Search

(1) Influenza causes a significant health and socio-economic burden every year, and health personnel (HP) are at higher risk of exposure to respiratory pathogens than the general population. (2) The study’s purpose was to describe and compare influenza vaccine uptake and its prognostic factors among Medical Doctors (MDs) and Non-Medical Health Personnel (NMHP) vs. Non-HP (NHP). We analyzed 2014–2018 data (n = 105,608) from the Italian Behavioral Risk Factor Surveillance System PASSI that, since 2008, has been collecting health-related information continuously in sampled adults. (3) MDs and NMHP represented, respectively, 1.1% and 4.6% of the sample. Among HP, 22.8% (CI 19.8–26.1%) of MDs and 8.5% (CI 7.5–9.5%) of NMHP reported to have been vaccinated vs. 6.3% (CI 6.1–6.5%) in NHP. This difference is confirmed in the three categories (MDs, NMHP, NHP), even more across age groups: in 18–34 yy, respectively, 9.9%, 4.4%, 3.4% vs. 28.4%, 13.9%, 10.6% in 50–64 yy. PASSI surveillance shows an increasing influenza vaccination uptake over time, especially among MDs (22.2% in 2014 vs. 30.5% in 2018). (4) Despite such an increase, especially among younger HP, influenza vaccination uptake is low. Even more under pandemic scenarios, these figures represent key information to address effective strategies for disease prevention and health promotion.

(1) Influenza causes a significant health and socio-economic burden every year, and health personnel (HP) are at higher risk of exposure to respiratory pathogens than general population. (2) The study purpose was to describe and compare influenza vaccine uptake and its prognostic factors among Medical Doctors (MDs) and Non-Medical Health Personnel (NMHP) vs Non-HP (NHP). We analysed 2014-2018 data (N=105,608) from the Italian Behavioural Risk Factor Surveillance System PASSI that, since 2008, has been collecting health-related information continuously in sampled adults. (3) MDs and NMHP represented, respectively, 1.1% and 4.6% of the sample. Among HP, 22.8% (CI 19.8% - 26.1%) of MDs and 8.5% (CI 7.5% - 9.5%) of NMHP reported to have been vaccinated vs 6.3% (CI 6.1% - 6.5%) in NHP. This difference is confirmed in the three categories (MDs, NMHP, NHP), even more across age groups: in 18-34yy, respectively, 9.9%, 4.4%, 3.4% vs 28.4%, 13.9%, 10.6% in 50-64yy. PASSI surveillance shows an increasing influenza vaccination uptake over time, especially among MDs (22.2% in 2014 vs 30.5% in 2018). (4) Despite such increase, especially among younger HP, influenza vaccination uptake is low. Even more under pandemic scenarios, these figures represent key information to address effective strategies for disease prevention and health promotion.

Il presente contributo ha la finalità di porre le basi per attività di ricerca volte allo sviluppo di laboratori di teatro sociale che abbiano come macro-obiettivo la tutela e promozione della salute. Inizialmente, si descrivono le caratteristiche dei laboratori di teatro sociale che li identificano come contesti privilegiati per condurre attività di ricerca; segue quindi una disamina epistemologica sul concetto di salute e della sua promozione, e sono poi rappresentate le dimensioni di salute associate all'ambiente di vita. Infine, si traduce quanto trattato nella traccia di sviluppo di un percorso di ricerca, i cui elementi qualificanti sono: a) l'obiettivo salute in termini di "abilità funzionale"; b) l'adozione dell'approccio life-course per fasi di vita; c) la considerazione delle relazioni con l'ambiente naturale tra i domini propri della tutela e promozione della salute, oltre che delle dimensioni del modello bio-psico-sociale.

