Patterns of Smoking Initiation in Italian Males and Females from 1955 to 1985

Methods. The changes in patterns of smoking initiation in Italian males and females in 1955, 1965, 1975, and 1985 were analyzed using data from the 1990-1991 Italian National Health Survey, based on a sample of 18,483 males and 19,320 females ages 19 to 59. The sample was randomly selected within strata of geographic area and size of place of residence and of household in order to be representative of the general Italian population. The age of each subject was reconstructed for each calendar year of interest (1954 to 1956, centered on 1955, 1964 to 1966, 1974 to 1976, and 1984 to 1986). For each calendar period and year of age of interest (14 to 24), the numerator of the smoking initiation rate was the number of subjects who started smoking and the denominator was the number of subjects at risk, i.e., nonsmokers of the same age. The same procedure was repeated for three separate age groups (14 to 17, 18 to 20, and 21 to 24). Results. Among males, there was a trend toward earlier age at start of smoking and higher initiation rates between 1955 and 1965, and a subsequent decline in initiation rate, particularly at age 18 or over and during the last calendar decade studied. In females, between 1955 and 1975 there was an increase of over fourfold in initiation rates and systematic tendencies toward earlier age at starting; only over the past decade have the starting rates begun to decline. The peak rate was reached at age 18-20 for males in 1965 (53.3%) and for females in 1975 (23.9%). Conclusion. The recent declines in smoking initiation have been relatively limited among the younger age groups, and this reflects an earlier average age at smoking initiation.