Alessandra Lugo

• Mario Negri Institute for Pharmacological Research

Background Over the past two decades, the Italian National Health Service has been gradually decentralised, with Italy's 21 regional governments now responsible for managing their health services. This change, coupled with austerity measures and a steadily ageing population, has adversely affected universal health coverage and equity, exacerbating...

Most gambling research focuses on problem gambling, often neglecting milder but more prevalent harmful patterns, whose prevention could prove highly cost-effective. This study analyzed factors associated with at-risk or problem gambling (Problem Gambling Severity Index ≥ 1) among 1060 recent gamblers in Italy (2022–2023). At-risk or problem gamblin...

Introduction: Relative or absolute safety of heated tobacco products (HTP) remains unknown, while independent literature suggests that these products do not favour tobacco control. We conducted a comprehensive systematic review and meta-analysis to evaluate HTP usage patterns and the effect of HTP use on conventional tobacco smoking (use transition...

Introduction: Some researchers speculated that novel nicotine-containing products, such as electronic cigarettes and heated tobacco products, could lower the risk of SARS-CoV-2 infection. The aim of this study is to investigate the role of electronic cigarettes on SARS-CoV-2 infection. Methods: We conducted a systematic literature review, updated t...

Introduction: Nasopharyngeal cancer is a relatively rare but aggressive malignancy with a significant impact on patients’ quality of life. This systematic review and meta-analysis aim at providing an updated estimate of the association between cigarette smoking and the risk of nasopharyngeal cancer. Methods: A systematic review and meta-analysis of...

Background: The lockdowns imposed by the government during coronavirus disease 2019 (COVID-19) pandemic have had a significant impact on the Italian population habits. Methods: LOckdown and lifeSTyles in Italy and in Tuscany studies collected data on a representative sample of the Italian adult population in 2020 (n = 6,003) followed up through 202...

Background Homes are one of the primary locations where people are exposed to second-hand smoke (SHS) in Europe. We describe the prevalence and identify the main determinants of having home-smoking restrictions in 12 European countries. Methods Cross-sectional survey in 12 European countries conducted in 2017–2018 (TackSHS Project). Approximately...

Background Lung cancer ranks as the leading cause of cancer-related deaths worldwide. There is evidence that second-hand smoke (SHS) exposure is a risk factor for the development of lung cancer in never-smokers. This systematic review and meta-analysis aims to provide the most accurate quantification of the association between SHS exposure and lung...

Smoke-free legislation has been shown to positively impact reducing secondhand smoke (SHS) exposure, especially in countries that have implemented comprehensive legislation rather than partial bans. Also, secondhand aerosols (SHA) that come from the heating of tobacco or liquids, with or without nicotine, in electronic nicotine delivery systems (EN...

Background: Despite the high frequency of tinnitus and its impact on wellbeing, little is known about its economic burden and no data to our knowledge are available on out-of-pocket (OOP) expenses. Methods: In 2022 a survey was conducted on OOP costs of tinnitus. We enrolled 679 participants with slight, moderate and severe tinnitus in Italy, Unite...

We conducted an umbrella review of the scientific literature followed by a systematic review to comprehensively collect existing evidence on global prevalence from national or regional representative samples of tinnitus. The present chapter shows selected results from a comprehensive recently published systematic review and meta-analysis (Jarach et...

This study aims at providing an accurate and up-to-date quantification of the dose–response association between cigarette smoking and gastric cancer (GC) risk, overall and by subsite. We conducted a systematic review and meta-analysis of case–control and cohort studies on the association between cigarette smoking and GC risk published up to January...

Background: Tinnitus is associated with a variety of etiologies, phenotypes, and underlying pathophysiological mechanisms, and available treatments have limited efficacy. A combination of treatments, addressing various aspects of tinnitus, might provide a viable and superior treatment strategy. Methods: In this multicenter, parallel-arm, randomized...

