Milan, Italy: new smoking regulation in public places, effective January 2025

The municipality of Milan, Italy, starting 1 January 2025, adopted a smoking ban for all public or publicly used spaces, including roads, except in isolated areas where it is possible to maintain a distance of at least 10 metres from other people [1]. This measure has a dual objective: to protect the health of citizens from active and passive smoking in public places frequented by minors and to promote the image of a tobacco-free city.
Milan had already introduced a ban starting on 1 January 2021, prohibiting smoking in public green spaces, except in isolated areas where it is possible to maintain a distance of at least 10 metres from other people; areas equipped for children’s games, sports or recreational activities (as regulated by art. 21, paragraph 7 of the Municipal Regulation); at public transport waiting stops, including taxi stands, up to a distance of 10 metres from the relevant shelters and signage infrastructure; cemetery areas; dog areas; and sport facilities of any type, including areas intended for the public [1]. These restrictions are exclusively local measures implemented by the city of Milan and do not apply at a regional or national level.
Nationwide, tobacco control in Italy dates back to November 1975 with the adoption of the law which banned smoking in selected places such as hospital corridors, school classrooms, station waiting rooms, closed spaces used for public meetings, cinemas, dance halls, and other selected indoor public places. A general ban on smoking in closed areas open to the public and workplaces was implemented with the introduction of law No. 3 of 16 January 2003 (Art. 51), commonly known as the “Sirchia Law” (named after the Health Minister who promoted it), effective from 10 January 2005. This law represents one of the most important legislative measures concerning tobacco control, aimed at the “Protection of Non-Smokers’ Health”. It extended the smoking ban to all closed spaces open to the public, including private and public workplaces, commercial and catering establishments, places of entertainment, gyms and sports centres, while excluding outdoor public areas.
The Sirchia law was one of the first smoke-free laws introduced in Europe after the Irish one, aiming to control smoking habits in all public and private places such as bars and restaurants [2].
However, no new national regulations have been introduced over the last 20 years to regulate tobacco use in Italy. Additionally, the cost of cigarettes is considerably lower in Italy than in many other European countries. For example, the average price for a 20-pack is currently around €6 in Italy vs. €8 in Germany, €9 in Belgium and the Netherlands, €13 in France, and €17 in Ireland and the UK [3].
To quantify the implementation of tobacco control policies at the country level, a Tobacco Control Scale (TCS) has been developed [4]. This scale evaluates six policies across European countries, identified by the World Bank and the World Health Organization as the most effective: increasing tobacco prices through higher taxation, banning smoking in public and private places, funding public information campaigns, introducing advertising bans and health warnings on cigarette packs, and improving access to smoking cessation treatments. The Italian score has decreased as compared with other European countries, dropping from eighth place (out of 30 countries) in the 2006 TCS to eighteenth place (out of 37 countries) in 2021 [5]. This decline is partly due to the lack of new measures adopted since the Sirchia law.
Despite the absence of recent tobacco control legis­lation, trends in lung cancer mortality – as the main indicator of all tobacco-related disease and deaths – have been similar in Italy as in the EU-27 as a whole (Figure 1). Both in Italy and the EU-27, male cancer mortality has shown a steep downward trend since the late 1980s, reaching a predicted rate of 19.7/100,000 in 2025 in Italy (–25% vs. 2020) and 27.1/100,000 in the EU-27 (–10% vs. 2020). The female mortality rate showed an unfavourable trend until the most recent period, with a levelling off only after 2020, reaching a predicted rate of 10.4/100,000 in Italy (–2% vs. 2020) and 13.7/100,000 in the EU-27 (+4% vs. 2020) [6-9]. These patterns reflect trends and prevalence in tobacco smoking in males and females. Sex differences in mortality trends align with the fact that the peak in smoking-attributable mortality among males in Western Europe was reached in the late 1980s, whereas it is now being reached for females. In Italy in 2024, lung cancer ranked third in new diagnoses (44,831) and first in the number of deaths (35,700) [10], with mortality rates predicted to decrease by almost 15% in males and increase by 6% in females compared to 2019 rates [7].
Tobacco control has a key role in controlling the lung cancer burden and reducing mortality from a large number of other diseases, including over 15 other neoplastic, vascular and respiratory diseases.
Life expectancy is reduced by 15 to 20 minutes for every cigarette smoked [11]. In 2023, according to ISTAT (National Institute of Statistics) data [12], the prevalence of smoking among the Ita­lian population aged 11 and over was 18.7%, mode­rately lower than in 2022 (19.0%). Over the past decade, smoking rates decreased from 20.3% in 2013 to 17.8% in 2019. Smoking prevalence remains higher among males than females (22.3% vs. 15.2%), although the gender gap has substantially narrowed over time. The highest smoking rate (26.9%) was observed among those aged 25-34. The prevalence then decreased slightly in successive age groups and declined considerably among those over 65. The prevalence of heavy smokers (20 or more cigarettes per day) was 3.5% (19% of smokers) and has decreased over the last decade (4.8% in 2013), particularly among males.
Preventing a substantial proportion of smoking- related deaths before 2050 requires adults to quit smoking; continuing to reduce the proportion of young people who start smoking will prevent many deaths, but its main effect will be on mortality from 2050 onwards [13].
The municipal legislation adopted in Milan serves as an important model for other Italian and European cities.

CONFLICT OF INTEREST

The authors declare no conflict of interest.

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