The battle against smoking addiction is far from won. We are reminded of this by the not at all comforting data regarding Italy and Europe. If on the one hand adults are trying to stop smoking, on the other there are young people – and we are talking about children who go to middle school – who start “vaping”. And then there are those – and there are more and more of them – who, thinking they are doing the best thing, smoke and vape, alternating the two habits. It’s a shame that they don’t know that this way the health risks are greatly increased. World No Tobacco Day is celebrated across the planet on May 31st: an initiative promoted by the World Health Organization with the aim of reminding everyone not only that cigarettes are not harmless, but neither are all other devices defined as alternative. Because the fight has now broadened its scope, and is looking for new weapons to save many more lives.
Italy is late
Almost 700 thousand people die every year from smoking in the European Union. An epidemic that still has 179 million tobacco and nicotine consumers on a continental level and 12.4 million in Italy, including traditional cigarettes and new products. A real health emergency, which was at the center of the recent European Conference on Tobacco or Health (ECToH), the main European summit on tobacco control, organized for the first time in Italy, in Milan, by Lilt (Italian League for the fight against cancer).
What dramatically penalizes Italy is the long regulatory delay on new products containing nicotine. Despite the historic ban on tobacco advertising introduced in 1962, massive advertising campaigns for electronic cigarettes and heated tobacco products are still permitted in Italy. Furthermore, the use of these new products remains permitted in numerous indoor environments, including bars, restaurants and workplaces, significantly contributing to the worsening of the Italian score within the Tobacco Control Scale report. In fact, our country has lost 14 positions in just 4 years, slipping from 18th place in 2021 to 32nd in 2025.
The European proposal: nicotine-free cities
How to run for cover? Guiding urban centers towards a radical transformation, which makes them not just residential centers but ecosystems that actively promote health. To do this, the proposal is the de-nicotinization of cities: from schools to parks, from streets to public transport hubs, freeing the air not only from traditional smoke, but also from aerosols from emerging products.
«In the fight against tobacco and products containing nicotine and/or carcinogenic substances, prevention represents the first and most effective tool for protecting public health», declares Professor Francesco Schittulli, breast surgeon-surgeon and oncologist, President of Lilt Nazionale. “It means acting before the disease can develop, reducing exposure to risk factors, protecting especially young people and the most vulnerable groups of the population, and promoting a culture of collective responsibility.”
You start vaping under the age of 13
The emergency on our continent is worrying and affects especially the very young. There are approximately 4 million adolescents in Europe, aged between 13 and 15, who use tobacco products. Furthermore, in many countries, such as the United Kingdom, electronic cigarettes are now overtaking traditional ones among younger people. The first electronic cigarette for 1 in 7 boys, between 15 and 18 years old, is “vaped” under the age of 13.
The alarm is no longer just about smoking, but about nicotine addiction across the board. The main European congress in the sector has in fact broadened its focus, putting e-cigs, heated tobacco products and nicotine pouches (nicotine sachets to be taken orally, which are all the rage on the web) under attack. In Italy, it is estimated that regular consumers of e-cigs and heated tobacco in the 18-34 age group are almost 1.7 million (Iss-Istat data), constituting almost half (around 45%) of all users of electronic cigarettes and heated tobacco in our country.
According to experts, the main risk is that the new devices will bring nicotine back to being perceived as a “normal”, modern and socially acceptable habit. «The so-called harm reduction proposed by the tobacco industry certainly represents a very effective market strategy», explains Silvano Gallus, epidemiologist at the Mario Negri Institute and president of the scientific committee of ECToH Milano 2026, «but it raises increasingly important questions from a public health point of view».
«The problem is not just the product, but the addiction», adds Roberto Boffi, director of Pneumology at the National Cancer Institute of Milan. “The real risk today is that nicotine will once again be perceived as harmless or even banal, especially among young people who would never have started smoking traditional cigarettes.” If nicotine is back in fashion, the credit also goes to the smartphone. A French study by the Comité National Contre le Tabagisme identified, in 2024 alone, 668 illegal online advertisements for nicotine products, conveyed via SMS, newsletters and social media. The king of promotion is Instagram, where influencers and adverts push products by focusing on captivating aromas, lifestyle and exclusive promotions, targeting very young people.
