The Italian national trends in smoking initiation and cessation according to gender and education

Objectives. This study aims to assess the trend in initiation and cessation of smoking across successive birth cohorts, according to gender and education, in order to provide useful suggestion for tobacco control policy. Study design. The study is based on data from the “Health conditions and resort to sanitary services” survey carried out in Italy from October 2004 to September 2005 by the National Institute of Statistics. Through a multisampling procedure a sample representative of the entire national territory was selected. Methods. In order to calculate trends in smoking initiation and cessation, data were stratified for birth cohorts, gender and education level, and analyzed through the life table method. Results. The cumulative probability of smoking initiation, across subsequent generations, shows a downward trend followed by a plateau. This result highlights that there is not a shred of evidence to support the hypothesis of an anticipation in smoking initiation. The cumulative probability of quitting, across subsequent generations, follows an upward trend, highlighting the growing tendency of smokers to become an “early quitter”, who give up within 30 years of age. Conclusion. Results suggest that the Italian antismoking approach, for the most part targeted at preventing the initiation of smoking emphasising the negative consequences, has an effect on the early smoking cessation. Health policies should reinforce the existing trend of “early quitting” through specific actions. In addition our results show that men with low education exhibit the higher probability of smoking initiation and the lower probability of early quitting, and therefore should be targeted with special attention