Improving estimates of the illicit cigarette trade through collaboration: lessons from two studies of Malaysia.

This paper critically analyses contrasting estimates of Malaysia's illicit cigarette trade in 2011, 2015 and 2019 by Bui et al and Koya et al who previously produced independent estimates at about the same time using tax gap analysis. Collaboration between the two authors' teams emerged due to the discrepancies in their results, generating this paper to explore the methodological issues identified and hence produce revised estimates of the rate of illicit. Key issues identified were: Bui et al's assessment of legally imported cigarettes impacting all years; their exclusion of ad valorem duty affecting the 2011 and 2015 estimates; Koya et al overlooked the value of cigarettes for export market in their ad valorem calculation and used the sales value of imported tobacco/tobacco products, not just cigarettes, both of which impact estimates for 2011 and 2015. Recalculations using Koya et al's consumption data reveal that in 2019, illicit cigarettes accounted for about 70% of the market, which is higher than Bui et al's estimate (38%) but slightly lower than Koya et al's (72%). For 2011 and 2015 where ad valorem applied, the corrected estimates show a share of the illicit cigarette market of approximately 41.1% and 52.7%, respectively, differing from Bui et al's 0% in 2011 and 29.6% in 2015, and Koya et al's 51% in 2011 and 55% in 2015. This paper provides essential lessons for addressing methodological issues between authors' teams and updated estimates of Malaysia's illicit cigarette trade, verifying that Malaysia faces a substantial illicit cigarette trade problem.

Smoking prevention that increases tax revenue: tobacco taxes in the Czech Republic 2004-2020.

OBJECTIVES: Increasing tobacco excise tax is one of the most effective smoking-prevention tools. The aim of the study is to assess the use of this tool in the Czech Republic (CR) by studying trends in cigarette taxes, prices, tax revenue, and the affordability of cigarettes in the CR. METHODS: Data on cigarette consumption, their tax rates, price, and tax revenue in the CR for 2004-2020 come from multiple sources. We used the consumer price index to convert nominal values to real values. Given an average daily consumption of 12.7 cigarettes per smoker, the affordability of cigarettes was measured as a percentage of the average monthly wage needed to buy 19 cigarette packs. RESULTS: Despite recent increases in excise taxes, cigarettes in the CR are becoming more affordable. We found that the affordability of cigarettes was greater in 2020 than in 2008. The values of both the specific and the minimum excise taxes are currently being eroded by inflation. Cigarette consumption has declined from 2015 to 2020, and the government still received a bit more excise tax revenue due to its earlier tax policy. However, if taxes are not increased further, the revenue will start to decline. CONCLUSIONS: Despite the trend of increasing tobacco taxes in the CR, both the affordability of cigarettes and their use are still high in the country. This means that the CR is not using tax policy effectively enough to reduce smoking prevalence. It needs a substantial and sudden tax increase, in addition to the currently planned tax increases, to reduce smoking prevalence and lower the burden of tobacco use in the economy. Such a move would not only improve public health in the CR, but also increase government revenue.

An overlooked market: loose cigarettes, informal vendors and their implications for tobacco taxation.

OBJECTIVE: To examine the features of markets for loose cigarettes in several low-income and middle-income countries and their effects on tobacco control policies, particularly taxation. DESIGN: An analysis of survey data targeting people who smoke in two African, one Southeast Asian and two South Asian countries and retailers across 16 African countries to study loose cigarette markets and examine how prices in these markets move relative to the prices for cigarette packs. RESULTS: Markets for loose cigarettes are large, and their consumer base tends to differ from the wider population of people who smoke. Loose cigarette prices are on average higher than those of cigarettes bought in packs, and they respond differently to tax increases, at least partially due to a denomination effect. CONCLUSIONS: The features of the loose cigarette markets present a challenge for tobacco control policy, especially tobacco tax policy. One way to overcome this challenge is to aim for large, rather than incremental, tax increases.

Response of legal and illegal cigarette prices to a tax increase in Ethiopia.