Background Walking or cycling regularly instead of using motorised vehicles returns benefits not only to our health but also to the environment: in Europe, during 2020 a spotlight has also been put on the importance of accessibility to zero-emission transport, for promoting an inclusive framework that involves everyone. Policies in favour of a diffused active mobility in the general population encourage also to take steps effectively in order to achieve the longer-term goal of a European continent that is carbon-neutral. Methods In the Italian Behavioural Risk Factor Surveillance System PASSI, active mobility identifies both adults (aged 18-69) who cycle or walk to go to work or to school or for their usual commuting and those who, thanks to this habit, reach out recommended levels of physical activity to gain health benefits. Basing on their own active mobility levels, people are classified in: physically active (they reach out at least 150 minutes per week by walking or cycling for usual commuting, in bouts of at least 10 minutes); partially active (they use bicycle and/or walk usually, but not till 150 minutes weekly); non-active (they do not practise any active mobility or they do for little time duration). Results PASSI data 2016-2019 show that 44% among adults residing in Italy has practised active mobility by cycling (11%) and/or walking (41%) for usual commuting. They do in average for 4-5 days per week: people who cycle and those who walk sum up an average of, respectively, 144 and 181 minutes weekly. In the North, active mobility is experienced more than in the other parts of the Country. Active mobility definitively contributes to reach out recommended levels of physical activity that ensure health benefits and, in Italy, 21% of the resident adult population results to be physically active just thanks to this healthy lifestyle. Conclusions Walking or cycling for urban commuting, at least for 150 minutes per week in bouts of 10 minutes each, can help to meet the recommendations for physical activity by the WHO, without counting movement in spare time or at work.

Background Insufficient physical activity (PA) or physical inactivity (PI) is one of the ten leading risk factors for global mortality. PI leads to 20-30% increased risk of all-cause mortality and monitoring its current levels and trends in general population is essential to track progress towards health targets, identify at-risk groups, assess policies' effectiveness, guide future planning. Methods PASSI (Progressi delle Aziende Sanitarie per la Salute in Italia - Progresses in ASSessing adult population health in Italy) is an ongoing cross-sectional Behavioral Risk Factor Surveillance System (BRFSS) that monitors prevalence and temporal trends for the major modifiable health-related risk factors in the adults (18-69 years) residing in Italy. Data are collected in the Local Health Units (LHU) by trained personnel who administer a standardized questionnaire telephonically to sampled people. In the period 2015-2018, 132,717 people were interviewed in more of 90% LHUs (89 out of 101 in 2018), achieving a response rate above 80%. Concerning PA/PI, respondents are classified as per the WHO indicators in: (i) Active - basing on levels achieved in leisure time and/or heavy work; (ii) Partially active - in leisure time and/or moderate work or in spare time and without regular work; (iii) Inactive - in leisure time with sedentary work or in spare time and without regular work. PASSI calculates prevalence of PA/PI overall and by socio-demographic characteristics, including 95% confidence intervals (CI), and a logistic regression model estimates adjusted prevalence ratios (APR). Results In Italy, 28.8% (CI95%:28.5-29.1%) of adult population is featured by a sedentary lifestyle: PI is greater among women (32.4% vs. 25.1%; APR: 1.26), grows with age (34% in over50 vs. 24.7% among 18-34 year-old; APR: 1.34), is higher among deprived people both per economic difficulties (41.7% if many vs. 22.4% if none; APR: 1.39) and for education level (23.7% university vs. 47.2% primary/any; APR: 1.33). We observed a highly evident geographic gradient: PI amounts to 18.3% in the North, 25.2% in the Centre and 40.6% in the South. A multivariate analysis confirms these values are statistically significant. Conclusions PASSI data provide strong evidence to support community prevention interventions on territorial planning or advice by health professionals.