Introduction: It is crucial to monitor changes in body weight and physical activity (PA) to understand if short-term effects of COVID-19 pandemic have had implications over time. Methods: This longitudinal study is based on data from 4,831 Italians aged 18-74 years interviewed during the first phase of COVID-19 pandemic (April-May 2020) and two...

Introduction: To assess nicotine-containing products (NCPs; heated tobacco products and/or electronic cigarettes) use in relation to conventional smoking. Methods: "LOST IN ITALY" ("LOckdown and Lifestyles IN ITALY") and "LOST IN TOSCANA" cross-sectional surveys estimated lifestyles changes before, during, and after the lockdown in a representat...

Objective: Psychoactive substance use is largely found to involve multiple substances. In recent years, the COVID-19 pandemic has changed psychoactive substance use patterns. Aim of this study is to investigate profiles of polysubstance and their pattern during and after the COVID-19 pandemic. Methods: We collected information on alcohol consump...

People who reach old age enjoying good physical and mental health can be defined as (health) “superheroes”, given their relatively low impact on healthcare expenditure and the desirable model they represent. To evaluate prevalence and possible determinants of being “physical superheroes” (i.e., free from the ten major chronic conditions, plus obesi...

INTRODUCTION Allen Carr's (AC) method is a pharmacotherapy-free approach to quit smoking that is delivered through seminars, online courses, or in the form of a book. It has gained popularity, but its effectiveness remains controversial due to a lack of scientific evidence. This systematic review aims to provide an updated overview of the current e...

Introduction: The use of cigarettes and novel tobacco products represents a public health risk, especially for young people. This study aims to provide information regarding the used products and the experiences and habits of smokers in Lombardy, and awareness among the citizens of Milan of the “Milan Smoke Free 2026” project, the process that will...

PurposeThe association between second-hand smoke (SHS) exposure and cervical cancer (CC) risk is still unclear. The aim of this study is to provide an accurate and updated estimate of this association.Methods Through an original methodology to identify original publications, we conducted a systematic review and meta-analysis of all epidemiological...

Lockdown measures in response to the COVID-19 pandemic in 2020 yielded dramatic changes in drug consumption. A cross-sectional study was conducted on a representative sample of 6003 Italian adults (18-74 years) in April-May 2020 - reporting information before lockdown and at the time of interview - and two years later (i.e., in February-March 2022)...

Introduction: Predicting the success of smoking cessation might be crucial to guide towards the treatment of smoking dependence in a clinical setting. We analyzed the potential determinants of successful smoking cessation with a specific focus on self-efficacy in predicting quitting smoking. Methods: All consecutive smokers (n=478; 224 men and 2...

Background The possible association between cigarette smoking and breast cancer risk has been quite controversial. Methods We conducted a systematic review and meta-analysis of all available observational studies published on the issue up to January 2020. Random-effects models were used to compute pooled relative risks (RRs) for cigarette smoking s...

Background: Discussion on the impact of pocket money on positive behaviors is still debated. Objective: To investigate the effect of diverse money allowance schemes on risky behaviors (smoking, alcohol, binge drinking, drug use, gambling) during adolescence. Method: 989 students aged 15 from Lombardy (Italy) reported information on money avail...

The association between current smoking and coronavirus disease 2019 (COVID-19) progression remains uncertain. We aim to provide up-to-date evidence of the role of cigarette smoking in COVID-19 hospitalisation, severity and mortality. On 23 February 2022 we conducted an umbrella review and a traditional systematic review via PubMed/Medline and Web...

Background: Despite the robust evidence of an excess risk of COVID-19 severity and mortality in ever smokers, the debate on the role of current and ex-smokers on COVID-19 progression remains open. Limited or no data are available on the link between electronic-cigarette (e-cigarette), heated tobacco product (HTP) and second-hand-smoke (SHS) exposu...

Objective: This study aimed to quantify SHS exposure in homes with residents who smoke in Europe according to households' characteristics, tobacco consumption habits, and national contextual factors. Methods: Cross-sectional study (March 2017-September 2018) based on measurements of air nicotine inside 162 homes with residents who smoke from nin...

