Tobacco smoking and use of novel nicotine-containing products in Lombardy: a study by LILT

Introduction: The use of cigarettes and novel tobacco products represents a public health risk, especially for young people. This study aims to provide information regarding the used products and the experiences and habits of smokers in Lombardy, and awareness among the citizens of Milan of the “Milan Smoke Free 2026” project, the process that will lead to the complete ban on smoking in outdoor public areas after 2025. Methods: The first survey, conducted in 2022, involved 895 smokers from Lombardy aged 18 to 70 years. Information about the products used and the age at first smoking experience was collected through a questionnaire. The second survey was based on 460 residents of Milan (smokers and non-smokers), and assessed their sensibility to environmental pollution related to smoking products, as part of the “Milan Smoke Free 2026” project. Results: Traditional cigarettes still emerge as the most commonly used product (73% of the sample use them), although there is a widespread use of heated tobacco devices (32%) and electronic cigarettes with nicotine (26%). Among those aged 18-24 years, the use of roll-your-own cigarettes (51% of young people in the sample use them) and heated tobacco products (44%) is more common. The first experience with a nicotine-containing product occurs on average at age 16. Although only 49% of the citizens of Milan are aware of the “Milan Smoke Free 2026” project, the initiatives proposed by the Milan municipality are appreciated and largely shared (63-79% of the Milanese responded positively to the stop smoking proposal), even by the smokers themselves (51-63%). Discussion: Widespread use of heated tobacco products and electronic cigarettes was observed among smokers in Lombardy, especially among young people. It is necessary to implement actions to avoid nicotine exposure among young or even underage people. Milanese citizens show broad sensibility to environmental issues and good adherence to tobacco control strategies, such as those currently carried out by the “Milan Smoke Free 2026” project.