L'associazione tra fumo di tabacco e crisi economiche in Italia.

OBJECTIVES: to analyse the association between smoking behaviour and economic crises in Italy between 1993 and 2015. DESIGN: ecological study, carried out on data of the Italian National Institute of Statistics, by means of fixed-effect panel regressions. SETTING AND PARTICIPANTS: the rate of smoking prevalence (disaggregated by gender and age) and the unemployment rate (disaggregated by gender and referring to individuals aged 15 or more) were collected for each of the twenty Italian regions. Also, percentage fluctuations of the national real gross domestic product (GDP) were collected to identify the years of severe economic crisis. MAIN OUTCOME MEASURES: number of people who smoke per 100 people with the same features. RESULTS: among men, increased regional unemployment rate was associated with increased smoking behaviour only in the group aged 25-34 years. Differently, severe economic crises were associated with increased smoking in almost all age groups, except for men aged 15-24 years. A 1-point decrease in GDP was associated with 0.75 more smokers aged 15 years or more. The highest coefficient was reported among men aged 35-44 years, where a 1-point decrease in GDP was associated with 1.16 more smokers (every 100 men). This age group is also featured by the second highest prevalence of tobacco smoking (36.8%). Among women, a 1-point increase in the regional unemployment rate was associated with 0.08 less smokers every 100 women. Similarly, periods of severe economic crisis at national level were associated with reduced smoking behaviour among women aged 15 years or more, specifically those aged 15-24 years. Differently, women aged 25-34 and 65 years or more showed an association similar to that reported among men. In these groups, a 1-point decrease in GDP was associated with 0.67 and 1.08 more smokers every 100 women. While among the latter the prevalence of tobacco smoking is the lowest, among the former it is the third highest prevalence (21.69%). Therefore, increased smoking behaviour due to economic crises seems to occur especially among women aged 25-35 years old, as happens among men. CONCLUSIONS: men in almost all age groups and women aged 25-34 and 65 years or more represent vulnerable groups in which smoking behaviour may increase in times of economic hardship. Therefore, specific policies should be implemented to prevent this occurrence, as well as the negative health outcomes of tobacco smoking.