Background One scope of the Active and Healthy Ageing framework is to increase awareness on elderly-related topics. The year 2020 has seen an upheaval across the world caused by the COVID-19 emergence, even higher to older persons. Methods In Italy, data gathered by the PASSI d'Argento behavioural surveillance system on general population aged 65+ in the timeframe 2016-2019 describe health conditions, lifestyles and care needs for elderly. Results Basing on physical activity recommended by the WHO globally, 33% of non-physically impaired older persons reaches out those levels, 27% are partially active, 40% is sedentary. 9% fell down within 30 days prior the interview, accessing hospital was necessary in 19% of cases; 64% of falling occurred at home, 20% outdoor. 61% refers at least one infrastructural housing issue, 15% perceive higher neighbourhood insecurity. 35% reported difficulties in accessing essential services, especially to local health premises and for necessities. About 19% lives socially isolated, 21% had not any contact (neither by phone) with anyone in a typical week, 71% do not attend collective meetings, such as at a club or church. Nearby 1 out of 3 (29%) represents an asset to the own family/community: 19% looks after cohabiting people, 14% relatives or friends not living together with, 6% engage in volunteering. Participation in training courses or social events (trips/stays organised) regards little more than 2 over65 out of 10: 5% partakes in learning courses, 23% enjoyed those latest occasions. Such low social connectedness is observed even among «younger elderly» (aged 65-74). Nearly 19% referred frailty impacting on their own families mainly, 94% of frail elderly is given help from relatives, 20% from professional caregivers, 12% from acquaintances. All these factors suffer from socio-economic and territorial differences. Among elderly reporting many economic difficulties, social isolation is 31%, frailty 28%, difficult access to services 58%, falling 15%, with a geographic gradient at the expense of the Southern Regions. Conclusions COVID-19 is a clear threat to older persons: in Italy, monitoring ageing dimensions under the pandemic scenario represents even a greater opportunity to have scientific data which describe the impact of health emergency on elderly.

(1) Age-friendly health systems ensure access to quality healthcare services to all people, especially older adults. (2) We used data on elderly population collected from 2016 to 2019 by the Italian ongoing surveillance system PASSI d’Argento to analyze the prevalence and associations between accessing health services and modifiable risk factors included in the 25 × 25 strategy for the burden of noncommunicable diseases with health outcomes. (3) Chronic diseases and hospitalization as descriptors of health status showed that the elderly perceived as having poor access to care and prevention incurred a higher risk of hospitalization. The association between difficulties in accessing health services and hospitalization was always the highest in terms of the adjusted prevalence ratio (aPR), regardless of the other behavioral risk factors considered, controlling each model with sociodemographic conditions. Elderly hospitalized at least once for two days or more in the last 12 months had greater risk to have problems in accessing health services, whereas the model included health conditions such as obesity (aPR = 1.95 95% CI 1.75–2.17), smoking (aPR = 1.95 95% CI 1.76–2.16), alcohol use (aPR = 1.93 95% CI 1.73–2.14), hypertension (aPR = 1.92 95% CI 1.73–2.13) and diabetes (aPR = 1.91 95% CI 1.73–2.12). (4) Health policies should encompass socio-economic and living environment barriers which prevent access to care among older adults.

Cardiovascular disease (CVD) is the first cause of death in Europe and over the world. This study analyses health-related behaviours in adults referring doctor-diagnosed CVDs.We used data from the Italian cross-sectional Behavioural Risk Factor Surveillance System PASSI gathered in 2015-2018. Complex survey design analyses included the Taylor series method for variance estimation and Poisson regression for associations between socio-demographic characteristics and CVD.Among 132,598 respondents, the prevalence of doctor-diagnosed CVD was 5%. Higher percentages are observed among: men, older individuals, socioeconomically disadvantaged people. Compared to the general population, people with CVD have greater risk and aggravating factors, and a worse health status overall. All protective behaviors and lifestyles shall be improved.In Italy, adults with CVD are more likely to be exposed to aggravating modifiable risk factors: it represents a valuable information for increased preventive interventions, even more in the light of the COVID-19 pandemic scenario.

