Contraband tobacco leads to reduced smoking cessation

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1. Contraband tobacco users are significantly less likely attempt to quit or abstain from smoking.  

2. Smoking contraband tobacco is highly associated with heavy smoking, length of smoking history, and perceived addiction.  

Evidence Rating Level: 2 (Good)

Study Rundown: In an effort to reduce tobacco use, Canada has implemented high taxes on tobacco products to provide an economic incentive to quitting. As an unintended consequence this has led to a significant increase in the unlawful sale and use of contraband cigarettes, estimated at 42% of the market in Ontario in 2008. Researchers used a telephone survey to identify 2786 individuals who self-reported as smokers to determine what differences exist between premium and contraband smokers and whether type of tobacco purchase affects smoking cessation intentions.

Based on responses, the contraband smokers were significantly less likely to have an intention to quit smoking or have attempted to quit. During one year follow-up calls with respondents who expressed an interest in quitting, only 8% of contraband smokers had actually followed through with a 30-day cessation, compared to 17.8% of premium cigarette smokers. Researchers also found that contraband tobacco was highly correlated to heavy smoking, history of smoking, and perceived addiction.

This study is somewhat limited by the size of the contraband sample which was only 365 of the total 2786. Furthermore, self-reporting may be limited because of the legality of the admission.

Click to read the study in Canadian Medical Association Journal

In-Depth [population cohort study]: Researchers used chi-squared and multivariable regression models adjusted for covariates to analyze the responses and identify associations in the data. Based on this analysis one of the main variables that differentiated contraband smokers from premium smokers was how heavy of a smoker they were based on the Smoking Index. Only 8.7% of premium smokers were classified as heavy smokers compared to 20.6% in the contraband population (p=0.001). Furthermore, contraband smokers had significantly longer history (31.9 years) as smokers than premium smokers (22.4 years). Lastly, in the contraband population 27.2% of respondents indicated an intention to quit compared to 40.3% in the premium population (p=0.001) indicating the preparation level for taking action on smoking cessation. Surprisingly, socioeconomic status was not strongly correlated to either premium or contraband smoking.

This study feeds into research looking at the intersection of public health, policy, and economics. More research in this field will continue to inform how public health is engaged on a macro level by government and authorities.

By Jordan Anderson and Andrew Bishara

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