Annals of Oncology Advance Access originally published online on November 7, 2005
Annals of Oncology 2006 17(2):346-347; doi:10.1093/annonc/mdj070
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
© 2005 European Society for Medical Oncology
Effects of new smoking regulations in Italy
1 Istituto di Ricerche Farmacologiche ‘Mario Negri’, Milan, Italy; 2 Dipartimento del Farmaco, Istituto Superiore di Sanità, Rome, Italy; 3 Istituto DOXA, Gallup International Association, Milan, Italy; 4 Istituto di Statistica Medica e Biometria, Università degli Studi di Milano, Milan, Italy
* Correspondence to: Dr S. Gallus, Istituto di Ricerche Farmacologiche ‘Mario Negri’, Via Eritrea 62, 20157 Milan, Italy. Tel: +39-02-39-014-526; Fax: +39-02-33-200-231; E-mail: gallus{at}marionegri.it
 |
Abstract |
|---|
 Top Abstract introductionpatients and methodsresultsdiscussionReferences |
|---|
Background: From 10 January 2005 the Italian government banned smoking in all indoor public places. We conducted a population-based survey to provide information on attitudes towards smoking regulation and to disentangle the impact of the smoking ban on tobacco consumption.
Patients and methods: We considered data from a survey on smoking, based on 3114 subjects aged 15 or over, representative of the general adult Italian population in terms of age, sex, geographic area and socioeconomic status.
Results: Once smoke-free policies were introduced, support for them in the public opinion tended to increase. In Italy, smoke-free policies accounted for around 8% decrease in cigarette consumption in the short run. Moreover, tobacco bans were almost universally accepted, and the smoke-free legislation did not seem to unfavourably affect the business of restaurants or cafes.
Conclusions: The results of our study on the first extensive smoking ban in a large country show the advantages of smoke-free legislations, which may have major public health implications.
Key words: Italy, population survey, smoking bans, tobacco smoking, workplace smoking
|
introduction |
|---|
|
TopAbstractintroductionpatients and methodsresultsdiscussionReferences |
|---|
From 10 January 2005 the Italian government banned smoking in all indoor public places, including cafes, restaurants (except for a few with separate and regulated smoking areas), airports, railway stations, as well as in all public and private workplaces. Italy, therefore, is the fourth European country, after Ireland, Norway and Malta [1
, 2], providing comprehensive and strict regulation for smoke-free areas. Besides reducing passive smoking [3, 4], smoke-free policies increase smoking cessation [5] and reduce tobacco consumption [6, 7]. After the ban came into force, we conducted a survey on a representative sample of the Italian adult population to provide information on attitudes towards smoking regulation in Italy. Moreover, we compared smoking consumption from subsequent nationally representative population-based surveys and from official legal sales over time in order to disentangle the impact of the smoking ban on tobacco consumption. |
patients and methods |
|---|
|
TopAbstractintroductionpatients and methodsresultsdiscussionReferences |
|---|
We considered data from a survey on smoking, conducted during March–April 2005 in Italy [8
] by DOXA, the Italian branch of the Gallup International Association, on a sample of 3114 subjects (1511 men and 1603 women) aged 15 years or over, who represented the general adult Italian population in terms of age, sex, geographic area, habitat, education and working status. The sample was defined through a representative multistage sampling of adults from 149 municipalities (the smallest Italian administrative division) in all of the 20 Italian regions (the largest Italian administrative division), identified in order to be representative of the geographical areas sampled. In the municipalities considered, individuals were randomly selected from electoral rolls, within strata of sex and age group. Wherever the selected subjects were unavailable, they were replaced by selecting among neighbours (living in the same floor/building/street) from the same gender and age group. Subjects aged between 15 and 17 years whose names did not appear on the electoral lists, were chosen by means of the ‘quota’ method (by gender and exact age) using the same approach. The data were collected by ad hoc trained interviewers using a structured questionnaire in the context of a computer assisted personal in-house interview. Besides general information on socio-demographic characteristics, data were collected on tobacco consumption, including smoking status and number of cigarettes smoked per day. Some specific questions referred to the attitudes towards the new smoking regulation. Legal sale data were derived from official publications. |
results |
|---|
|
TopAbstractintroductionpatients and methodsresultsdiscussionReferences |
|---|
Overall in 2005, 25.6% of Italian adults described themselves as current smokers (29.3% of men, 22.1% of women). Current smokers consumed a mean of 14.6 cigarettes/day (16.3 for men and 12.4 for women). Using data from official legal sales, 28.3 million kg of cigarettes were sold in Italy during the period January–April 2005. The corresponding value for the same period in 2004 was 31.1 million kg. This corresponds to a decline in cigarette sales by 8.9%. This compares well with a 7.6% fall in consumption revealed by the comparison between results from the 2005 survey and those from a companion survey conducted in March–April 2004: smoking prevalence decreased by 2.3% (a difference of 0.6% in absolute terms) and the mean number of cigarettes per smoker per day decreased by 5.5% (from 15.4 to 14.6). The fall in consumption from 2004 to 2005 was apparently greater for the young (23.0% for the 15–24 year age group) and for women (10.5%).
