Use of contraband cigarettes among adolescent daily smokers in Canada

'Both Sides of the Argument'? A critical review of existing evidence on the illicit trade in tobacco products in Canada

INTRODUCTION

The illicit trade in tobacco products (ITTP) is widely recognised as a substantial and complex problem in Canada. However, the independence of available data and quality of analyses remains unknown. Reliable and accurate data on the scale and causes of the problem are needed to inform effective policy responses.

METHODS

We searched the scholarly and grey literature using keywords related to ITTP in Canada. We identified 26 studies published in English since 2008 that present original research drawing on primary data. We analysed these studies for their independence from the tobacco industry, methodology, findings and gaps in knowledge.

RESULTS

The study finds 42% of the literature reviewed has links to the tobacco industry. These studies provide insufficient methodological detail, present higher estimates of the volume of ITTP and attribute the causes to higher rates of tobacco taxation. The classification of all indigenous tobacco sales as illicit, by both industry linked and independent studies, contributes to overestimates and serves the interests of transnational tobacco companies. There is need for independent and comprehensive data on the ITTP in Canada over time, across population groups and geographies.

CONCLUSION

While there is evidence that the ITTP in Canada is a major and complex issue that requires effective tobacco control policies, there is a limited evidence base on which to develop such responses. This review finds industry-linked studies lack independence, employ biased methodologies and serve tobacco industry interests. Independent studies present more rigorous approaches, but primarily focus on youth and the province of Ontario.

Levels and trends in cigarette contraband in Canada

Background

There is overwhelming evidence that increases in tobacco taxes reduce tobacco use, save lives and increase government tax revenue. High taxes, however, create an incentive to devise ways to avoid or evade tobacco taxes through contraband tobacco. The associated consequences are significant and call for an accurate measurement of contraband's magnitude. However, its illegal nature makes the levels and trends in contraband intrinsically difficult to measure accurately.

Objective

To examine levels and trends in cigarette contraband in Canada.

Methods

We employed 2 approaches: first, we contrasted estimates of tax-paid cigarettes sales with consumption estimates based on survey data; second, we used data from several individual-level surveys that examined smokers' purchasing and use behaviours. We placed a particular emphasis on the provinces of Québec and Ontario because existing research suggests that cigarette contraband levels are far higher than in any other province.

Results

The estimates presented show a clear upward trend from the early 2000s in cigarette contraband in Québec and Ontario followed by, on the whole, a decreasing trend from about 2007 to 2009. None of the data presented provide support to the narrative that cigarette contraband has been increasing in recent years. Of note are Québec estimates which suggest relatively low levels of cigarette contraband since 2010, at levels no higher than in the early 2000s.

Conclusions

The data presented suggest that policies to tackle cigarette contraband introduced from the mid-2000s to late 2000s, at both federal and provincial levels, may have dampened the demand for contraband cigarettes.

Preventing smoking in children and adolescents: Recommendations for practice and policy

Canada has witnessed a general decrease in smoking prevalence among all age groups in recent years. However, despite large numbers of campaigns and interventions, thousands of young Canadians continue to initiate cigarette smoking every year. The increasing popularity of alternative tobacco products and e-cigarettes is also creating new health challenges. Research has shown that the deleterious effects of nicotine and cigarette smoke are significant and long lasting. Health care professionals have key responsibilities in preventing tobacco use among youth and their families, and need to know more about effective smoking prevention and cessation strategies. Clinicians need to integrate tobacco counselling into health assessments of teenagers and be aware of the roles that families, communities and governments can play in promoting tobacco-free environments. Information, effective strategies and opportunities for health care professionals to intervene and advocate for Canadian adolescents are discussed.

Association between contraband tobacco and illicit drug use among high school students in Canada

A particularly challenging issue to tobacco cessation efforts is the availability of contraband cigarettes. While studies have linked contraband tobacco to smoking initiation and poor cessation outcomes, little is known about its association with illicit drug use among adolescents. We examine the association between contraband tobacco and illicit drug use among adolescent students using a national representative sample of 2,136 current smoker students in grades 9-12 from the 2010-2011 Youth Smoking Survey. About 31 % of adolescent current smokers in grades 9-12 use contraband cigarettes. Prevalence in the use of illicit drugs ranged from 9 to 37 %, with MDMA being the most commonly used drug. Adjusted logistic regression revealed that smokers of contraband cigarettes, when compared with non-contraband cigarette smokers, were more likely to use cocaine (OR 2.14; CI 1.29-3.56), heroin (OR 7.92; CI 3.00-20.91), amphetamines (OR 4.25; CI 2.07-8.74), MDMA (OR 2.00; CI 1.25-3.19), hallucinogens (OR 2.18; CI 1.34-3.55), and ketamine (OR 3.48; CI 1.61-7.54). This paper adds to the existing evidence of the negative effects of contraband tobacco by showing that adolescent contraband smokers are more likely to use illicit drugs. Given the addictive nature of these drugs and the potential for such behavior to spill over into adulthood, more efforts should be invested in addressing this problem.

Cigarette tax avoidance and evasion: findings from the International Tobacco Control Policy Evaluation (ITC) Project

BACKGROUND

Decades of research have produced overwhelming evidence that tobacco taxes reduce tobacco use and increase government tax revenue. The magnitude and effectiveness of taxes in reducing tobacco use provide an incentive for tobacco users, manufacturers and others, most notably criminal networks, to devise ways to avoid or evade tobacco taxes. Consequently, tobacco tax avoidance and tax evasion can reduce the public health and fiscal benefit of tobacco taxes.

