Illicit Tobacco Use Research Articles

Theoretically framing views of people who smoke in understanding what might work to support smoking cessation in coastal communities: adapting the TIDieR checklist to qualitative analysis for complex intervention development

IntroductionPeople living in coastal communities have some of the worst health outcomes in the UK, driven in part by high smoking rates. Deprived coastal communities include socially disadvantaged groups that struggle to access traditional stop smoking services. The study aimed to seek the views of people who smoke living in coastal communities, to assess the optimal smoking cessation intervention for this population. In addition, the Template for Intervention Description Replication (TIDieR) checklist was adapted as an analytical framework for qualitative data to inform intervention design.MethodsCurrent or recent ex-smokers (n = 25) were recruited to participate in qualitative interviews from a range of community locations in a deprived English seaside town. A thematic analysis of the interview data was undertaken adapting the TIDieR framework. This analysis was triangulated with relevant literature and notes from stakeholder meetings and observations to map onto the TIDieR checklist to describe the optimal intervention.ResultsBarriers to quitting smoking in the target population included low motivation to quit, high anxiety/boredom, normalisation of smoking and widespread illicit tobacco use. There was broad support for combining behavioural support, e-cigarettes and financial incentives, with a strong preference for the intervention to be delivered opportunistically and locally within (non-healthcare) community settings, in a non-pressurising manner, ideally by a community worker specially trained to give stop smoking support.ConclusionsAn intensive community-based smoking cessation intervention was acceptable to the target population. Adapting the TIDieR checklist as a deductive qualitative analytical framework offered a systematic approach to intervention development. Combined with other intervention development activities, this ensured that the intervention design process was transparent and the proposed intervention was well defined. It is recommended that prior to intervention development researchers speak to members of the target population who may give valuable insight into the optimal intervention.

Smoking out Australia's growing illicit tobacco market: Current trends and future challenges

Data from the Australian Taxation Office and Australian Border Force show notable recent increases in illicit tobacco seizures across Australia. The illicit tobacco market results in substantial losses in tax revenue, funds organised crime, and perpetuates tobacco use, threatening to undermine Australia's ability to achieve its national commercial tobacco endgame goal of 5 % or less smoking prevalence by 2030. This commentary discusses recent trends in Australia's illicit tobacco trade, reasons why this is of concern, potential drivers of Australians’ illicit tobacco use, and policy measures that could be implemented to mitigate increasing illicit tobacco trade such as implementing a track and trace system, increased investment in the Australian Border Force to enhance detection of illicit tobacco shipments at Australia's borders, and encouraging public tip-offs of illicit tobacco sales.

Potential smoke-free dividend across local areas in England: a cross-sectional analysis

BackgroundThe value that might be added to local economies each year through the money that people who smoke tobacco would save if everyone quit smoking is called the ‘smoke-free dividend’....

Analysis of wastewater from 2013 to 2021 detected a recent increase in nicotine use in Queensland, Australia

Previous wastewater-based epidemiology (WBE) studies have reported decreasing trends of nicotine and tobacco use in Australia before 2017, but there is concern that increasing illicit use of nicotine in vaping products and illicit tobacco could reverse this progress. This study aimed to assess temporal trends of nicotine consumption and specifically tobacco consumption via wastewater analysis in a population in Australia between 2013 and 2021. One week of daily wastewater samples were analyzed every two months from February 2013 to December 2021 in a regional city serving ∼100,000 people. A total of 340 daily samples were analyzed for anabasine (tobacco specific biomarker) and nicotine metabolites, cotinine and hydroxycotinine, using direct injection method by liquid chromatography with tandem mass spectrometry. Daily consumption estimates were calculated from daily flow data, population estimates and previously reported excretion factors. Linear spline regression was performed to identify periods when significant change of slopes occurred and to evaluate the temporal trends. Tobacco use monitored using anabasine as a biomarker, showed a decreasing trend over the whole period with a higher rate of decrease during the first two years (2013-2014, 21 % decrease) compared to the later 7 years (2015-2021, 10 % decrease). Nicotine use, monitored using cotinine and hydroxycotinine, showed a downward trend between 2013 and 2018 (2013‐2014: 18 % decrease, p < 0.05; 2015‐2016: 6 % increase, p = 0.48; Feb-Dec 2017: 15 % decrease, p = 0.39) followed by a significant increase from 2018 to 2021 (40 % increase, p < 0.001). This finding suggests the increasing use of non-tobacco nicotine-based products. Additionally, the tobacco use estimate by wastewater analysis was higher than the tobacco sales data, which suggests the use of illicit tobacco in the catchment.

Perceptions of Illicit Tobacco Sources Following a Proposed Reduction in Tobacco Availability: A Qualitative Analysis of New Zealanders Who Smoke.

