Abstract
Backround: The availability of contraband cigarettes provides incentives for price-sensitive smokers to reduce their monetary costs of smoking. The objectives of this study were to examine whether Canadian smokers’ geographic proximity to First Nations reserves and attempts to quit smoking influenced the likelihood of purchasing lower-cost cigarettes from reserves. Methods: Data were from the International Tobacco Control (ITC) Canada Survey, a prospective survey of Canadian adult smokers conducted from 2002 to 2014 using telephone and online interviewing methods. Analysis was restricted to smokers from Ontario (n=2105) and Quebec (n=1427) participating in at least one survey wave. Smokers’ postal codes were used to calculate distance to the nearest reserve. Weighted logistic generalised estimating equations (GEE) regression examined the linear relationship between distance and the log odds of last purchasing cigarettes on reserve in each province. GEE models also examined the relationship between past-year quit attempts and the log odds of on-reserve purchasing. Results: Controlling for other factors, from 2002–2014, smokers from Ontario who lived 10 km closer to reserves than otherwise similar smokers had significantly higher odds of last purchasing on reserve (OR ranged from 1.16 to 1.65). Distance had little effect on smokers’ purchasing behaviours in Quebec. Moreover, in Ontario, for every 10 km increase in distance, smokers who did not try to quit had significantly greater odds of purchasing from a reserve than smokers who tried to quit (p=0.002). Conclusion: In order for tobacco taxation policies to achieve their maximal benefit, governments must limit potential sources of lower-cost cigarettes. Collaborative governance arrangements can ensure tobacco products sold on reserve to non-Indigenous people are appropriately taxed while allowing First Nations communities to keep the revenue generated by such taxes.
Highlights
Tobacco taxes reduce consumption by increasing the price of tobacco products (Chaloupka, Straif, & Leon, 2011; Chaloupka, Yurekli, & Fong, 2012; International Agency for Research on Cancer, 2011)
Collaborative governance arrangements can ensure tobacco products sold on reserve to non-Indigenous people are appropriately taxed while allowing First Nations communities to keep the revenue generated by such taxes
Because the Canadian contraband tobacco problem is concentrated in Ontario and Quebec, this study examined whether on-reserve purchases differed by province and whether the likelihood of on-reserve purchases changed over time as a function of geographic proximity
Summary
Tobacco taxes reduce consumption by increasing the price of tobacco products (Chaloupka, Straif, & Leon, 2011; Chaloupka, Yurekli, & Fong, 2012; International Agency for Research on Cancer, 2011). In the face of tax increases, price-sensitive smokers may actively search for lower-priced alternatives to reduce their financial burden of continuing to smoke. Pricesensitive smokers lower their costs using a variety of tactics, including cross-border shopping, internet orders, and duty-free shops (U.S National Cancer Institute and World Health Organization, 2016). In North America, it is possible for smokers to purchase cigarettes from Indigenous people on tribal lands, which are usually known as First Nations reserves in Canada and Indian reservations in the United States. While non-Indigenous people buying cigarettes from First Nations reserves in Canada must pay all applicable federal and provincial taxes, this is not strictly enforced (Luk et al, 2009; Mecredy et al, 2013)
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