Smoking habits among adolescents in a northern Italian high school

Tobacco use remains a major global health issue, causing over seven million deaths annually. In Italy, nearly one-quarter of the population are current smokers, with increasing use of electronic and heated tobacco products, particularly among adolescents. The expanding availability of high-nicotine vaping devices highlights the need to better understand smoking behaviors in young people. This study aimed to assess the prevalence and determinants of smoking habits in a high school in northern Italy.

An anonymized online survey was administered to all students of a high school in Pavia between March and October 2025, collecting information on demographics, smoking behaviors, product use, age and context of initiation, and parental smoking.

A total of 1179 valid questionnaires were analyzed. Overall, 41.2% of students had used at least one tobacco or nicotine product, with e-cigarette use exceeding traditional cigarette smoking. The mean age at first use was about 14 years. Most adolescents initiated smoking in social settings. Parental smoking was strongly associated with adolescent use of cigarettes (OR=1.69), e-cigarettes (OR=1.68), and cannabis (OR=1.43). Price increases and reduced peer smoking were the most frequently reported motivators for cessation.

Adolescent nicotine use in this cohort was markedly higher than national and international estimates, with earlier initiation and narrowing gender differences compared with past data. Parental and peer influences remain key determinants. Early, school-based and family-oriented strategies are essential to reduce experimentation and promote long-term cessation.