Tobacco companies claim that substantially reducing tobacco retail outlets in Aotearoa New Zealand will increase illicit tobacco trade and crime. However, we know little about whether people who smoke anticipate using illicit tobacco once this measure is implemented. Exploring current illicit tobacco use and expected market development would clarify the likely scale of this potential problem. We undertook online in-depth interviews with 24 adults who smoke and explored their experiences of illicit tobacco, perceptions of illicit market growth once legal tobacco became less available, intentions to engage in this market, and potential measures that could curb illicit market development. We interpreted the data using a qualitative descriptive approach. Few participants had purchased illegally imported or stolen tobacco. While most did not know how to access illicit tobacco products, many expected illicit trade and crime would increase, if legal tobacco became difficult to access. While cheaper tobacco appealed to many, most perceived illicit supply routes as unsafe and saw products obtained via these sources as likely to be of poor quality. Few suggested measures to control illicit markets, though a minority called for social reforms to reduce poverty, which they thought fueled illegal practices. Although illicit trade may appear to threaten new policy initiatives, participants' limited knowledge of these markets and concerns regarding product safety suggest illegal tobacco may pose less of a threat than tobacco companies have claimed. Policy makers should not be deterred from reducing tobacco availability by industry arguments. Although participants believed illicit trade would increase if the number of tobacco retailers was substantially reduced, few anticipated purchasing illegal tobacco. They viewed supply routes as unsafe and product quality as likely to be low. Industry predictions that illicit tobacco trade will grow if tobacco becomes less available do not reflect how people who smoke expect to engage with these markets and should not deter the introduction of retail reduction measures.

Prevalence of illicit tobacco use and tobacco tax avoidance in pregnancy.

BackgroundSmoking during pregnancy is associated with adverse maternal and fetal outcomes. Tobacco tax avoidance and tax evasion undermine the effectiveness of tobacco tax policies, resulting in cheaper prices for smokers and increased tobacco usage.AimsThe purpose of this study was to explore the purchasing habits of pregnant smokers with regard to tobacco expenditure and use of illicit tobacco.MethodsProspective cohort study. Face to face interviews were conducted with 90 attendees (age range 18–42 years; mean age 28 years) of a smoking cessation antenatal clinic in a large Irish tertiary level maternity hospital. Information regarding smoking habits, quantity of tobacco smoked, and location of purchase of tobacco was collected in addition to socioeconomic details. Tobacco products were examined to establish whether these were purchased from legitimate sources.Results76.6% of women smoked 10 or fewer cigarettes per day. The mean weekly spend on tobacco was €39. Seventeen women (18.8%) smoked roll-your-own tobacco. One woman (1.1%) currently possessed a pack of illicit tobacco, while another 5.5% of participants had purchased illicit tobacco in the past. Four women (4.4%) practiced tobacco tax avoidance by purchasing tobacco abroad or in Duty Free.ConclusionsUse of illicit tobacco is low and only a minority of women engaged in tobacco tax avoidance. As the average price of tobacco in Ireland increases, weekly expenditure on tobacco products is a significant financial impact on low-income women. Smoking cessation would deliver significant financial gains in addition to health benefits.

Standardized packaging and illicit tobacco use: A systematic review.

INTRODUCTIONTo systematically review the evidence regarding the effect of standardized packaging on illicit tobacco use.METHODSData sources were EMBASE, Web of Knowledge, Scopus, PsycInfo, Medline, and the British Library catalogue, from 01/01/1987 to 28/11/2016. Reference lists of included studies were hand searched for additional papers. Search strategies were based on the terms ‘tobacco’, ‘packaging’ and ‘illicit’. The search was restricted to English language references. Two reviewers screened titles and abstracts for empirical studies that addressed the topic of standardized packaging and illicit tobacco use. This resulted in 153 full text papers retrieved for screening. Following exclusions, ten papers were included in the review. Two reviewers’ extracted data using piloted standardized data extraction forms. Studies were assessed for quality and relevance using CASP.RESULTSThere was little homogeneity between included studies, so a narrative synthesis was employed. Of the relevant studies five reported smokers did not intend to or actually purchase further illicit tobacco following standardized packaging, although one suggested a small number of responders to online news felt smokers would be more inclined to purchase illicit tobacco, following standardized packaging. Two studies reported retailers did not intend to or actually increase sales of illicit tobacco following standardized packaging. Finally, two studies reported industry data on illicit tobacco were of poor quality and not supported by independent data.CONCLUSIONSThere were few studies examining tobacco standardized packaging and illicit trade, however those available showed no evidence that standardized packaging could lead to increases in illicit trade.

Estimating cigarette tax avoidance and evasion: evidence from a national sample of littered packs

IntroductionA number of recent studies document the proportion of all cigarette packs that are ‘contraband’ using discarded packs to measure tax avoidance and evasion, which we call tax non-compliance. To...