Knowledge on the role of diet in tinnitus onset is mostly based on few cross-sectional studies. In 2016–2019 we conducted a hospital-based case-control study in northern Italy on 185 incident idiopathic tinnitus cases and 198 controls, providing data on dietary habits through a 37-item food-frequency questionnaire. Odds ratios (OR) for tinnitus ris...

Background: We aimed to assess the prevalence of depressive and anxiety symptoms, hopelessness and insomnia in the older adults before and during the COVID-19 pandemic identifying subgroups at higher risk of mental distress. Methods: Within the Lost in Lombardy project, a web-based cross-sectional study was conducted on a representative sample o...

Introduction: COVID-19 lockdown in Italy resulted in increased smoking consumption, mainly associated with mental distress. This study aims to update previous findings investigating changes in smoking intensity during the whole COVID-19 pandemic. Methods: This analysis was carried out within the "LOST IN ITALY" ("LOckdown and lifeSTyle IN ITALY"...

This paper updates a previous cross-sectional study on the effectiveness of electronic cigarettes (e-cigarettes) as an aid to quit smoking. In the 2014-2021 PASSI survey, the ongoing Italian behavioural risk factor surveillance system, on a total of 239,812 subjects representative of the Italian adult population respondents who smoked and made at l...

Investigating pediatric overweight and physical activity correlates is essential to design effective preventive programs. We used regional data (Lombardy, northern Italy) from the 2019 survey “OKKio alla Salute” (3093 children aged 8–9 years with measured anthropometric data), and from the 2018 wave of the “Health Behaviour in School-aged Children”...

Objective: Cervical cancer (CC) is the fourth most frequent cancer worldwide. Cigarette smoking has been shown to influence CC risk in conjunction with human papillomavirus (HPV) infection. The aim of this study is to provide the most accurate and updated estimate of this association and its dose-response relationship. Methods: Using an innovati...

Aims/Hypothesis Identifying risk factors for tinnitus could facilitate not only the recommendations for prevention measures, but also identifying potential pathways for new interventions. This study reports the first comprehensive systematic review of analytical observational studies able to provide information about causality (i.e., case–control a...

Italy was the first country to be hit by the 2019 coronavirus disease (COVID-19) in Europe holding one of the highest clinical burdens. Older adults are those paying the highest price for the COVID-19 emergency. Within the Lost in Lombardy project, a web-based cross-sectional study assessing the prevalence of depressive and anxiety symptoms, hopele...

The aim of this study was to assess the relationship between adherence to a healthy diet, such as the Mediterranean diet (MedDiet), and C-reactive protein (CRP) in Italian heavy smokers undergoing an LDCT screening program (bioMILD trial), using scores calculated by simple questionnaires. Simple formats of food frequency questionnaires were adminis...

Electronic cigarette (e-cigarette) use emits potentially hazardous compounds and deteriorates indoor air quality. Home is a place where e-cigarettes may frequently be used amid its increasing prohibition in public places. This study assessed the real-life scenario of bystanders' exposure to secondhand e-cigarette aerosol (SHA) at home. A one-week o...

Importance: To date, no systematic review has taken a meta-analytic approach to estimating the prevalence and incidence of tinnitus in the general population. Objective: To provide frequency estimates of tinnitus worldwide. Data sources: An umbrella review followed by a traditional systematic review was performed by searching PubMed-MEDLINE an...

Introduction: Using data from the TackSHS survey, we aim to provide updated estimates on the prevalence and determinants of overweight and obesity in Europe. Methods: A face-to-face survey was conducted in 2017-2018 in 12 European countries (Bulgaria, England, France, Germany, Greece, Ireland, Italy, Latvia, Poland, Portugal, Romania, and Spain)....

Introduction: Using data from the TackSHS survey, we aim to provide updated estimates on the prevalence and determinants of overweight and obesity in Europe. Methods: A face-to-face survey was conducted in 2017-2018 in 12 European countries (Bulgaria, England, France, Germany, Greece, Ireland, Italy, Latvia, Poland, Portugal, Romania, and Spain)...

