory at the Mario Negri Institute from Milan -. In practice, anyone who is 14 years old today will become an adult in four years, but will still not be able to buy tobacco. A group of European experts has proposed the same thing for all citizens born after 1 January 2010 and the collection of signatures is open for a bill in the EU Parliament. Other winning examples? The countries that have achieved the most important successes are the United States, which since 2019 has raised the minimum age for purchasing to 21 – recalls Gallus -. Then Australia which, in addition to the absolute ban on the sale of e-cigs (which can only be purchased with a medical prescription), raised the price of a pack to almost 20 euros: result? Less than 10% of Australians now smoke. Great Britain has also done well, being the first European country to impose a high price (15 euros per pack) and which also reimbursed the treatments that help people quit: thus the number of smokers has dropped significantly, by around a third in the last 50 years, from the Seventies to today, but 13% of the population continues to smoke, six and a half million Britons in total. And there is a worrying reversal of trend affecting young people and especially e-cigs. And there has also been a collapse in consumers in France, where in a few years the cost of a package has almost doubled (over 10 euros today).
The Italian situation
As for Italy, the estimates of the latest national report on smoking (May 2023) by the Istituto Superiore di Sanit indicate that 20.5% of the Italian population over 15 years of age smokes (10.5 million people, 25 1% of men and 16.3% of women) and which increases the average number of cigarettes smoked: 12 per day, a quarter of smokers exceed 20. Over 81% consume packaged cigarettes, over 11% handmade cigarettes, 14% heated tobacco and 5% e-cig. Even here smokers have decreased – explains Gallus -: there was a notable drop, by as much as 25%, between 2003 and 2013. This is thanks to the Sirchia law, adopted in 2005, which not only introduced important bans, but it also made smoking “socially unaccepted”. But then we were trapped in a stalemate situation: in the last 10 years there has been no improvement, also because nothing (or almost nothing) has been done at a strategic level. As for bans, in recent years our country has expanded the list of areas in which it is not legal to light up a cigarette (such as in a car in the presence of children and pregnant women, or in school and hospital courtyards, for example) and has increased fines and penalties for those who sell smoking products to minors. The increase in cost, however, was minimal even though in 2021 the Umberto Veronesi Foundation had presented a petition to Parliament for a significant increase in the price of cigarette packs, loose tobacco and heated tobacco devices.
Teenager alert
The latest ISS data indicate that the law is widely circumvented by children: more than a third of Italian students aged between 14 and 17 who take nicotine use one of the products available on the market, and a significant share uses them all. They smoke even if they are not of the legal age to be able to buy cigarettes, without great difficulty in getting what they want, mixing a bit of everything: classic cigarettes, loose rolling tobacco, e-cigs or heated tobacco products. Many people, especially younger people, believe that vaping is a safe choice for their health, but any type of smoking causes harm. In teenagers who vape, scientific research has also highlighted an increase in respiratory disorders, such as bronchitis, asthma, breathlessness and more frequent inflammation. Not even heated tobacco is free from dangers and damage to health. And it gets worse: first, many kids who start with vaping then move on to traditional tobacco; second, young people largely believe they can stop whenever they want (but obviously this isn’t the case) and then they struggle a lot to say enough is enough.
The trend of puff bars
Young people, in particular, like to vape. You can see it in the videos on social networks where they have competitions and games in the circles that they manage to draw with the smoke they exhale. The problem is at the center of attention in the most important medical conferences and there is an increasingly large scientific literature that investigates the issue, also pointing the finger at the industry that specifically creates new products with captivating flavors for teenagers. The latest trend is puff bars, basically disposable e-cigs, which cannot be recharged – explains Roberto Boffi, pneumologist, head of Pneumology and the Anti-smoking Center of the IRCCS National Cancer Institute of Milan -. They cost less than 10 euros and provide on average more than 300 puffs, or more than 20 cigarettes. And above all, as with e-cig liquids, they are sold in many attractive aromas: fruit, sweets, mint and various oddities. They capture a younger audience, as do the packaging and devices themselves: colorful and fun they become fashion objects. They exist with and without nicotine, so they can (and often are) addictive.
Never too late to quit
Thinking that vaping can help you quit smoking is a big mistake. This is reiterated by the new Guideline for the treatment of tobacco and nicotine addiction published by the Higher Institute of Health on the occasion of World No Tobacco Day 2023: E-cigs or electronic cigarettes and heated tobacco cigarettes cannot be used in any way consider it a suitable tool for starting therapy for smoking cessation. E-cigs, introduced on the market as useful tools for quitting smoking, have instead generated new categories of consumers, the “dual consumers” who have added the use of electronic cigarettes and heated tobacco ones to the consumption of traditional cigarettes. As many scientific studies have now shown, it is never too late to stop: The advantages, tangible and concretely measurable, are also seen in extreme cases such as, for example, in cancer patients who have a greater chance of survival if they stop compared to those who continue on away from smoking – recalls Paolo Veronesi, president of the Umberto Veronesi Foundation which, since its inception in 2003, has been involved on various fronts in the fight against tobacco -. About a third of Italian smokers have tried to say enough, most try on their own, but it’s more difficult. While with the support of trained healthcare personnel, the success rates are higher.
Asking for help increases the chances of success
The reasons, when one decides to abandon the smoking habit, are decisive. It is equally important to ask for help from an anti-smoking center (the toll-free number of the Higher Institute of Health 800554088) where based on the identikit (how much and when you smoke, why, for how long and your attitude, including psychological, towards smoking) of the individual person, the doctor decides which strategy to prescribe to help him or her deal with the symptoms related to withdrawal: from nicotine replacement therapy, with sweets, patches, inhalers or chewing gum, to drugs (buproprion, varenicline, cytisine) which also constitute a valid support also for mental addiction, up to psychological support to learn to face the most difficult moments.
Raising costs discourages young people
Italy, however, ranks last in Europe in the sale of drugs used in smoking cessation therapy. However, to be successful, personalizing the intervention and asking for help from an Anti-Smoking Center can be the best way to receive both psychological support and medicines or the most appropriate support for the individual smoker – reiterates Silvano Gallus -. In addition to the toll-free number 800 554 088, lon the Smettodifumare.iss.it platform offers, among other things, the geolocalized map of the Anti-Smoking Centers present on the national territory. In our country, however, tobacco prices remain among the lowest in Western Europe: in 2020 France brought the price of a pack to 10 euros, in Norway the average was 13.90, in the United Kingdom 10.50 and in Ireland 13. In Australia the cheapest one costs around 18 euros and the most expensive is almost 30. The increase in price affects consumption, especially in a crucial segment such as young people, and helps to mobilize useful resources for other purposes – underlines the president of the Umberto Veronesi Foundation -. Raising spending on tobacco means protecting people, increasing resources for treatment, helping people quit smoking and conducting independent research. The alternative is hardly justifiable inaction.
Over 25 diseases caused by smoking
One in three cases of cancer is due to smoking
. Tobacco alone is responsible for 90% of lung cancer cases, 70% of bladder cancer cases and thousands of other types of cancers (stomach, liver, larynx, pharynx, pancreas) that are diagnosed every year. Smoking then increases the possibility of damage to the heart and circulatory system, favoring pathologies such as stroke, atherosclerosis and peripheral vascular diseases. And to this we must add another long series of diseases: from chronic obstructive pulmonary disease (COPD), destined to become the third cause of death worldwide, to bronchitis and pneumonia; from skin damage to bone and muscle damage, up to erectile dysfunction and impotence in males.
October 5, 2023 (modified October 5, 2023 | 5:39 pm)
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