Use of illicit tobacco following introduction of standardised packaging of tobacco products in Australia: results from a national cross-sectional survey

ObjectivesTo assess whether following standardisation of tobacco packaging in Australia, smokers were, as predicted by the tobacco industry, more likely to use illicit tobacco.MethodsNational cross-sectional telephone surveys conducted continuously from...

Early evidence about the predicted unintended consequences of standardised packaging of tobacco products in Australia: a cross-sectional study of the place of purchase, regular brands and use of illicit tobacco

ObjectivesTo test for early evidence whether, following the standardisation of tobacco packaging, smokers in Australia were—as predicted by the tobacco industry—less likely to purchase from small mixed business retailers, more...

‘No-one actually goes to a shop and buys them do they?’: attitudes and behaviours regarding illicit tobacco in a multiply disadvantaged community in England

To explore attitudes towards, and experience of, illicit tobacco usage in a disadvantaged community against a backdrop of austerity and declining national trends in illicit tobacco use. Qualitative study using 10 focus groups. Multiply disadvantaged community in Nottingham, United Kingdom. Fifty-eight smokers, ex- and non-smokers aged 15-60 years. Focus group topic guides. There was high awareness and use of illegal tobacco sources, with 'fag houses' (individuals selling cigarettes from their own homes) being particularly widespread. Rather than being regarded as marginal behaviour, buying illicit tobacco was perceived as commonplace, even where products were known to be counterfeit. Smokers' willingness to smoke inferior 'nasty' counterfeit products may be testament to their need for cheap nicotine. Illicit tobacco was seen to be of mutual benefit to both user (because of its low cost) and seller (because it provided income and support for the local economy). Illicit tobacco sellers were generally condoned, in contrast with the government, which was blamed for unfair tobacco taxation, attitudes possibly heightened by the recession. Easy access to illicit tobacco was seen to facilitate and sustain smoking, with the main concern being around underage smokers who were perceived to be able to buy cheap cigarettes without challenge. National strategies to reduce illicit tobacco may have limited impact in communities during a recession and where illicit trade is part of the local culture and economy. There may be potential to influence illicit tobacco use by building on the ambivalence and unease expressed around selling to children.

What price quitting? The price of cigarettes at which smokers say they would seriously consider trying to quit

BackgroundDeciding on an appropriate level for taxes on tobacco products is a critical issue in tobacco control. The aim of the present study was to describe the critical price points for packs for smokers of each pack size, to calculate what this would equate to in terms of price per stick, and to ascertain whether price points varied by age, socio-economic status and heaviness of smoking.MethodsIn November 2011, 586 Victorian smokers of factory-made cigarettes were asked during a telephone survey about their usual brand, including the size and cost of their usual pack. They were also asked about use of illicit tobacco. Smokers estimated what price their preferred pack would need to reach before they would seriously consider quitting.ResultsThree-quarters of regular smokers of manufactured cigarettes could envisage their usual brand reaching a price at which they would seriously consider quitting. Analyses revealed that answers clustered around whole numbers, (AUD$15, $20, $25 and $30), with a median nominated price point of AUD$20 per pack. The median price point at which regular smokers would consider quitting was calculated to be 80 cents per stick, compared to the current median reported stick price of 60 cents.Of the smokers who nominated a price point, 60.1% indicated they would seriously consider quitting if the cost of their usual brand equated to 80 cents per stick or less; 87.5% would seriously consider quitting if sticks reached one dollar each.ConclusionsThese results do suggest a potentially useful approach to setting taxes in Australia. If taxes can be set high enough to ensure that the cost of the smokers’ preferred packs exceeds critical price points, then it seems likely that more people would seriously attempt to quit than if the price increased to a level even slightly below the price points. Our study suggests that a tax increase large enough to ensure that a typical pack of 25 cigarettes in Australia cost at least AUD$20 would prompt more than 60% of smokers able to nominate a price point to seriously think about quitting, with particularly strong effects among low-SES smokers.

Understanding the motivations of contraband tobacco smokers

Aim: This study explored the motivations behind illicit tobacco use in Australia. A key focus was to investigate the hypothesis that the primary motivation for illicit tobacco use is its low cost in comparison to the price of legal tobacco.Methods: An Australian tobacco usage telephone survey was conducted in 2007. Illicit tobacco smokers completed a longer version of the questionnaire, with questions relating to illicit tobacco usage and perceptions.Findings: Of the current smokers of illicit tobacco surveyed, almost half would consider increasing illicit tobacco consumption if the cost of legal tobacco were to increase to four times the price of illicit tobacco, although others stated consumption would remain the same regardless of such a price change. Almost all former smokers of illicit tobacco claimed that price did not influence the decision to stop smoking illicit tobacco.Conclusions: Some illicit tobacco smokers appear to be sensitive to the price of tobacco products, but price is not always an underlying motivator. Personal preference and supply also influence illicit tobacco consumption. The findings suggest that reducing the availability of illicit tobacco would be a useful strategy for combating the growing illicit tobacco problem.