Tobacco Use and Self-Reported Perceptions of Health Risks among 7,213 Adolescents Living in Sicily (Italy): A Cross-Sectional Survey-Based Study

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ABSTRACT

Aim

To assess tobacco and e-cigarette use, risk perceptions, and educational exposure among adolescents in Sicily (Italy).

Background

Tobacco consumption, including electronic nicotine delivery systems (ENDS), is rising among adolescents and is often associated with misperceptions about health risks. Reliable epidemiological data are essential to guide prevention policies, particularly in regions where evidence remains limited.

Methods

A cross-sectional observational survey was conducted among 7,213 students aged 11–19 years attending 48 middle and high schools. Data were collected through an anonymous, self-administered questionnaire investigating tobacco use, vaping behaviors, and awareness of systemic and oral health risks. Associations and response patterns were examined using Multiple Correspondence Analysis (MCA).

Results

Most participants reported no current use (82.8%); nevertheless, experimentation with tobacco cigarettes (28.6%), e-cigarettes (27.0%), or both (42.5%) was frequent. Nearly half of e-cigarette users perceived vaping as less harmful than conventional smoking (48.0%). Gender differences emerged, with higher e-cigarette use among females (p = 0.019). MCA revealed distinct behavioral and perceptual profiles, showing that e-cigarette use clustered with inconsistent or underestimated risk perception, especially among students lacking family- or school-based education on smoking risks. Despite generally high awareness of smoking-related harm, knowledge alone appeared insufficient to prevent experimentation.

Conclusion

Adolescent experimentation with tobacco and e-cigarettes remains substantial despite high levels of reported risk awareness. Misperceptions about vaping safety and gaps in educational exposure highlight the need for structured, age-appropriate school-based prevention programs and provide a descriptive basis for future longitudinal and interventional research.

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