Prices and Illicit Trade of Cigarettes in the European Union, a Cross-sectional Analysis.

Within the context of the World Health Organization Framework Convention on Tobacco Control Protocol to Eliminate Illicit Trade in Tobacco Products and the impending revision of the EU directive on tobacco excise rules we assessed whether cigarettes price is linked to being offered illicit cigarettes.We combined data being offered illicit cigarettes from the 2015 Special Eurobarometer Survey on Illicit Tobacco (N=27,672) with area-level data on Gross Domestic Product, unemployment, perceived corruption and sharing a border with a non-European Economic Area (non-EEA) state. We used the 2015 Weighted Average Price of cigarettes (WAP), which reflects the average price of a cigarette pack in each member state. We assessed associations between prices and illicit trade using 3-level ordered regression models.19.6% of respondents reported ever being offered illicit cigarettes, 6.4% repeatedly. In fully adjusted models WAP was not associated with being more likely to have been offered illicit market cigarettes more often (adjusted Odds Ratio=1.02, 95% Confidence Interval 0.91; 1.15). Sharing a border with a non-EEA member state was associated with increased likelihood of reporting being offered illicit cigarettes more often (1.73, 1.26;2.39).This study found no significant association between cigarette prices and reporting being offered illicit cigarettes; sharing a border with a non-EEA member state was linked to illicit trade. This study adds to evidence that increasing prices of cigarettes are not associated with illicit trade and that the focus should remain on securing supply chains, including through features such independent traceability systems.After adjusting for individual and regional factors, we did not identify an association between prices of cigarettes and likelihood of reporting being offered illicit cigarettes in the EU. Sharing a border with a non-EEA state however, was associated with increased likelihood of reporting being offered illicit cigarettes more often. This study adds to evidence that increasing taxes and prices of cigarettes are not a driver of illicit trade and that policies should maintain their focus on securing the supply chain.