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Objective. Apart from cancer, cardiovascular and respiratory diseases, smoking is associated with an increased risk of accidents and injuries. Many of these can be accounted for by dangerous smoking behaviors such as smoking in bed or while driving. We estimated therefore the prevalence of these hazardous smoking behaviors and the perceived risk of accidents associated with them in Italy. Methods. Data were derived by a survey on smoking on 3057 subjects, representative of the Italian population aged : 15 years. Specific questions were included on prevalence and risk perception of smoking while driving or in bed. Results. Of all current smokers (23.5% of the Italian population), 12% reported smoking while in bed, 69% reported smoking while driving a car, and 17% reported smoking while driving a motorcycle. Predictors of smoking while driving were younger age, male sex, and being a heavy smoker. Of the total population, 81% reported that smoking while driving increased the risk of accident, but public perception was lower in men, the young, current smokers, and among the subjects engaging in these behaviors. About 7% of car injuries in Italy could involve a subject who smokes while driving. Conclusion. Efforts should be taken, therefore, to disseminate knowledge about the smoking behaviors associated to high risk of injuries. (C) 2008 Elsevier Inc. All rights reserved.