Predicting the future prevalence of cigarette smoking in Italy over the next three decades

Background: Smoking prevalence in Italy decreased by 37 from 1980 to now. This is due to changes in smoking initiation and cessation rates and is in part attributable to the development of tobacco control policies. This work aims to estimate the age- and sex-specific smoking initiation and cessation probabilities for different time periods and to predict the future smoking prevalence in Italy, assuming different scenarios. Methods: A dynamic model describing the evolution of current, former and never smokers was developed. Cessation and relapse rates were estimated by fitting the model with smoking prevalence in Italy, 1986-2009. The estimated parameters were used to predict prevalence, according to scenarios: (1) 2000-09 initiation/cessation; (2) half initiation; (3) double cessation; (4) Scenarios 2+3; (5) triple cessation; and (6) Scenarios 2+5. Results: Maintaining the 2000-09 initiation/cessation, the 10 goal will not be achieved within next three decades: prevalence will stabilize at 12.1 for women and 20.3 for men. The goal could be rapidly achieved for women by halving initiation and tripling cessation (9.9, 2016), or tripling cessation only (10.4, 2017); for men halving initiation and tripling cessation (10.8, 2024), or doubling cessation and halving initiation (10.5, 2033), or tripling cessation only (10.8, 2033). Conclusion: The 10 goal will be achieved within the next few decades, mainly by increasing smoking cessation. Policies to reach this goal would include increasing cigarette taxes, introducing total reimbursement of smoking cessation treatment, with a further development of quitlines and smoking cessation services. These measures are not yet fully implemented in Italy.