Background: Health Literacy (HL) has been recently hypothesized to affect the relationship between socio-economic status (SES) and health conditions. However, to date no study has yet assessed the potential contribution of HL in the pathway through which SES affects influenza vaccination status. We aim to examine the relationships among HL, SES factors, and influenza vaccination uptake in Tuscan (Italy) residents belonging to different high-risk groups (HRGs) for influenza. Methods: The study was performed within the Tuscan population sample selected in the Italian Behavioral Risk Factor Surveillance System in 2017–2018. HL was assessed using the Italian version of the 6-items European Health Literacy Survey Questionnaire (HLS-EU-Q6). Mediation analyses were conducted using SES variables as independent variables, influenza vaccination status as dependent variable and HL as mediator variable. Results: A total of 3278 people belonged to HRGs for influenza. In the whole sample, 19.4% of the participants were vaccinated against influenza. Participants who were not employed or had a poor financial status were more likely to be vaccinated against influenza (OR 1.56, 95%CI 1.26–1.94, p < 0.001, and OR 1.21, 95%CI 1.00–1.48, p = 0.047 respectively). HL did not mediate the relationship of any of the independent variables with influenza vaccination status. Conclusions: Some SES determinants resulted to influence influenza vaccination uptake, while HL did not affect the likelihood of influenza vaccination uptake among HRGs. Universal health care systems, as in the case of Italy, offering influenza vaccination free of charge to HRGs help in reducing inequalities and mitigating HL demands.

Background: Health Literacy (HL) is one of the main determinants of health and is crucial for the prevention of noncommunicable diseases, by influencing key health-related behaviours. The aim of the present study was to assess the role of HL and sociodemographic factors in predicting the adoption of two healthy behaviours—physical activity and fruits and vegetables consumption. Methods: This study was conducted on the Tuscan population subsample of the Italian Behavioral Risk Factor Surveillance System in 2017–2018. HL was assessed using the Italian version of the six-item European Health Literacy Survey Questionnaire (HLS-EU-Q6). Results: About 40% of the 7157 interviewees reported an inadequate or problematic HL level. Female sex, poor financial status, foreign nationality, and low education were associated with a problematic HL level, while an inadequate HL level was associated with being 50–69 years old, low education level, foreign nationality, poor financial status and unemployment or inactive status. Inadequate HL level was a strong predictor of both eating less than three portions of fruits/vegetables per day and not engaging in sufficient PA during leisure times. Conclusions: Our findings showed that an inadequate level of HL could negatively affect physical activity and diet, independently from the other sociodemographic conditions, confirming the role of HL as a relevant social determinant of health.

Introduction: Italy was one of the earliest countries to experience a severe COVID-19 epidemic and vaccinating the elderly, who constitute 23% of the population and have experienced the highest mortality rates, is a top priority. Estimating prevalences and understanding risk factors for COVID-19 vaccine hesitancy or refusal are important for development of targeted interventions.Methods: We used data from a specially developed COVID-19 module of PASSI D'Argento, an ongoing surveillance system of residents 65+ years of age to measure the prevalence and identify risk factors for hesitancy and refusal to receive the COVID-19 vaccine. We calculated multinomial regression relative risk ratios to examine the association between demographic characteristics, health status, COVID-19 attitudes and experiences and likely vaccine hesitancy and refusal.Results: Of the 1876 respondents, 55% reported they would accept vaccination and 16% would likely refuse; the remaining 29% were categorized as hesitant. Compared with the acceptance group, we identified several risk factors in common between the hesitancy group and the refusal group, including not having received vaccination against influenza during the previous flu season (hesitancy: RRR = 2.0; 95% CI 1.4–2.9; refusal: RRR = 12.1; 95%CI 7.6–19.4) and lower risk of having had a death from COVID-19 among family or friends (hesitancy: RRR = 4.8; 95%CI 2.0–11.4; refusal: RRR = 15.4; 95%CI 3.7–64.5). The hesitancy group was significantly more likely being worried and they did not know if consequences of the disease would be serious for them.Conclusion: Our findings show the importance of establishing and maintaining active contact between the preventive services, primary care providers and the population because trust is difficult to establish during an emergency like the COVID-19 pandemic. Italian public health is based on a capillary network of general practitioners and having them reach out to their patients who have not previously received influenza vaccine may be a useful strategy for targeting efforts to further encourage uptake of COVID-19 vaccination.

