When professor Giuseppe La Torre teaches a class on smoking cessation, he’s fighting an uphill battle. Among the group of students from the Sapienza University of Rome that he’s working with (and studying), a whopping 50 percent of them smoke tobacco. It’s an optional class, and fewer than one in 10 eligible students shows up. What’s particularly “frustrating,” La Torre says, is that “at the end of the class they start smoking again!”

All the more frustrating? These students really should know better, because they’re all training to be medical health professionals. Elsewhere, that might be shocking and counterintuitive. But in Italy:

44 percent of Italian health professionals smoke — twice the rate of the general population.

That’s according to a widely cited 2011 study from a team of researchers across the country, including La Torre, that sampled more than 1,000 nurses, doctors, medical students and other health care workers. The problem of smoker doctors “is real and worrying in Italy,” writes Florence-based tobacco researcher Dr. Giuseppe Gorini in an email with the subject line “Italian doctors are the worst.” La Torre describes often seeing doctors and nurses smoking on hospital grounds and even in hospital bathrooms, sometimes while still wearing their medical uniforms.

Most surprisingly, the study found that both Italian nurses (50 percent) and physicians (34 percent) are smoking like chimneys, at substantially higher rates than the general population (currently, 22 percent). In most other countries, research shows that the smoking rates of medical health professionals fall well before those of the public. Though national surveys vary, in the United States around 12 percent of nurses smoke and fewer than 2 percent of physicians do so, compared to 17 percent of the general public.

Many medical students pick up smoking while at university, says La Torre, pointing the finger at high-stress levels in medical courses, students who may be away from home for the first time and the lack of formal anti-smoking education. The problem is worst among health professionals in the south and center of the country, he says.

Most worryingly, research suggests that doctors and nurses who smoke are likely to be less proactive in advising their patients to kick the habit. La Torre also points to a national problem of teen smoking, especially among young girls: In the most recent report from the European School Survey Project on Alcohol and Other Drugs, Italy had the highest rates in Europe of 15- and 16-year-olds who had smoked a cigarette within the past 30 days — 35 percent for boys and 40 percent for girls.

However, overall smoking rates have fallen substantially in Italy, thanks at least in part to government regulation. Italy introduced a ban on smoking in public places in 2005, one of the first European countries to do so, and has since continually toughened legislation on smoking in advertising and graphic warning labels on packages and has stiffened penalties for those selling to minors. It’s becoming less socially acceptable, says Gorini, though the decline in smoking rates has started to level off.

And yet, doctors and other health professionals don’t seem to be getting the message, with La Torre suggesting, anecdotally, that he’s seen no improvement in recent years. “The case of smoking prevalence among doctors is an outlier” in Italy, says Gorini. While health authorities in some regions have had success in reducing smoking — tactics include fining those found smoking on the job, or by enforcing that cigarette breaks have to be taken off the clock and without wearing hospital uniforms — others have a long way to go, say the experts.

It seems the Boot of Europe is struggling to stamp out the habit.