Changes in the use of nicotine-containing products during and after the COVID-19 pandemic in a representative sample of the Italian adult population

Abstract

Introduction. To assess nicotine-containing products (NCPs; heated tobacco products and/or electronic cigarettes) use in relation to conventional smoking. Methods.“LOST IN ITALY” (“LOckdown and Lifestyles IN ITALY”) and “LOST IN TOSCANA” cross-sectional surveys estimated lifestyles changes before, during, and after the lockdown in a representative sample of the Italian population. A Poisson regression model was used to estimate prevalence ratios of NCP use according to sociodemographic, mental distress, and smoking variables. Results. The prevalence of conventional cigarette smokers did not decrease, remaining stable at 23%. Exclusive conventional cigarette smokers decreased from 21% before the lockdown in 2020 to 15% in 2023 but dual users, representing the large majority of NCP users, increased by 4 times, and exclusive NCP users decreased from 7% in 2020 to 5% in 2023. Conclusions. NCPs are mostly accompanying instead of replacing conventional cigarettes. A targeted campaign should be developed in Italy to raise awareness on that.