Purpose Benefits of national-level stay-at-home order imposed in Italy to prevent SARS-CoV-2 transmission need to be carefully weighed against its impact on citizens’ health. In a country with a strong familial culture and where welfare relies on households, confinement drastically decreased support provided by elder relatives, which may have resul...

Healthcare delivery reorganization during the COVID-19 emergency may have had a significant impact on access to care for older adults with chronic conditions. We investigated such impact among all adults with chronic conditions aged ≥ 65 years, identified through the electronic health databases of two local health agencies—ATS Brianza and ATS Berga...

Background Alcohol Withdrawal Syndrome (AWS) is characterized by different phases (acute, early and protracted). Protracted alcohol withdrawal (PAW) presents some symptoms, which may persist for several weeks, months or even years after drinking cessation. Methods We conducted a systematic review of the literature in major scientific databases on...

Aims Restrictions imposed to prevent SARS-CoV-2 transmission should be weighed against consequences on vulnerable groups’ health. Lifestyles and disease management of older people with diabetes might have been differentially impacted compared to non-chronic individuals. Methods A cross-sectional study (LOST in Lombardia) was conducted on a represe...

Investigating pediatric overweight and physical activity correlates is essential to design effective preventive programs. We used regional data (Lombardy, northern Italy) from the 2019 survey “OKKio alla Salute” (3093 children aged 8–9 years with measured anthropometric data), and from the 2018 wave of the “Health Behaviour in School-aged Children”...

Background The COVID-19 pandemic and the lockdown period lasted from March to May 2020, resulted in a highly stressful situation yielding different negative health consequences, including the worsening of smoking habit. Methods A web-based cross-sectional study on a convenient sample of 1013 Italian ever smokers aged 18 years or more was conducted...

Background Evidence showed that mental health problems have risen markedly during COVID-19. It is unclear if part of the mental sufferings relates to the climate of uncertainty and confusion originated by rough communication by health officials and politicians. Here we test the impact of unanticipated policy announcements of lockdown policies on me...

Background: European countries differ considerably in the scope and the extent of their policies to protect people from the harms of secondhand smoke exposure. Public opinion may have a substantial influence on several stages of policy development, implementation, and compliance. For this reason, we aimed to evaluate the population level of support...

Background: Heated tobacco products (HTP) are new forms of tobacco consumption with limited information available on their use among the general population. Our objective was to analyze the prevalence and associations of use of HTP across 11 countries in Europe. Methods: Within the TackSHS Project, in 2017-2018 we conducted a cross-sectional study...

Background Although a direct relationship between tinnitus or hearing difficulties and COVID-19 has been suggested, current literature provides inconsistent results, and no research has been undertaken in older adults. Methods In November 2020, we conducted the LOST in Lombardia survey, a telephone-based cross-sectional study on a sample of 4,400...

Most COVID-19-related fatalities occurred among older adults, however to date, evidence on determinants of SARS-CoV-2 infection in this population is limited and mostly based on case series without a comparison group. A telephone-based cross-sectional study was conducted in November 2020 on a representative sample of 4,400 Italians aged ≥65 years r...

Background & Aims COVID-19 containment measures significantly impacted lifestyle of the general population, including physical activity. Although the older adults are particularly susceptible to the potential consequences of sedentary lifestyle and inactivity, few studies investigated pandemic effects in this segment of the population. We aimed to...

Background The importance of trait impulsivity in development, continuation and escalation of addictive behaviors has long been recognized. Methods A cross-sectional population-based survey was conducted during the COVID-19 lockdown on 6003 Italian adults aged 18-74 years, representative of the Italian general population, to investigate the relati...

Only a few studies investigated changes in electronic cigarette (e-cigarette) and heated tobacco product (HTP) use during pandemic restrictions. We conducted a web-based cross-sectional study of a representative sample of 6,003 Italian adults during the strictest phase of the Covid-19 lockdown (April–May 2020). Participants were asked to report cha...