BACKGROUND: In 2020, Ethiopia passed a landmark tax proclamation implementing an evidence-based mixed excise system aimed at curbing tobacco use. This study evaluates the impact of the tax increase of more than 600% on both legal and illegal cigarette prices in order to gauge the impact of the tax reform in the presence of a sizeable illicit cigarette market. METHODS: Data on 1774 cigarette prices were obtained from retailers during Empty Cigarette Pack Surveys in the capital and major regional cities conducted in 2018 and 2022. Packs were categorised as 'legal' or 'illicit' using criteria from the tobacco control directives. Descriptive and regression analyses were used to study the cigarette price changes during the period of 2018-2022, capturing the impact of the 2020 tax increase. RESULT: Prices of both legal and illegal cigarettes increased in response to the tax increase. In 2018, the stick prices ranged from ETB0.88 (Ethiopian birr) to ETB5.00 for legal cigarettes while they ranged from ETB0.75 to ETB3.25 for illegal ones. In 2022, a legal stick sold for ETB01.50-ETB2.73 and an illegal stick for ETB1.92-ETB8.00. The average real price of legal and illegal brands increased by 18% and 37%, respectively. The multivariate analysis confirms that prices of illicit cigarettes grew faster compared with the legal ones. By 2022, illicit brands were on average more expensive compared with their legal counterparts. This result is statistically significant at p<0.01. CONCLUSION: The prices of both legal and illegal cigarettes increased following the 2020 tax increase, with the average real cigarette price increasing by 24%. As a result, the tax increase likely had a positive impact on public health despite a sizeable illicit cigarette market.

Extent of illicit cigarette market from single stick sales in Ghana: findings from a cross-sectional survey.

OBJECTIVE: This study aims to measure the extent of illicit cigarette consumption from single stick sales, to determine the nature and types of illicit cigarettes present in Ghana, and to identify the factors associated with illicit cigarette consumption in Ghana. DESIGN: A cross-sectional study using empty cigarette packs generated by 1 day's single stick cigarette sales collected from cigarette vendors. SETTING: Five large cities (Accra, Kumasi, Takoradi, Tamale and Bolgatanga) and three border towns (Aflao, Paga/Hamele and Elubo) in the northern, middle and coastal belt of Ghana. PROCEDURE AND PARTICIPANTS: Ten areas were randomly selected in each city/town, and all shops selling cigarettes within 1 km of the central point were surveyed. OUTCOME MEASURES: (1) Estimates of the share of illicit cigarette packs in the total cigarette sales from vendors selling single stick cigarettes in Ghana; (2) nature and types of illicit cigarette packs; (3) factors associated with illicit cigarette sales in Ghana. RESULTS: Of a total of 4461 packs, about 20% (95% CI 18.3 to 20.7) were found to be illicit. Aflao (Ghana-Togo border) and Tamale (Ghana-Burkina Faso border) had the highest percentage of illicit cigarette sales at 99% and 46%, respectively (p<0.001). Over half of the illicit packs originated from Togo (51%), followed by Nigeria (15%) and then Cote d'Ivoire (10%). Adjusted and unadjusted logistic regression models indicated that convenience stores, border towns, pack price and the northern zone had higher odds of illicit cigarette sales. CONCLUSION: To effectively tackle illicit cigarettes, market surveillance and strengthening supply chain control are required, particularly at the border towns and the northern region of the country.

Estimating the Size of Illicit Tobacco Market in Lithuania: Results from the Discarded Pack Collection Method.

INTRODUCTION: For decades in Lithuania, the threat of illicit trade has been used to weaken evidence-based tobacco-control policies and to undermine efforts to reduce smoking prevalence and its attributable burden, while also depriving the government of much-needed tax revenue. The aim of this study is to estimate the size of the illicit cigarette market in Lithuania using data from a nationally representative discarded pack collection. AIMS AND METHODS: The study employed a two-stage cluster design by first randomly selecting 65 well-defined population settlements (30 cities and 35 townships), representing both urban and rural areas, in all 10 counties in Lithuania. Next, we randomly selected 358 polling districts within these settlements. Each polling district had one route along which discarded packs were collected between September 2019 and 2020. RESULTS: In total, 28.9% (95% CIs = 27.7 to 30.1) of discarded cigarette packs were classified as illicit. The vast majority (90.1%) of illicit packs originated from Belarus with most (86.9%) packs produced in the Grodno Tobacco Factory Neman. Tax stamps were present on 93.6% of legal packs and also on 76% of illegal packs. CONCLUSIONS: Data from this study suggest that the illicit cigarette trade in Lithuania is more widespread than indicated by other methods and primarily supplied by the neighboring Belarus state-owned tobacco factory in Grodno. This signals the need to adopt Belarus-specific border control and security measures. IMPLICATIONS: This study presents data from the first national industry-independent study on illicit tobacco trade in Lithuania using discarded cigarette pack collection method. As customs seizure data show, our results also indicate that the illicit cigarette market is primarily supplied by Belarus state-owned Grodno Tobacco Factory Neman known for filling Europe with cheap cigarettes. An estimate derived from this study is higher than both the industry-independent estimate obtained by the survey method and the estimates offered by the tobacco industry. This adds to the evidence that the difference in estimates obtained by different methods reflects the strengths and weaknesses of each. The study also demonstrates the impact of a rogue neighbor on the illicit market in an adjacent country and offers suggestions on how to address it.