(1) Cases of cancer are expected to increase in the next years and the risk of cancer increases with age. Data 2016–2019 from the Italian population-based surveillance PASSI d’Argento (PdA) allow the description of the physical and psychosocial well-being of people aged ≥65 years diagnosed with cancer (Ca), and the comparison with elderly suffering from other chronic conditions (Ch) and healthy older individuals (H). (2) Data are collected by Local Health Units’ professionals using a standardized questionnaire during telephone interviews. (3) A total of 8051 out of the 56,352 interviewees reported a previous diagnosis of cancer: an annual average cancer prevalence of 12.8% (95% CI 12.4–13.3%) corresponding to 1.725 million elderly residing in Italy. In comparison to the H, Ca were more likely to refer bad health (aPR = 4.21; 95% CI: 3.70–4.79), suffer from depressive symptoms (aPR = 2.65; 95% CI: 2.35–2.99), disability (aPR = 2.50; 95% CI: 2.22–2.81) or sensory problems (aPR = 1.51; 95% CI: 1.40–1.63), be frail (aPR = 1.45; 95% CI: 1.30–1.61). Ca are often current smokers (aPR = 1.26; 95% CI: 1.11–1.45) and sedentary (aPR = 1.10; 95% CI: 1.03–1.18). (4) PdA provides valuable information to researchers and policy-makers by showing the difficulties for older people with cancer in contributing socially and accessing basic social and health services, which amplifies the risk of cognitive decline, isolation, and psychological deterioration.

Data on smoking among Italian Health Personnel (HP) from PASSI surveillance system from 2014-2018 were analysed.Among 169,678 working-age respondents, smoking prevalence was estimated among 1,253 Medical Doctors (MDs), 4,840 Non-Medical HP (NMHP), 87,749 Non-HP (NHP) and multivariate analysis was conducted.Current smokers were 23.0% among HP. Smoking prevalence in MDs (16.0%) was significantly lower than those observed in NMHP (25.3%) and NHP (28.6%). A declining trend was detected in all three groups and was more evident among MDs: from 20.8% in 2014 to 11.5% in 2018. Amongst MDs, smoking was significantly associated with male gender (Adjusted Odds Ratio, AdjOR=1.61), younger age (AdjOR=2.00), residing in South (AdjOR=1.71). Among NMHP, smoking prevalence was associated with low economic condition (AdjOR=1.54) and non-university education.To further reduce smoking in HP, it is necessary to develop specific training courses in educational curricula.

Introduction Current lengthening of average life and constant increase of population ageing associated to forces that include rapid unplanned urbanisation and globalisation of unhealthy behaviours have determined the huge relevance of noncommunicable diseases (NCDs). Monitoring key modifiable behavioural risk factors has resulted to be crucial both in spatial terms and as per temporal trends in order to allow comparisons between different geographic areas or levels and over time. Materials and Methods In Italy, PASSI (Progressi delle Aziende Sanitarie per la Salute in Italia) and Passi d’Argento are the ongoing Behavioural Risk Factor Surveillance Systems (BRFSSs), respectively, on adults (people aged 18−69) and elderly (65 and older). Results The two Italian surveillances are information systems providing data not only on the third Sustainable Development Goal (SDG) that explicitly addresses ensuring healthy lives and promoting well-being for all, but on a total of nine health-related SDGs (HRSDGs) and 19 HRSDG targets/indicators. We describe these pairs more in detail specifying where in case of BRFSS core indicators (N = 14 HRSDG targets/indicators) concerning six HRSDGs or, on the other hand, as per BRFSS further in-depth analysis (N = five HRSDG targets/indicators) in regard of four different HRSDGs. About the HRSDG 3, HRSDG target 3.4, HRSDG indicator 3.4.1, from the PASSI and Passi d’Argento data it is possible not only to detect the prevalence of NCDs in adults and elderly living in Italy, but also to evaluate the social determinants of health, such as gender, age group, educational level, economic difficulties, as well as the associations with modifiable lifestyle risk factors. Conclusions The two Italian BRFSSs generate accurate data, which are highly relevant to design, implement, monitor, and evaluate programs and policies at different levels (local, regional, national) for NCD prevention and health promotion. They provide numbers which can also serve as propaedeutic or, in some cases, complementary ground to address a robust measurement of several HRSDG patterns.

