BACKGROUND-AIM:
Italian law prohibits the sale of all nicotine-containing products to individuals under 18 years of age. Nevertheless, one in three Italian minors smokes cigarettes or uses other nicotine products. The aim of this study is to assess adolescents’ knowledge of sales restrictions on nicotine-containing products. In addition, the study seeks to estimate their support for innovative legislative proposals aimed at reducing tobacco use among young people.

METHODS:
This study used data from a survey conducted between November 2024 and May 2025 among 7396 underage students (<18 years) attending middle and high schools across five Italian regions. Students were asked about their knowledge of the Italian ban on the sale to minors of conventional cigarettes, heated tobacco products (HTPs), electronic cigarettes (ECs), and nicotine pouches (NPs). In addition, their support for the following tobacco control measures was assessed: (i) raising the minimum legal age for purchasing tobacco to 21 years (Tobacco21, T21), (ii) prohibiting sales to individuals born after January 1, 2009 (Smoke-Free Generation, SFG), and (iii) increasing inspections and penalties for the sale of nicotine products to minors. Logistic regression models adjusted for sex, school grade, and region were used to identify factors associated with awareness that the sale of these products to minors is prohibited.

RESULTS:
In our sample of underage students, 14.2% were unaware that the sale of conventional cigarettes to underage individuals is prohibited, 21.1% were unaware of this ban for HTPs, 29.5% for ECs, and 16.0% for NPs. Users of conventional cigarettes or other nicotine-containing products were more likely to be unaware of the sales ban on conventional cigarettes than non-users (OR = 1.41 and 1.29, respectively). Overall, 44.9% of students (53.8% among non-smokers and 9.6% among smokers) expressed support for T21, 61.4% (68.7% among non-smokers and 28.7% among smokers) supported the SFG measure, and 73.7% (82.8% among non-smokers and 30.5% among smokers) supported strengthening enforcement measures.

CONCLUSIONS:
About one in five Italian minors does not know that the sale of nicotine-containing products is prohibited to underage individuals. Surprisingly, those who use these products showed lower awareness of the ban, suggesting that their ability to purchase them is likely not hindered. New youth-oriented legislative proposals received broad support, particularly among non-smokers, while nearly three out of four adolescents expressed support for strengthening enforcement measures. It is therefore necessary, at a minimum, to intensify monitoring of retail outlets to ensure compliance with existing regulations.