Table 1 shows the attitudes of the population towards smoke-free policies after the implementation of the tobacco regulation. Overall, 90.4% were moderately to strongly in favour of smoke-free areas in public places such as cafes and restaurants and 86.8% supported the total ban of smoking in all workplaces, public and private. The corresponding estimates for current smokers were 76.3% and 68.8%, respectively. Almost 90% of the population had the perception that the smoking bans were observed in bars and restaurants, and 70% in the workplace, including small workplaces.
|
Overall, after the introduction of the new policies, 9.6% of subjects reported to go more frequently and 7.4% less frequently to cafes and restaurants.
|
discussion |
|---|
|
TopAbstractintroductionpatients and methodsresultsdiscussionReferences |
|---|
In 2001, 83.3% were favourable to a smoking ban in public places, such as pubs or restaurants [9
], and this figure increased to over 90% after the ban came into force. This study confirms, therefore, that the support for smoke-free policies increased once the policies were introduced [6].
Moreover, the study quantified the fall in cigarette sales since the ban came into force in Italy at around 8%, confirming the decrease in the short run found in selected US states and in Ireland [7]. The new smoke-free legislation seemed to affect women and the younger population more frequently, although the estimate for the young was based on a small number of subjects and hence had a wide confidence interval.
Furthermore, in Italy the legislation is almost universally observed, at least in pubs, cafes and restaurants. Out of about 6000 checks by the police and other civil forces, less than 100 (1.5%) violations were observed. Moreover, these results suggest that smoke-free legislations do not unfavourably affect the business of restaurants or cafes.
|
Acknowledgements |
|---|
This work was conducted with the contribution of Italian Ministry of Health, the Italian League Against Cancer and the Italian Association for Cancer Research. The authors thank Ms M. P. Bonifacino for editorial assistance.
Received for publication August 21, 2005. Revision received September 30, 2005. Accepted for publication October 6, 2005.
|
References |
|---|
|
TopAbstractintroductionpatients and methodsresultsdiscussionReferences |
|---|
1. McElvaney NG. Smoking ban – made in Ireland, for home use and for export. N Engl J Med 2004; 350: 2231–2233.
2. Howell F. Ireland's workplaces, going smoke free. Br Med J 2004; 328: 847–848.
3. Farrelly MC, Nonnemaker JM, Chou R et al. Changes in hospitality workers' exposure to secondhand smoke following the implementation of New York's smoke-free law. Tob Control 2005; 14: 236–241.
4. Siegel M, Albers AB, Cheng DM et al. Effect of local restaurant smoking regulations on environmental tobacco smoke exposure among youths. Am J Pub Hlth 2004; 94: 321–325.
5. Longo DR, Johnson JC, Kruse RL et al. A prospective investigation of the impact of smoking bans on tobacco cessation and relapse. Tob Control 2001; 10: 267–272.
