An Italian panel of expert composed by a Scientific Committee of five member and 15 key opinion leaders used for the first time the Delphi Consensus methodology to analyze 38 statements on the use of smoke free alternatives. This groundbreaking initiative reveals critical insights into the ongoing debate over smoke-free alternatives, public health strategies, and anti-smoking legislation.
Despite global efforts to reduce smoking, Italy’s prevalence rates remain troublingly high. Approximately 20.5% of Italians were smokers in 2023, marking a slight decline from recent peaks. Tobacco combustion continues to account for millions of deaths worldwide, emphasizing the urgency for innovative solutions.
However, the role of smoke-free alternatives to cigarettes for tobacco harm reduction remains controversial.
A Scientific Committee that consisted of five specialists in various therapeutic areas gathered in July 2022 to draft a list of statements that covered three general areas: harm from tobacco smoking and strategies for harm reduction, smoke-free alternatives to cigarettes, and anti-smoking legislation. The statements were submitted for online voting to an Expert Panel, which, in addition to members of the Scientific Committee, included 15 key opinion leaders who were members of several Italian scientific societies. The selection of a diverse group of 20 experts helped ensure a wide range of perspectives, reducing the likelihood of bias.
“We are among the first to publish the results of research conducted using the Delphi Consensus methodology on key topics related to tobacco control policies and the role smoke-free alternatives can play in mitigating the harm caused by the scourge of smoking in Italy and worldwide,” explains Prof. Pasquale Caponnetto, University of Catania, author of the study. “The rigid nature of the Delphi Consensus ensures balanced results born from dialogue and equal collaboration among commission members. The data obtained and the review process highlight the methodological expertise acquired by the research team, which can be leveraged in the future for evaluating other sector-specific studies“.
The Delphi Consensus is a methodology used to achieve agreement among a group of experts on a specific topic. It is widely employed in fields such as public health, education, and policymaking to address complex issues where definitive evidence or solutions may be lacking. The method relies on multiple rounds of anonymous input and feedback to build consensus, minimizing the influence of dominant individuals and promoting unbiased, collective decision-making.
In total, during the first round of voting, consensus was reached regarding 17 statements. During the second round of voting, consensus was reached regarding seven additional statements. Consensus was reached on key principles, such as the necessity for transparent dissemination of scientific findings and the importance of providing adult smokers with accurate information to make informed decisions.
However, while promising initial findings suggest that smoke-free products could reduce exposure to harmful chemicals, the expert panel emphasized the need for further long-term research to establish their safety and efficacy.
Disagreements persisted on issues like the long-term impact of dual use (traditional and smoke-free products) and the role of industry involvement in promoting harm reduction.
The Expert Panel agreed that harm reduction can be a valuable public health strategy for reducing the negative impact of damaging behaviors in individuals who are unable or unwilling to quit smoking.The Expert Panel concurred that current scientific evidence while promising requires further studies to establish the risk-reduction potential of smoke-free products in comparison to traditional cigarettes.
Crafting Effective Anti-Smoking Legislation
The study also called for robust regulatory frameworks to deter youth initiation, support smoking cessation, and evaluate the risks of novel products. Experts agreed on the need for proportional interventions, tailoring regulations based on product risk profiles, and ensuring consumer access to reliable, evidence-based information.
Towards a Comprehensive Approach
The Delphi process illuminated the complexities of tobacco harm reduction, balancing scientific evidence with societal and ethical considerations. While full cessation remains the “gold standard,” the panel highlighted the importance of intermediate solutions for smokers unwilling or unable to quit.
This study serves as a crucial step in bridging diverse viewpoints, fostering nuanced discussions, and guiding evidence-based policy in Italy and beyond. It advocates for ongoing research, international dialogue, and a commitment to addressing the evolving landscape of tobacco use and harm reduction.
The findings emphasize the urgent need for a collaborative, informed, and balanced approach to tackle smoking—a public health crisis that continues to claim lives worldwide. With Italy’s leadership in harm reduction research, the nation has the potential to set a global precedent in this crucial fight for healthier futures.