Introduction: Over the last few decades in Italy, we observed a substantial reduction in conventional tobacco cigarette consumption, the introduction of electronic cigarettes (e-cigarette) in 2010, and the launch of heated tobacco products (HTP) in 2015. Methods: We investigated novel products, i.e. e-cigarettes and HTP, use in Italy in 2018-202...

Mesenchymal stromal cells (MSCs) are widely used in preclinical models of traumatic brain injury (TBI). Results are promising in terms of neurological improvement but are hampered by wide variability in treatment responses. We made a systematic review and meta-analysis: (1) to assess the quality of evidence for MSC treatment in TBI rodent models; (...

Introduction The current study determined the level and trends associated with the incidence, death and disability rates for bladder cancer and its attributable risk factors in 204 countries and territories, from 1990 to 2019, by age, sex and sociodemographic index (SDI; a composite measure of sociodemographic factors). Methods Various data source...

Background: Limited data on electronic cigarette prevalence, patterns and settings of use are available from several European countries. Methods: Within the TackSHS project, a face-to-face survey was conducted in 2017-2018 in 12 European countries (Bulgaria, England, France, Germany, Greece, Ireland, Italy, Latvia, Poland, Portugal, Romania and Spa...

Background Tinnitus prevalence studies report large variability across countries that might be due to inconsistent research methods. Our study aimed to report a single Pan-European estimate for tinnitus prevalence and investigate the effect of individual and country-level characteristics on prevalence. We explored the relationships of healthcare re...

Background: To explore how sexual activity was impacted by COVID-19 lockdown measures in the general adult population. Methods: A cross-sectional survey was conducted on 6,003 Italian adults aged 18-74 years, representative of the Italian general population. Study subjects were recruited at the time of the Nation-wide stay-at-home order (from Ap...

Background and aims: Few preliminary studies have shown an impact of COVID-19 confinement on gambling habits. We aim to evaluate short-term effects of lockdown restrictions on gambling behaviors in Italy. Methods: Within the project Lost in Italy, a web-based cross-sectional study was conducted on a representative sample of 6,003 Italians aged 1...

Tinnitus disability is a heterogeneous and complex condition, affecting more than 10% and compromising the quality of life of 2% of the population, with multiple contributors, often unknown, and enigmatic pathophysiology. The available treatment options are unsatisfactory, as they can, at best, reduce tinnitus severity, but not eliminate its percep...

Background The potential benefits of the COVID-19 lockdown need to be carefully weighed versus the possible impact on people's daily life and negative mental health effects.We aimed to assess the prevalence of depression, anxiety, insomnia and quality of life before and during the COVID-19 lockdown,identifying subgroups at higher risk of mental dis...

Objective Due to partial or poorly enforced restrictions secondhand tobacco smoke (SHS) is still present in outdoor hospitality venues in many European countries. This study aimed to assess SHS concentrations in outdoor hospitality venues across Europe and identify contextual exposure determinants. Methods Cross-sectional study. We measured airbor...

The design of e-cigarettes (e-cigs) is constantly evolving and the latest models can aerosolize using high-power sub-ohm resistance and hence may produce specific particle concentrations. The aim of this study was to evaluate the aerosol characteristics generated by two different types of electronic cigarette in real-world conditions, such as a sit...

The design of e-cigarettes (e-cigs) is constantly evolving and the latest models can aerosolize using high-power sub-ohm resistance and hence may produce specific particle concentrations. The aim of this study was to evaluate the aerosol characteristics generated by two different types of electronic cigarette in real-world conditions, such as a sit...

Objectives Italy is one of the first countries that imposed a nationwide stay-at-home order during the COVID-19 outbreak, inevitably resulting in changes in lifestyles and addictive behaviours. The aim of this work is to investigate the impact of lockdown restrictions on smoking habits using data collected within the Lost in Italy project. Methods...

