Smoking low-cost cigarettes: disparities evident.

The availability of low-cost cigarettes undermines tobacco control’s most effective measure to reduce smoking prevalence: keeping cigarette prices high by raising tobacco taxes.1 The discount cigarette market share has grown considerably since 2003,2 with discount cigarettes selling for $10-$15 less per carton than premium brands. Contraband cigarettes – cigarettes sold illegally – are even cheaper than discounts.3 There is an urgent need to understand who is smoking these reduced-price cigarettes. We compiled baseline data from the Ontario Tobacco Survey, a population-based telephone survey of Ontario adults.4 Smokers’ usual brand of cigarettes was categorized as premium, discount or contraband according to a list of discount cigarette brands5 and known contraband cigarettes in Ontario. Differences in the characteristics of premium, discount and contraband cigarette smokers were examined using Chi-square tests and multinomial regression models. Analyses were adjusted for the complex survey design. The proportions of users smoking premium, discount and contraband cigarettes were 60%, 30% and 10%, respectively. Discount cigarette smokers were more likely to be older, female, have made more lifetime quit attempts, and were more addicted to cigarettes compared to premium cigarette smokers (p<0.0001; Table 1); only perceived addiction was not significant in the adjusted model (Table 2). Contraband cigarette smokers were more likely to reside in rural areas, be older, female, have less than high school education, have made more lifetime quit attempts, were more addicted to cigarettes, and had no intention to quit compared to premium smokers (Table 1). Age and perceived addiction were not significant in the adjusted model (Table 2). Compared to discount smokers, contraband cigarette smokers were more likely to reside in rural areas, be more addicted and less likely to intend to quit (Table 2). In Ontario, 40% of smokers are smoking low-cost cigarettes, with 1 in 10 seeking illegal sources of cigarettes. This is significant and reduces the impact of tobacco control interventions in Ontario. While young adults are more sensitive to cigarette price, they are also more susceptible to advertising and branding,6 which may explain why they were less likely to smoke discount brands than older adults. Women were more likely to smoke both discount and contraband cigarettes, consistent with previous research indicating they are more price sensitive than men.7 It was also expected that smokers with greater nicotine addiction smoked cheaper sources of cigarettes, consistent with findings of number of cigarettes smoked from previous studies.7,8 While an earlier study reported that those purchasing low or untaxed sources had higher levels of education,9 we found contraband brand use associated with lower levels of education. There is substantial use of low-cost cigarettes, presenting a challenge for tobacco control in Ontario. Socio-economic disparities are evident among discount and contraband cigarette smokers. Minimum price laws and tax increases can counter the growing discount market; licensing, tax agreements with First Nations com-