Tobacco industry compliance with the EU track and tracing system in Lithuania.

BACKGROUND: The European Union (EU)-wide tobacco tracking and tracing system (T&T system) became operational on 20 May 2019, allowing a transitional period and gradual installation of the system until May 2020. This study attempts to assess the EU T&T system using a sample of discarded cigarette packs collected in Lithuania. METHODS: The empty pack survey was conducted between September 2019 and September 2020, covering both the transitional period and the period of full implementation. The study employed a two-stage cluster design by first randomly selecting 65 well-defined population clusters (30 cities and 35 towns) representing both urban and rural areas in all 10 counties in Lithuania. Second, we randomly selected 358 polling districts (routes) in each cluster. RESULTS: The fieldworkers walked at least 1074 km and collected 5727 discarded empty cigarette packs. None of the packs found during the EU T&T transitional period had a unique identifier (UI). After the full implementation of the EU T&T system, 32.0% of the collected packs were still without a UI. 5.8% of licit packs were without a UI after the May 2020 deadline. Most of the legal non-compliant packs (131, or 69.7%) were intended for the Lithuanian market. Close to 85% of packs that had duty-free markings were non-compliant. CONCLUSION: The tobacco industry most likely disregarded the EU T&T transitional period as no packs with UIs were found up until the full implementation. Packs without UIs were still found 4 months after the full implementation of the EU T&T system.

Analysis of the illicit tobacco market in Georgia in response to fiscal and non-fiscal tobacco control measures.

BACKGROUND: Georgian illicit cigarette consumption was 1.5% in 2017. In 2018, a new tobacco control law took effect followed by a substantial cigarette excise tax increase in 2019. Research shows these policies reduce tobacco consumption, but the tobacco industry argues they increase illicit trade. There is limited evidence on this, particularly from developing countries. METHODS: A panel household survey in Georgia obtained data over three waves: 2017 baseline, 2018 after the tobacco control law took effect and 2019 after taxes increased. A sample of 1578 smokers (and quitters in later waves) from five regions reported their tobacco use and were asked to present a cigarette pack in their possession. These were examined for tax stamps and health warnings to establish legality. FINDINGS: There was no evidence of an increase in illicit cigarette consumption in Tbilisi, Kutaisi, Akhaltsikhe or Gori in any wave. In Zugdidi, near the Russian-occupied Abkhazia, illicit cigarette consumption was increasing even prior to the tax increase, reaching 30.9% by wave 3. A country-wide shift occurred from manufactured cigarettes to roll-your-own tobacco (whose tax remained unchanged) between waves 2 and 3. CONCLUSION: No evidence of a country-wide increase in illicit cigarette trade was found after non-fiscal tobacco measures took effect and cigarette taxes increased. Relatively high illicit cigarette consumption in Zugdidi highlights the role of disputed territories and border administration in illicit cigarette supply. Substitution towards roll-your-own tobacco after manufactured cigarette taxes increased demonstrates the importance of equalising taxes on tobacco products to maximise public health benefits.

Magnitude of illicit cigarette trade in Malaysia: empirical evidence compared with industry studies.

