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Impact of COVID-19 lockdown on smoking consumption in a large representative sample of Italian adults
  1. Giulia Carreras1,
  2. Alessandra Lugo2,
  3. Chiara Stival2,
  4. Andrea Amerio3,4,5,
  5. Anna Odone6,7,
  6. Roberta Pacifici8,
  7. Silvano Gallus2,
  8. Giuseppe Gorini1
  1. 1 Oncologic Network, Prevention and Research Institute (ISPRO), Florence, Italy
  2. 2 Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
  3. 3 IRCCS Ospedale Policlinico San Martino, Genoa, Italy
  4. 4 Department of Psychiatry, Tufts University, Boston, MA, USA
  5. 5 Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy
  6. 6 School of Medicine, University Vita-Salute San Raffaele, Milan, Italy
  7. 7 Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
  8. 8 National Centre on Addiction and Doping, Istituto Superiore di Sanità, Roma, Italy
  1. Correspondence to Dr Silvano Gallus, Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan 20156, Italy; silvano.gallus{at}


Objectives Italy is one of the first countries that imposed a nationwide stay-at-home order during the COVID-19 outbreak, inevitably resulting in changes in lifestyles and addictive behaviours. The aim of this work is to investigate the impact of lockdown restrictions on smoking habits using data collected within the Lost in Italy project.

Methods A web-based cross-sectional study was conducted on a representative sample of 6003 Italian adults aged 18–74 years. Study subjects were recruited from 27 April to 3 May 2020 and were asked to report changes in smoking habits before the lockdown and at the time of interview.

Results During the lockdown, 5.5% of the overall sample quit or reduced smoking, but 9.0% of the sample started, relapsed smoking or increased their smoking intensity. In total, the lockdown increased cigarette consumption by 9.1%. An improvement in smoking habits was associated with younger age, occasional smoking and unemployment, whereas a worsening was mainly associated with mental distress. In particular, an increase in cigarette consumption during lockdown was more frequently reported among those with worsening quality of life (OR: 2.05; 95% CI: 1.49 to 2.80), reduction in sleep quantity (OR: 2.29; 95% CI: 1.71 to 3.07) and increased anxiety (OR: 1.83; 95% CI: 1.38 to 2.43) and depressive symptoms (OR: 2.04; 95% CI: 1.54 to 2.71).

Conclusions COVID-19 lockdown had a huge impact on smoking consumption of the Italian general population. The main concern is for smokers who increase their cigarette consumption due to an increased mental distress. Providing greater resources for cessation services capable of reducing mental health symptoms in smokers is urgently needed.

  • COVID-19
  • surveillance and monitoring
  • prevention

Data availability statement

Data are available upon reasonable request. Please contact the corresponding author who will evaluate the request.

This article is made freely available for personal use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

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Data availability statement

Data are available upon reasonable request. Please contact the corresponding author who will evaluate the request.

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  • Contributors All authors conceptualised and designed the study. RP and AO provided data. GC, AL and CS analysed the data under the supervision of GG and SG. GC and GG wrote the first draft of the manuscript. AL, AA, AO, RP and SG provided important contributions for the interpretation of findings. AO, GG and SG provided important intellectual supports in various steps of the study. All authors carefully revised the final version of the manuscript. All authors have read and approved the last version of the manuscript.

  • Funding The survey was co-funded by the Italian National Institute of Health (ISS) and Fondazione Cariplo. The work of GG and GC was in part carried out within the Lost in Toscana Project, financially supported by the Tuscany Region. The work of SG, AL and CS is partially supported by a research grant of the DG-Welfare of Lombardy Region (Call: Progetti di ricerca in ambito sanitario connessi all’emergenza COVID 19; DGR n. XI/3017) and by the Italian League Against Cancer (LILT, Milan). The work by AA is partially supported by a grant of the AXA (AXA Research Fund—Call for Proposals Covid-19).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.