BACKGROUND-AIM:
In Italy, nearly one in four adults smokes, contributing to 85-90% of new lung cancer cases and over 90000 deaths per year. Although one third of smokers attempt to quit each year, in almost 76% of cases the attempts fail. Those who succeed do so mostly without help (64%), and support services provided by health centres remain underused. A total of 223 Anti-Smoking Centres (CAFs) operate nationwide, with wide heterogeneity in distribution, service models, and organizational features. This study seeks to identify the main challenges and key areas of development for CAFs, focusing initially on centres in the Lombardy Region.

METHODS:
Managers and staff from Lombard CAFs were invited to participate in an online focus group (FG) and to provide written information on the organization and functioning of their centres. The FG, held in July 2025, addressed five domains: user pathways, challenges, collaborations, user profiles, and development priorities. Recordings were transcribed verbatim and analysed using thematic content analysis. Ethical approval was obtained from Bocconi Ethics Committee.

RESULTS:
Lombardy hosts 27 CAFs, 19 affiliated with the National Healthcare Service (SSN) and 8 with the Italian League for the Fight against Tumors (LILT), concentrated mainly in Milan and Bergamo provinces. Centres differ in professional staffing and treatment options, with LILT sites providing exclusively educational and psychological support. Most centres require user co-payment; only a minority request GP referral. 23 CAFs, participated in the study. Existing collaborations within CAFs involve pneumology departments, private companies (Workplace Health Promotion), and EU projects, while participants expressed interest in strengthening ties with GPs, pharmacies, and regional actors involved in lung cancer screening. Current users are predominantly aged over 40, highly dependent on tobacco and with smoking-related comorbidities, which often require hospitalization. Centres wish to reach young consumers of novel nicotine products, foreign-born smokers, and residents of remote areas. CAFs encounter persistent structural and organizational barriers: insufficient staff, limited spaces and resources, stigma associated with addiction services where most CAFs are located, and lack of reimbursement for smoking cessation medications. Low institutional visibility, weak integration with primary care, limited public awareness and emerging novel products consumption further restrict the service reach. Priority areas for development include reimbursement of therapies by the SSN, dedicated spaces for cessation activities, GP training, communication strategies targeting the youth, multicentre research evaluating outcomes, and the adoption of complementary therapies alongside standard treatments.

CONCLUSIONS:
Findings from the Lombard FG could inform a national survey to be administered to all Italian CAFs, guiding future accessibility policy and service improvements.