BACKGROUND: The tobacco industry contends that the illicit market in Malaysia occupies 62.3% of the total cigarette market. If this is true, Malaysia has one of the largest shares of illicit cigarettes in the world. METHODS: This study employs a rigorous gap analysis to measure the size of the illicit cigarette trade in Malaysia and compare it with the industry estimates. FINDINGS: We found that in 2019, the illicit cigarette market share ranged from 38.2% to 52.5%, depending on assumptions with respect to consumption under-reporting, which is substantially less than the industry estimates. We found that the size of the illicit cigarette market was not driven by higher excise tax: doubling the excise tax rate from RM0.20 to RM0.40 per stick in November 2015 resulted in only a slight increase in the illicit cigarette market share and no increase in the number of illicit cigarettes in the market. CONCLUSIONS: Therefore, a reduction in cigarette excise taxes, as suggested by the industry, will not solve the problem of illicit cigarette trade in Malaysia. Instead, the government should ratify the Framework Convention on Tobacco Control's Protocol to Eliminate Illicit Trade in Tobacco Products and implement the strategies outlined in the protocol.

How much to pay for a track and trace system: a simulation model for South Africa.

BACKGROUND: The illicit trade in tobacco reduces the effectiveness of tobacco-control policies. Independent track and trace (T&T) systems are considered one of the most effective measures available to reduce the illicit tobacco trade. South Africa, with an illicit trade estimated at over 35% of the total market, is yet to implement a T&T system. METHODS: An Excel-based simulation model is used to determine the break-even T&T marker cost per pack. At the break-even cost per pack, the government would recover all costs associated with implementing T&T by collecting additional revenues. We conduct a scenario analysis to provide a range of break-even marker costs. FINDINGS: A marker cost of between R2.68 (US$0.17) and R5.24 (US$0.34) per pack allows the South African government to collect enough additional revenue to recover all costs associated with T&T. Implementing such a system would reduce cigarette consumption by between 5% and 11.5%. Given that comparable systems cost significantly less than this range (roughly US$0.02 per pack), the government would in all likelihood be able to implement a system at a cost below the break-even rate, thus generating additional revenue. CONCLUSION: The break-even simulation model provides a practical tool for the government to plan the implementation of T&T and to set up an evaluation criteria for the T&T tender process. The simulations illustrate that implementing T&T in South Africa would both reduce consumption (licit and illicit) and generate additional revenue. With some modifications, the model can be applied to other countries as well.

Cigarette Prices and Smoking Experimentation in Sierra Leone: An Exploratory Study.

This study examines the effect of cigarette prices on the likelihood of experimental smoking among adolescents in Sierra Leone. The study links data from the 2017 Global Youth Tobacco Survey (GYTS) to price data covering 2008-2017 obtained from the World Health Organization (WHO). After employing duration analysis techniques, we find that increases in cigarette prices are associated with a lower probability of smoking experimentation, with an estimated price elasticity of -1.63 (CI: -.24 to -3.02). Other factors affecting an adolescent's decision to experiment with smoking are parental and friends' smoking status, gender, exposure to tobacco advertising, and income. We conclude that higher prices, through excise taxation, are important tools for controlling smoking uptake among the youth of Sierra Leone.

Effect of relative income price on smoking initiation among adolescents in Ghana: evidence from pseudo-longitudinal data.

OBJECTIVE: Many smokers initiate smoking during adolescence. Making tobacco products less affordable is one of the best ways to control tobacco use. Studies on the effect of relative income price (RIP (ie, affordability)) of cigarettes on smoking initiation are scarce in low-income and middle-income countries, especially in Sub-Saharan Africa where data are limited. The goal of this study is to examine the effect of cigarette RIP on adolescent smoking initiation in Ghana. SETTING: The study uses a pseudo-longitudinal data set constructed from the Global Youth Tobacco Surveys (GYTS (2000-2009 and 2017)) and RIP for the most sold cigarette brand in Ghana. PARTICIPANTS: The GYTS is a national survey on adolescents. PRIMARY AND SECONDARY OUTCOME: Effect of RIP on adolescent smoking initiation in Ghana. RESULTS: Using the GYTS 2000-2009 data, we find that the probability of smoking initiation falls significantly in response to a higher RIP, with an elasticity of -0.372 (95% CI -0.701 to -0.042) for the unmatched sample and -0.490 (95% CI -0.818 to -0.161) for the matched sample. The RIP elasticity for women ((-0.888) (95% CI -1.384 to -0.392) and (-0.928) (95% CI -1.434 to -0.422)) is statistically significant at 1% in both the unmatched and the matched samples, respectively, while the RIP elasticity for men is statistically insignificant in the 2000-2009 surveys. Analysis of the 2017 GYTS shows a similar outcome: a negative relationship between RIP and smoking initiation, and the results are statistically significant for both men and women, and for both matched and unmatched samples. CONCLUSION: The affordability (RIP) of cigarettes is negatively related to the probability of smoking initiation among adolescents in Ghana. Raising tobacco taxes in line with income growth would make cigarettes less affordable and dissuade adolescents from initiating smoking.

