Trends in cross-border and illicit tobacco purchases among people who smoke in England, 2019-2022

Abstract

Objectives: The last 5 years have seen substantial changes in England's social and economic landscape as a result of Brexit, the COVID-19 pandemic and cost of living crisis. We aimed to examine changes in cross-border and illicit tobacco purchasing over this period.

Design: Nationally representative monthly cross-sectional survey.

Setting: England, 2019-2022.

Participants: 11 232 adults (≥18 years) who smoked in the past year.

Main outcome measures: We estimated time trends in the proportion reporting purchasing tobacco from (1) cross-border and (2) illicit sources in the past 6 months.

Results: Between February 2019 and October 2022, there was a non-linear increase in the proportion of participants reporting cross-border tobacco purchases (from 5.2% to 16.1% overall; prevalence ratio (PR)=3.10, 95% CI 2.03-4.73). Prevalence first increased from 5.2% to 15.4% between February 2019 and April 2020, before falling to 7.8% between April 2020 and September 2021 during the COVID-19 pandemic, and then increasing again to 16.1% by the end of the period. Changes in cross-border tobacco purchasing were more pronounced among participants from more advantaged (from 6.6% to 23.3%; PR=3.52, 95% CI 2.05-5.91) compared with less advantaged (4.4% to 11.5%; PR=2.61, 95% CI 1.17-5.20) social grades (p_interaction=0.034). There was no overall change in the proportion reporting illicit tobacco purchases (from 9.2% to 8.5%; PR=0.92, 95% CI 0.70-1.21), nor any significant difference in trends by social grade (p_interaction=0.783).

Conclusions: Despite a fall in cross-border tobacco purchasing during the first year of the COVID-19 pandemic among adults in England who smoke, the proportion reporting cross-border tobacco purchases is now three times higher than it was at the start of 2019. The proportion reporting illicit tobacco purchases has not changed substantially.

Keywords: Cessation; Illegal tobacco products; Socioeconomic status; Surveillance and monitoring.

Figure 1. Percentage of adults in England who smoked in the past year and who reported purchasing cross-border and illicit tobacco, February 2019 to October 2022. Data are presented for all adults who smoked in the past year (A, C) and by social grade (B, D). Lines represent point estimates from logistic regression with survey month modelled non-linearly using restricted cubic splines (with four knots for cross-border tobacco and three knots for illicit tobacco; see online supplemental material for details of model selection). Shaded areas represent SEs. Points represent raw weighted prevalence by quarter (see online supplemental material for figures showing raw weighted prevalence by month).