Smoking prevalence in Italy from 1993 to 2024: a trend analysis framed by public health policies and emerging consumption behaviors

BACKGROUND: Smoking remains a major public health issue in Italy, despite decades of tobacco control measures. This study aimed to describe trends in smoking prevalence and in consumption of other tobacco-derived products, in Italy from 1993 to 2024 stratified by gender and age group. METHODS: This is an observational ecological time-series analysis. Smoking prevalence data were obtained from the Italian Institute of Statistics. Joinpoint regression model was applied to estimate the Annual Percentage Change (APC) and the Average Annual Percentage Change (AAPC). Data on tobacco-derived products were analyzed descriptively using data from the Italian National Health Institute (2013-2023). RESULTS: Overall smoking prevalence declined significantly over the study period (AAPC = -0.78%; P < .0001), with a greater reduction among men (AAPC = -1.31%; P < .0001). However, an increase is observed from 2020 to 2024 (APC +1.53; P = .009). Long-term reductions were observed among midlife women, while smoking increased among younger and older women. E-cigarette use declined (-40%), while heated tobacco products and hand rolled cigarettes use rose steadily (+236% and +181%, respectively). CONCLUSIONS: The recent rise in smoking and the growing use of alternative nicotine products demand renewed prevention and cessation efforts, with targeted education and stronger regulation.