The risks of dual consumption
Furthermore, the promise that the electronic cigarette helps to stop smoking clashes with the reality of the Italian data, which demonstrate how vaping leads to the opposite result: in fact it often does not encourage the abandonment of traditional cigarettes, but causes relapses. So many kids end up in the trap of “dual consumption” (smoking and vaping at the same time), a mix that increases health risks even compared to those who smoke “only” traditional cigarettes. It is estimated that in Italy more than 80% of e-cigarette consumers are dual users. «The data shows that those who use cigarettes and e-cigs at the same time have a significantly higher risk than smokers exclusively of conventional cigarettes», continues Gallus, «+29% cardiovascular risk, +39% risk of stroke, +41% risk of chronic obstructive pulmonary disease and +42% of oral diseases».
Cytisine: an effective weapon against addiction
The last frontier against smoking is all natural. Is called cytisine: it is a molecule extracted from the laburnum, a magnificent tree which blooms in May and populates its branches with yellow flower clusters. Smokers like it first of all because it is not a chemical product and then – for a few months – because it has passed through the National Health Service.
It is an agonist/antagonist of nicotine, the addictive substance. What is its mechanism of action? By inhaling the cigarette, nicotine reaches the brain: here it binds to some specific receptors, triggering the release of neurotransmitters such as serotonin, known as the “good mood molecule”, and dopamine, defined as the “pleasure molecule”. Cytisine binds precisely to those receptors, with a strength 7 to 10 times greater than that of nicotine: so the latter, when it reaches them, finds them occupied. This process causes a sort of “rebound effect” which generates a feeling of nausea which, in the long run, leads to giving up smoking. In practice, cytisine simulates the action of nicotine, giving a sense of satisfaction but without directly involving dopamine, which is involved in addiction.
The advantages of the molecule are many: it is an effective drug, well tolerated and non-addictive, unlike some nicotine substitutes. At the end of the therapeutic process, therefore, it can be suspended without difficulty. Furthermore, an important factor is that it also helps those who vape, not just those who smoke traditional cigarettes.
The drug is now reimbursable
Cytisine is nothing new, from a clinical point of view. In fact, the drug, in galenic form, had already been used for some time in anti-smoking centres, with more than satisfactory results. The recent revolution lies in having made it reimbursable by the NHS and no longer paid by the citizen. However, it cannot be prescribed by the family doctor, but only by anti-smoking centres, which will follow a standard administration protocol, with a 25-day cycle of decreasing tablet dosage.
Psychological support is needed
To quit smoking, however, a drug is not enough. Strong motivation and considerable psychological energy are needed to resist in moments when the desire for cigarettes returns. And he does it often. For this reason, in addition to targeted pharmacological therapy, anti-smoking centers offer a counseling service, a necessary complement in the process of quitting nicotine. The internal conflict that the smoker faces is a great psychological burden: having the desire for something that at the same time one wants to abandon. The aim of the counseling is to accompany him throughout the de-addiction process, to find not only the strength to stop (breaking phase) but also to maintain abstention (duration phase). This is the most difficult part, so much so that smoking addiction is defined as “a relapsing pathology”. And every fall needs adequate support.
5 smoker’s alibis (that don’t hold up)
Anyone who smokes knows this well. There are many excuses for not quitting. However, none of these are really valid, nor based on scientific theses. Here are some of them, highlighted by the experts of the Veronesi Foundation.
It relaxes me. It’s a pure illusion. In fact, nicotine increases the heart rate and raises blood pressure, narrowing the blood vessels and tiring the heart, conditions that generate stress. The cigarette therefore calms the withdrawal agitation, but in reality it is a source of stress, it does not dampen it.
I eat healthy and do sports. A diet based on fruit and vegetables, rich in antioxidants, is not sufficient to counteract the carcinogenic effects of toxic substances (around 8,000!) that are ingested with cigarette smoke. In addition, smoking reduces sports performance by 20 percent.
I don’t aspire, so I don’t risk it. It’s false. Even without breathing in, toxic substances come into contact with the mouth, throat, esophagus and trachea, increasing the risk of head and neck cancers.
I stop whenever I want. Some people succeed, but many don’t. Because the moment you decide to say enough, you realize how nicotine is an addiction and that, without the help of an expert, you won’t be able to get out of it.
I smoke the “light” ones. In “light” cigarettes the quantity of nicotine, tar and carbon monoxide is lower, but this does not mean that the body absorbs them less deeply. Indeed, precisely because they are “light”, in many cases they smoke more.
I want to quit: who should I contact?
Once the decision is made, the most important step is taken. The second step is to turn to experts capable of guiding us along the (often difficult) path to de-addiction.
To request assistance you can contact:
on the anti-smoking hotline, 800.554088, managed by the Higher Institute of Health (Monday to Friday from 10am to 4pm);
to the nearest anti-smoking centre, consulting the map (smettodifumare.iss.it). Access is free, all you need is a referral from your family doctor.
