When I first arrived in Rome to attend university last summer, I was surprised by both the widespread cigarette smoking and the lack of vaping I witnessed.
In the Washington, DC, metro area, where I spent the first 23 years of my life, vaping is significantly more commonplace. Many of my friends there vape, either nicotine or THC. Vape shops, with their familiar neon signs, are a common sight.
Here, I’ve yet to see a single one, although I’ve been to many a tobacconist for everyday items like stamps or bus tickets, and some of these do carry vaping products. (IQOS, a heated tobacco product which I’d only read about before, and which does reduce harm compared with cigarettes, seems more widely used and advertised.)
I’ve noticed that many of my American classmates used to vape but now regularly smoke combustible cigarettes instead.
Statistics support my anecdotal observations. Over 23 percent of the Italian population is estimated to smoke, about double the rate in the United States.
“Chronic exposure to combustion chemicals generated from tobacco cigarettes can kill,” Dr. Riccardo Polosa, an Italian expert in tobacco harm reduction, told Filter. “That’s why we need combustion-free tools that can cause much less harm and that are attractive for cigarette substitution.”
I’ve also noticed that many of my American classmates used to vape but now regularly smoke combustible cigarettes instead. Of course, opponents of vaping would immediately allege a “gateway” effect—but such a notion has been debunked at a population level, even as some US health officials cling to it. Youth smoking has fallen to historic lows in the US as youth vaping has increased, and then declined. Most people who vape do so to stop smoking. And some research has suggested that if vapes weren’t available, more youth would be smoking instead.
In the university’s smoking section—essentially the entirety of the garden, in spite of signs relegating people who smoke to one side only—one rarely sees a vape. The one or two times I have seen students vape there, the cartridge contained not nicotine but weed. Curious about this, I decided to interview my classmates.
Nancy, an 18-year-old freshman, started vaping in her senior year of high school. “[But] I couldn’t bring my vape on the plane, I got scared,” she explained with a laugh. “So, when I came here I bought a Blu—which is a different kind of vape here—and then my friends just started smoking cigarettes.”
This led her to start smoking as well. “For the first three weeks I was here, I was like, this shit is expensive, [and] I was going to quit. Then I went to psych class and she told us that it’s a 10-day physical addiction but the mental addiction can be up to 15 years. So I was kind of like, Fuck it.”
Nancy said that she doesn’t actively seek out information about the risks of smoking or harm reduction, but that she hasn’t knowingly experienced any health effects yet. When she went back to the US for a time she continued to smoke there, partly because both her parents smoke. “[Dad] always talks about my spending but he never mentions cigarettes.”
“I vaped for like a few months, when it was a trend or whatever.”
Two of the students I spoke with were a lot more casual about their tobacco use. Mark, 21, told me: “I vaped [in the US] for like a few months, when it was a trend or whatever.” He’d taken up smoking a few months after arriving in Italy.
“Over break I don’t smoke, but back here I do,” he explained. He didn’t struggle to stop smoking when he returned to the US. “It wasn’t hard at all.” Here, though, he’s often asked for a cigarette by strangers, which he thinks would make quitting a lot more difficult if he were trying. He doesn’t think either vaping or smoking will be difficult to stop again, partly because he hasn’t been smoking for very long. He said vaping also made him feel sick, which encouraged him to quit. Yet he really wasn’t sure which was more dangerous.
Alex, 20, similarly told me, “I used to vape in the United States very briefly, because it was a trend—especially during COVID. And then I didn’t smoke any tobacco products till I came here [to] Italy. If I were in the United States, I wouldn’t be smoking.” In Italy, she is.
The respective cultural milieus have certainly contributed to her choices. “At least where I’m from in California, you don’t see anybody smoking,” she said. “There is a social stigma that shames you, so you don’t want to be in public smoking a cigarette. Whereas here, it’s very prominent culturally.” Growing up, she was always informed of the risks of smoking. But she never specifically sought out information or researched the matter. She does not plan to smoke long-term.
“I fully understand the risks, but at our age I think it’s just hard to weigh them appropriately.”
In contrast, Logan, 19, didn’t start using nicotine products until after arriving here in Italy. For the first four or so months, he vaped. Even now, he still primarily vapes. “I prefer the taste of cigarettes but hate the loss of energy that comes with them,” he said. “If I smoke, I can’t run for a few days, but if I vape, I feel normal.”
Interestingly, he’s done quite a lot of reading about the risks of smoking as well as ways to combat them. “I fully understand the risks, but at our age I think it’s just hard to weigh them appropriately.” He was also aware of the fact that, whilst neither vaping nor smoking are entirely without risks, the former is much safer. As for quitting? “I actually successfully quit [both] for over a month; I’d like to permanently quit one day.”
One might wonder if the tobacconists—a common sight here, and one Americans tend to comment on—could be part of the issue. Dr. Polosa quickly dispelled this notion. “On the contrary, in many other countries tobacco cigarettes can also be bought in grocery stores, discos, petrol stations, convenience stores, etc,” he said. “Therefore, it is speculative to link the number of tabacchi licenses to high smoking prevalence.”
“Perhaps, by educating tobacconists about the benefits of harm reduction, it will be possible to switch a large number of smokers to tar-free nicotine delivery products.”
He explained that cigarette sales in Italy are only permitted in specific, licensed locations and that the number of licenses is intentionally related to the number of local residents (specifically, there can only be one tabacchi for every 1,500 people in the neighborhood).
Polosa also pointed out the fact that tobacconists can also sell vaping products. “Perhaps,” he said, “by educating tobacconists about the benefits of harm reduction, it will be possible to switch a large number of smokers to tar-free nicotine delivery products.”
Italy is still culturally and politically somewhat resistant to tobacco harm reduction, however. “It is ironic,” Polosa said, “that much of this resistance comes from health care organizations and institutions, which have now decided that ‘zero nicotine addiction’ is the ultimate goal.”
This kind of all-or-nothing thinking is all too familiar to American harm reductionists. Polosa said that fear-mongering about vaping in Italy discourages people who might’ve switched from smoking—just like in the US. “However, on the taxation front, the Italian government seems to recognize the principle of harm reduction, given that the existing taxation scheme takes into consideration the lower risk of combustion-free products relative to conventional tobacco cigarettes.”
The one student who did seek out harm reduction information had a much more solid grasp of the relative risks.
Judging by my interviews, cultural attitudes seem to be the largest factor in the tendency of American students to switch from vaping to smoking upon moving to Italy. It didn’t seem so much to be misinformation, as I’d initially assumed from discussions about “popcorn lung” in the smoking section at my university—although a lack of information was evident. Unfortunately, the average college student who uses nicotine products isn’t that likely to seek out harm reduction information. This is dangerous, when people’s health and lives are at stake.
Ideally, both the Italian and US governments would put more effort into calm, factual harm reduction messaging regarding all drugs, legal or not. But frankly, that doesn’t seem likely to happen soon.
At least the one student who did seek out harm reduction information, Logan, had a much more solid grasp of the relative risks of these two forms of nicotine consumption. I don’t think it’s a coincidence that he primarily vapes rather than smokes—which is obviously good news.
Photographs by M.L. Lanzillotta
The Influence Foundation, which operates Filter, has received grants from Philip Morris International, which manufactures IQOS. Both The Influence Foundation and the Center of Excellence for the Acceleration of Harm Reduction (CoEHAR), founded by Dr. Polosa, have received grants from the Foundation for a Smoke-Free World. Filter‘s Editorial Independence Policy applies.