OBJECTIVES

First, this study aims to document, using data from the International Tobacco Control Policy Evaluation Project (ITC), levels and trends in cigarette users' tax avoidance and tax evasion behaviour in a sample of 16 low-, middle- and high-income countries. Second, this study explores factors associated with cigarette tax avoidance and evasion.

METHODS

We used data from ITC surveys conducted in 16 countries to estimate the extent and type of cigarette tax avoidance/evasion between countries and across time. We used self-reported information about the source of a smoker's last purchase of cigarettes or self-reported packaging information, or similar information gathered by the interviewers during face-to-face interviews to measure tax avoidance/evasion behaviours. We used generalised estimating equations to explore individual-level factors that may affect the likelihood of cigarette tax avoidance or evasion in Canada, the USA, the UK and France.

FINDINGS

We found prevalence estimates of cigarette tax avoidance/evasion vary substantially between countries and across time. In Canada, France and the UK, more than 10% of smokers reported last purchasing cigarettes from low or untaxed sources, while in Malaysia some prevalence estimates suggested substantial cigarette tax avoidance/evasion. We also found important associations between household income and education and the likelihood to engage in tax avoidance/evasion. These associations, however, varied both in direction and magnitude across countries.

Cigarette packaging: Youth perceptions of "natural" cigarettes, filter references, and contraband tobacco

PURPOSE

The current study examined youth perceptions of appeal and harm of cigarette packaging with "natural" tobacco descriptors and references to filtration, as well as contraband tobacco in generic packaging.

METHODS

In a between-group experiment, 7,647 youth were randomized to view a pair of cigarette packages and rate perceptions of appeal and relative risk.

RESULTS

The findings indicate that packages with "natural" descriptors were rated as significantly more appealing and less harmful. Packages with filter references were rated as significantly less harmful, whereas contraband cigarettes were rated as significantly less appealing than leading brands.

CONCLUSIONS

The findings suggest that cigarette packaging can enhance the appeal of cigarettes and may promote false beliefs about the reduced harm of brands. The lower appeal of contraband cigarettes suggests that other factors, such as reduced price and ease of access, likely account for contraband use among youth.

'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

AIMS

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.

DESIGN

Qualitative study using 10 focus groups.

SETTING

Multiply disadvantaged community in Nottingham, United Kingdom.

PARTICIPANTS

Fifty-eight smokers, ex- and non-smokers aged 15-60 years.

MEASUREMENTS

Focus group topic guides.

FINDINGS

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.

CONCLUSIONS

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.

Contraband tobacco on post-secondary campuses in Ontario, Canada: analysis of discarded cigarette butts

Background

No studies to date have assessed young adults’ use of First Nations/Native tobacco, a common form of contraband tobacco in Canada. This study examined the proportion of First Nations/Native cigarette butts discarded on post-secondary campuses in the province of Ontario, and potential differences between colleges and universities and across geographical regions.

Methods

In 2009, discarded cigarette butts were collected from high-traffic smoking locations at 12 universities and 13 colleges purposively selected to represent a variety of institutions from all 7 health service regions across Ontario. Cigarette butts were identified as First Nations/Native tobacco if they were: known First Nations/Native brands; had names not matching domestic and international legally-manufactured cigarettes; had no visible branding or logos.

Results

Of 36,355 butts collected, 14% (95% CI = 9.75–19.04) were First Nations/Native. Use of this tobacco was apparent on all campuses, accounting for as little as 2% to as much as 39% of cigarette consumption at a particular school. Proportions of First Nations/Native butts were not significantly higher on colleges (M = 17%) than universities (M = 12%), but were significantly higher in the North region.

Conclusions

The presence of cheap First Nations/Native (contraband) tobacco on post-secondary campuses suggests the need for regulation and public education strategies aimed to reduce its use. Strategies should account for regional variations, and convey messages that resonate with young adults. Care must be taken to present fair messages about First Nations/Native tobacco, and avoid positioning regulated tobacco as a healthier option than contraband.

Factors associated with different cigarette access behaviours among underage smoking youth who usually smoke contraband (native) cigarettes

OBJECTIVES

Given that little is known about how youth access contraband cigarettes, the current study seeks to examine factors associated with how underage smoking youth report usually accessing contraband cigarettes.

METHODS

This study used nationally representative data collected from 41,886 students (grades 9 to 12) as part of the 2006-07 Canadian Youth Smoking Survey (YSS). Using data from current smokers who report that their usual brand of cigarettes is contraband, three logistic regression models were used to examine factors associated with buying cigarettes from a store, getting cigarettes from a family member, or getting cigarettes from friends or strangers.

RESULTS

In 2006, 7.9% (n = 1 3,300) of Canadian youth who were current smokers reported that their usual brand of cigarettes was contraband. Among these youth, the majority reported that they usually get their cigarettes from a friend or stranger (54.8%), whereas 26.4% report usually getting them from a family member and 18.8% usually buying their own from a store. Boys were more likely to buy contraband cigarettes from a store, whereas youth with a parent who smokes contraband cigarettes were substantially more likely to get contraband cigarettes from a family member and youth with friends who smoke contraband cigarettes were substantially more likely to get contraband cigarettes from a friend or stranger.

CONCLUSION

Ongoing surveillance of contraband cigarette use among youth and how youth access contraband cigarettes is required for guiding future tobacco control policy and programming activities.