Epidemics and pandemics are natural events recurring over the time: their impact can be appropriately minimised but most countries only rely on emergency response. The European Decision 1082/2013 on serious cross-border threats to health is innovative in recognising risk communication as an essential tool in coping with public health emergencies of international concern (PHEIC). The Decision serves as proper context for the EU-funded ASSET (Action plan in Science in Society in Epidemics and Total pandemics) research project that aims to create the blueprint for a better response to PHEIC, through improved forms of dialogue and better cooperation at different levels on Science-in-Society (SiS) issues (governance, engagement, ethics, gender, science education, open access). A Mobilization and Mutual Learning (MML) approach was developed through the ASSET Strategic and Action Plans toward different targets and relevant stakeholders. An integrated participatory approach needs to be recognized into the national plans for preparedness and response.

Background In Italy, HPV vaccination is offered to 11-year-old girls since 2007. In 2012 coverage was 69%. Strategies for offering and promoting HPV vaccination and coverage rates (26–85%) vary among Regions and Local Health Authorities (LHAs). We conducted a national study to identify strategies to improve HPV vaccination uptake. Methods In 2011–2012 we invited the 178 LHAs to fill a web-questionnaire, inquiring implementation of HPV vaccination campaigns (immunization practices, logistics of vaccine delivery, training, activities to promote vaccination, barriers, local context). We described type of offer and vaccination promotion in each LHA and studied the association of these factors with vaccination coverage rates. Results We analyzed 133 questionnaires. The communication tools more frequently used to promote vaccination were: brochures/leaflets (92% of LHAs), fliers/posters (72%). Television (24%) and radio (15%) were less used. Using ≥3 communication channels was associated to a coverage ≥70% (OR adj = 5.9, 95%CI 2.0–17.4). The probability to reach a coverage ≥70% was higher if the invitation letter indicated a pre-assigned date for HPV vaccination (OR adj = 7.0, 95%CI 1.2–39.8) and >1 recall for non-respondents was planned (OR adj = 4.1, 95%CI 1.8–9.3). Immunization services and paediatricians were involved in informative and training activities in most LHAs (80–90%), instead general practitioners, women and family's healthcare services and public gynaecologists in 60–70%, cervical cancer screening services and private gynaecologists in 20–40%. The main factors that negatively affected vaccination uptake were: poor participation to training events of professional profiles different from personnel of immunization services (reported by 58% LHAs), their mistrust towards HPV vaccination (55%) and insufficient resources (56%). Conclusion The synergy of multiple interventions is necessary for a successful vaccination programme. Practices such as pre-assigning vaccination date and repeatedly recalling non-respondents could improve vaccination uptake. Efforts are required to strengthen the training of different professional profiles and services and encourage their collaboration. Economical resources are needed to promote vaccination.

