[Impact of the Italian smoking ban and comparison with the evaluation of the Scottish ban].

The Italian smoking ban entered into force on January 10th, 2005, and banned smoking from enclosed workplaces and hospitality premises (HPs), even though provided separated smoking areas. Actually, only 1-2%of HPs built these areas, while no figures are available on the prevalence of smoking rooms in workplaces other than HPs. Italians were more in favour of the law after the ban. In 2008 Italians were the Europeans most in favour of a national smoking ban (88%). Measurements of environmental nicotine and particulate matter with a diameter <2.5 μm (PM2.5) collected in some Italian towns before and after 1-2 years from the implementation of the ban, recorded a 60-97%reduction. Second-hand smoke exposure decreased at home. After the ban, the highest exposures were recorded in some discos. In outdoor areas of HPs, covered in winter, second-hand smoke (SHS) exposure was similar to that recorded before the ban in enclosed areas. Enforcement controls carried out in 2005-2009 showed the compliance was good: out of 20,550 controls, in only about 2%of cases people were smoking.Whereas 80-90%of interviews in national surveys reported the ban was respected in HPs, only 70% said the same for workplaces. Controls in HPs and workplaces should become routine activity for technicians of National Health System Prevention Departments. Cigarette consumption decreased annually by 2% in 2004- 2010 (from 98.9 to 87 millions of kilos), and smoking prevalence annually decreased by 1-3% in men and by 0.4-2.0% in women. In 2005, cigarette consumption decreased by 6.2% and 3.5% of this reduction was attributable to the introduction of the ban. In 2005 medicinal nicotine sales increased by 69%. Out of 5 studies on reduction of acute myocardial infarction after the ban, four recorded a 11-13% reduction in persons aged <60 years. Despite the protests of hospitality sector against the ban in 2004, no studies on impact of the ban on hospitality industry businesses were conducted in Italy. We used the conceptual model for the evaluation of the impact of smoke-free policies, proposed by the International Agency for Research on Cancer (IARC), to compare Italian and Scottish evaluations of the bans. The Scottish evaluation was planned some years before the implementation, and was based on a network of researchers of different disciplines. The quantification of decrease in second-hand smoke (SHS) exposure in the general population and in hospitality workers was one of the main objectives of the Scottish evaluation. The Italian evaluation devoted more attention to distal (reduction of hospital admissions) and incidental effects of the law (trend in smoking prevalence, cigarette consumption). Qualitative studies in bars, homes, and communities recording changes in attitudes on tobacco smoking after the introduction of the ban, were conducted only in Scotland. In Italy the main problem was to develop and fund a network of researchers involved on a shared evaluation plan.