6. Jamrozik K. Population strategies to prevent smoking. Br Med J 2004; 328: 759–762.
7. Anonymous. Ireland's smoking ban is an admirable achievement. Lancet 2005; 365: 1282.[Medline]
8. Gallus S, Pacifici R, Colombo P et al. Smoking in Italy 2003, with a focus on the young. Tumori 2004; 90: 171–174.[Medline]
9. La Vecchia C, Garattini S, Colombo P et al. Attitudes towards smoking regulation in Italy. Lancet 2001; 358: 245.[Medline]
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  D. G. Meyers, J. S. Neuberger, and J. He Cardiovascular effect of bans on smoking in public places: a systematic review and meta-analysis. J. Am. Coll. Cardiol., September 29, 2009; 54(14): 1249 - 1255. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. C. Grassi, D. Enea, A. K. Ferketich, B. Lu, and P. Nencini A smoking ban in public places increases the efficacy of bupropion and counseling on cessation outcomes at 1 year Nicotine Tob Res, September 1, 2009; 11(9): 1114 - 1121. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Brown, C. Moodie, and G. Hastings A longitudinal study of policy effect (smoke-free legislation) on smoking norms: ITC Scotland/United Kingdom Nicotine Tob Res, August 1, 2009; 11(8): 924 - 932. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 I Tramacere, S Gallus, E Fernandez, P Zuccaro, P Colombo, and C La Vecchia Medium-term effects of Italian smoke-free legislation: findings from four annual population-based surveys J Epidemiol Community Health, July 1, 2009; 63(7): 559 - 562. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. J. Mullally, B. A. Greiner, S. Allwright, G. Paul, and I. J. Perry The effect of the Irish smoke-free workplace legislation on smoking among bar workers Eur J Public Health, April 1, 2009; 19(2): 206 - 211. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S Gallus, I Tramacere, P Zuccaro, P Colombo, and C La Vecchia Cigarette smuggling in Italy, 2005-8 Tob. Control, April 1, 2009; 18(2): 159 - 160. [Full Text] [PDF]
|
|
|
|
|
|
L Hirte, E Nolte, E Mossialos, and M McKee The changing regional pattern of ischaemic heart disease mortality in southern Europe: still healthy but uneven progress J Epidemiol Community Health, April 1, 2008; 62(4): e4 - e4. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. T. Braverman, L. E. Aaro, and J. Hetland Changes in smoking among restaurant and bar employees following Norway's comprehensive smoking ban Health Promot. Int., March 1, 2008; 23(1): 5 - 15. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. Gorini, E. Chellini, and D. Galeone What happened in Italy? A brief summary of studies conducted in Italy to evaluate the impact of the smoking ban Ann. Onc., October 1, 2007; 18(10): 1620 - 1622. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Narkiewicz Second-hand smoke--a license to kill due to expire Nephrol. Dial. Transplant., June 1, 2007; 22(6): 1508 - 1511. [Full Text] [PDF]
|
|
|
|
 |
|
 F. Barone-Adesi, L. Vizzini, F. Merletti, and L. Richiardi Short-term effects of Italian smoking regulation on rates of hospital admission for acute myocardial infarction Eur. Heart J., October 2, 2006; 27(20): 2468 - 2472. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Levi, P. Colombo, and C. La Vecchia Effects of new smoking regulations Ann. Onc., August 1, 2006; 17(8): 1335 - 1335. [Full Text] [PDF]
|
|
|
|
 |
|
 R. Boffi, A. Ruprecht, R. Mazza, M. Ketzel, and G. Invernizzi A day at the European Respiratory Society Congress: passive smoking influences both outdoor and indoor air quality. Eur. Respir. J., April 1, 2006; 27(4): 862 - 863. [Full Text] [PDF]
|
|
|
|
 |
|
 R. Dobson Italy's smoking ban has led to an 8% drop in tobacco consumption BMJ, November 19, 2005; 331(7526): 1159 - 1159. [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||