Background In Italy, free-of-charge HPV vaccination is offered to 11-year-old girls since 2007. The National Immunization Plan established the target coverage at a minimum of 70%; it should increase to 95% within 3-year time frame. In 2012, four year after the introduction of HPV vaccination, coverage was stable at 69%. We conducted a national cross-sectional study to explore barriers to vaccination in Italy. Methods Vaccination services selected, through the immunization registries, a sample of unvaccinated girls born in 1997 or 1998 and posted to their families a 23-items questionnaire inquiring barriers to vaccination, HPV knowledge, source of information on HPV, perception of risk of contracting HPV, advice from consulted health professionals on HPV vaccination. Results We analysed 1,738 questionnaires. Main barriers were fear of adverse events (reported by 80% of families), lack of trust in a new vaccine (76%), discordant information received by health professionals (65%) and scarce information on HPV vaccination (54%). Overall, 54% of families replied correctly to more than half of 10 questions exploring knowledge on HPV vaccination. Families with a high knowledge score were more likely to live in Northern and Central Italy, be Italian, have a high educational level, include a mother who attended cervical screening regularly and consult more information sources. Although paediatricians/general practitioners and gynaecologists were considered the most trusted source of information by 79% and 61% of respondents, they were consulted only by 49% and 31%. Among parents who discussed vaccination with a physician, 28% received discordant advices and 31% received the recommendation of accepting vaccination. Conclusions Fear of adverse events, discordance of information and advices from physicians, and scarce information were the more commonly reported barriers to HPV vaccination. Health professionals played a key role as information providers, thus they must be better trained to provide clear notions. Training needs to include the development of communication skills; transparent discussion about the pros and cons of vaccination may reduce fear of adverse events and increase trust in vaccination. The creation of a public health network around vaccination would allow sharing information and attitudes on vaccinations, so that homogeneous messages could reach the target population. Electronic supplementary material The online version of this article (doi:10.1186/s12879-014-0545-9) contains supplementary material, which is available to authorized users.

The aim of this paper is to report compliance with the smoking ban and the spread of smoke-free homes after 3–8 years since the Italian smoking ban implementation, according to the ongoing Italian surveillance system for behavioural risk factors (PASSI). PASSI is based on representative annual samples of the Italian population aged 18–69 years. We considered questions on smoking habits, self-reported compliance with the ban, and on smoke-free homes of 176,236 interviews conducted in 2008–2012. Ninety percent of respondents in 2012 reported that the smoking ban was enforced in hospitality premises (HPs), with a significant 3 % increase from 2008. Similarly, 91.3 % in 2012 reported a high compliance in workplaces other than HPs, with a significant 5 % increase. Perception of compliance did not change among smokers and non-smokers. Seventy-eight percent of respondents in 2012 reported smoke-free homes, with a significant increase from 2008 to 2012. The high compliance with the ban that is still increasing even after 8 years since its implementation may partially have caused the concurrent increase in smoke-free homes.

Purpose Field substitution of nonrespondents can be used to maintain the planned sample size and structure in surveys but may introduce additional bias. Sample weighting is suggested as the preferable alternative; however, limited empirical evidence exists comparing the two methods. We wanted to assess the impact of substitution on surveillance results using data from Progressi delle Aziende Sanitarie per la Salute in Italia—Progress by Local Health Units towards a Healthier Italy (PASSI). Methods PASSI is conducted by Local Health Units (LHUs) through telephone interviews of stratified random samples of residents. Nonrespondents are replaced with substitutes randomly preselected in the same LHU stratum. We compared the weighted estimates obtained in the original PASSI sample (used as a reference) and in the substitutes' sample. The differences were evaluated using a Wald test. Results In 2011, 50,697 units were selected: 37,252 were from the original sample and 13,445 were substitutes; 37,162 persons were interviewed. The initially planned size and demographic composition were restored. No significant differences in the estimates between the original and the substitutes' sample were found. Conclusions In our experience, field substitution is an acceptable method for dealing with nonresponse, maintaining the characteristics of the original sample without affecting the results. This evidence can support appropriate decisions about planning and implementing a surveillance system.