In Italy, electronic cigarettes have spread since 2010 and heated tobacco products (HTP) since 2016. We investigated their public health consequences on conventional cigarette smoking, taking advantage of a series of cross-sectional studies annually conducted between 2001 and 2019 in Italy. Every year, the sample, including around 3000 individuals,...

Introduction Secondhand smoke (SHS) causes morbidity and mortality among non-smokers. Objectives To investigate SHS presence in outdoor areas from 12 European countries and its association with country-level characteristics. Methods Cross-sectional study performed in 2017–2018 within the TackSHS project. We conducted a face-to-face survey on a re...

Introduction: Exposure to secondhand aerosol from e-cigarette (SHA) may pose harmful effects to bystanders. This study aims to investigate the prevalence, duration and determinants of SHA exposure in various indoor settings in 12 European countries. Methods: In 2017-2018, we conducted a cross-sectional study, the TackSHS survey, on a representativ...

Introduction Secondhand smoke (SHS) causes morbidity and mortality among non-smokers. Objectives To investigate SHS presence in outdoor areas from 12 European countries and its association with country-level characteristics. Methods Cross-sectional study performed in 2017-2018 within the TackSHS project. We conducted a face-to-face survey on a re...

Background Heated tobacco products (HTP) are new forms of tobacco consumption with limited information available on their use among the general population. Our objective is to analyse the prevalence and associations of use of HTP across 11 countries in Europe. Methods Within the TackSHS Project, in 2017-2018 we conducted a cross-sectional study wit...

Background Heated tobacco products (HTP) are new forms of tobacco consumption with limited information available on their use among the general population. Our objective is to analyse the prevalence and associations of use of HTP across 11 countries in Europe. Methods Within the TackSHS Project, in 2017-2018 we conducted a cross-sectional study w...

INTRODUCTION: Exposure to secondhand aerosol from e-cigarette (SHA) may pose harmful effects to bystanders. This study aims to investigate the prevalence, duration and determinants of SHA exposure in various indoor settings in 12 European countries. METHODS: In 2017-2018, we conducted a cross-sectional study, the TackSHS survey, on a representativ...

Introduction: Tinnitus is a symptom and not a disease in its own right. A number of medical conditions are known to increase the risk of developing tinnitus. Most known risk factors are otological or neurological, but general health and lifestyle can also precipitate the condition. Understanding these modifiable risk factors can help to identify vu...

We monitored the burden of cancer in Italy and its trends over the last three decades, providing estimates of cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years (DALYs), for cancer overall and 30 cancer sites using data from the Global Burden of Disease study 2017. An overview of mortali...

Smoke-free legislation reduced second-hand smoke (SHS) exposure in public places, and indirectly promoted private smoke-free settings. Nevertheless, a large proportion of adults is still exposed to SHS at home. The aim of this paper is to quantify the burden of disease due to home SHS exposure among adults in the 28-European Union (EU) countries fo...

Introduction: Tobacco presence in outdoor children's playgrounds is concerning not only because it leads to secondhand smoke (SHS) exposure, but also cigarette butt pollution and tobacco normalization. Objectives: This study aimed to assess SHS exposure in children's playgrounds, according to area-level socioeconomic status (SES), smoke-free reg...

Objective Previous studies from European countries noted that food products promoted on TV for children did not comply with international guidelines, including the World Health Organization European Nutrient Profile Model (WHO-ENPM) and the EU Pledge Nutrition Criteria (EU-PNC, an initiative developed by leading food companies). We aim to provide n...

Background Secondhand smoke (SHS) exposure at home and fetal SHS exposure during pregnancy are a major cause of disease among children. The aim of this study is quantifying the burden of disease due to SHS exposure in children and in pregnancy in 2006–2017 for the 28 European Union (EU) countries. Methods Exposure to SHS was estimated using a mult...

Background: Secondhand smoke (SHS) exposure at home and fetal SHS exposure during pregnancy are a major cause of disease among children. The aim of this study is quantifying the burden of disease due to SHS exposure in children and in pregnancy in 2006-2017 for the 28 European Union (EU) countries. Methods: Exposure to SHS was estimated using a...