Trends in cross-border and illicit tobacco purchases and associations with motivation to stop smoking and quit attempts: a representative survey of smokers in England, 2019-2022

ObjectivesThe last five years have seen substantial changes in Englands 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, and associations with quitting activity, over this period. DesignNationally-representative monthly cross-sectional survey. SettingEngland, 2019-2022. Participants11,232 adult ([≥]18y) past-year smokers. Main outcome measuresWe estimated time trends in the proportion of smokers reporting purchasing tobacco from (i) cross-border and (ii) illicit sources in the past 6 months, and examined associations with motivation to stop smoking (among current smokers) and past-year quit attempts (among past-year smokers). ResultsBetween February 2019 and October 2022, there was a non-linear increase in the proportion of smokers reporting purchasing cross-border tobacco (from 5.2% to 16.1%; PR=3.10, 95%CI=2.03-4.73) but no overall change in the proportion reporting purchasing illicit tobacco (from 9.2% to 8.5%; PR=0.92, 95%CI=0.70-1.21). Both cross-border (ORadj=0.65, 95%CI=0.56-0.77) and illicit (ORadj=0.74, 95%CI=0.63-0.86) tobacco purchasing were associated with lower odds of reporting a recent quit attempt. Smokers who purchased cross-border tobacco also reported lower motivation to stop smoking (ORadj=0.84, 95%CI=0.75-0.95). ConclusionsDespite a fall in cross-border tobacco purchasing during the first year of the Covid-19 pandemic, the proportion of smokers in England reporting purchasing cross-border tobacco is now three times higher than it was at the start of 2019. The proportion reporting purchasing illicit tobacco has not changed substantially. Tackling the increasing use of cheap tobacco in England may be an important target for motivating quit attempts. What this paper addsO_ST_ABSWhat is already known on this topicC_ST_ABSTobacco tax avoidance and evasion strategies, such as buying tobacco cheaply from cross-border or illicit sources, undermine the effectiveness of tax policy. What this study addsSince February 2019, the proportion of smokers in England reporting purchasing cross-border tobacco has tripled, while the proportion reporting purchasing illicit tobacco remains similar. Smokers who use cheap tobacco are less likely to try to quit. How this study might affect research, practice or policyPolicy measures that reduce smokers access to these cheaper sources of tobacco could help to increase the rate of quit attempts among smokers and accelerate progress toward the governments smokefree 2030 target.