Is Illicit Cigarette Market a Threat to Tobacco Control in Ethiopia?

INTRODUCTION: The presence of an illicit cigarette trade is used as an argument in Ethiopia to halt pro-health tobacco tax policies. The National Tobacco Enterprise (NTE) recently reported that the illicit cigarette market accounts for over 61% of the total market, and over 90% in the Eastern part of Ethiopia. AIMS AND METHODS: The aim of the study is to estimate the magnitude of the illicit cigarette trade in Ethiopia. We employed a cross-sectional observational study of empty packs collected in Ethiopia from retailers and from the streets in 10 towns, representing 10 regional states, and two autonomous cities. RESULTS: The majority (80.1%) of the 6438 empty cigarette packs collected (5368 from the streets and 1070 from retailers) belonged to locally produced brands, while the remaining 19.9% were foreign packs, including those allowed to trade in Ethiopia. Overall, 18.9% of the collected empty packs were classified as illicit. However, the share of illicit cigarette packs varied considerably across the country with as many as 97.7% of the packs collected near the Eastern border being illicit. Since the smoking prevalence is significantly higher in that part of Ethiopia, the weighted estimate of illicit cigarette market reached 45.4%. CONCLUSIONS: To address this alarming situation, Ethiopia should adopt technologies such as a track and trace system to control its cigarette supply chain, because cigarette packs currently bear no indication that the proper tax was paid. In addition, law enforcement and border security need to be strengthened, especially in the East. IMPLICATIONS: This is the first study to estimate the magnitude of the illicit cigarette trade in Ethiopia. It shows that the illicit cigarette trade is low in most parts of the country, but points to some problematic areas near the border with Somalia where illicit cigarette prevalence and overall smoking prevalence are high. We propose a solution to control illicit cigarette trade in Ethiopia that the whole region would benefit from.

Illicit cigarette trade in the cities of Pakistan: comparing findings between the consumer and waste recycle store surveys.

BACKGROUND: Concerns about the magnitude of illicit cigarette trade have prevented the Government of Pakistan from increasing tobacco taxes. We estimated the proportion of illicit cigarettes sold in Pakistani cities. Moreover, we compared two methods for collecting cigarette packs and investigated if the illicit cigarette trade equates to tax evasion. METHOD: We analysed cigarette packs collected from 10 cities of Pakistan using two methods: consumer survey based on a two-stage random sampling strategy to recruit adult smokers and photograph their cigarette packs and waste recycle store survey to purchase used cigarette packs. Cigarettes were considered illicit if any one of the following was absent from their packs: text and pictorial health warning, underage sale prohibition warning, retail price and manufacturer's name. From the consumer survey, we also estimated the proportion of smokers who purchased loose cigarettes (illegal) and packs below the minimum retail price. Taxation officers (n=4) were consulted to assess their level of confidence in judging tax evasion using the above criteria. RESULTS: Out of 2416 cigarette packs in the consumer survey, 454 (17.8%; 95% CI 15.4% to 20.2%) were illicit. Similarly, out of 6213 packs from waste recycle shops, 1046 (16.8%; 95% CI 15.9% to 17.7%) were illicit; the difference was not statistically significant (p=0.473). Among consumers, 29.5% bought loose cigarettes and 13.8% paid less than the minimum retail price. The taxation officers considered the manufacturer's name and retail price on cigarette packs as the most relevant criteria to detect tax evasion. CONCLUSIONS: One in six cigarette packs consumed in Pakistan could be illicit. These figures are far less than those propagated by the tobacco industry. Collecting packs from waste recycle stores is an efficient and valid method to estimate illicit cigarette trade.

Analysing the trend of illicit tobacco in the Philippines from 1998 to 2018.

Tobacco taxation is the most effective measure to reduce cigarette consumption and consequently improve public health outcomes. It is also an important source of government revenue. The presence of an illicit tobacco market diminishes the public health and fiscal gains of cigarette levies by making cheaper non-taxed cigarettes available. To date, the research on the extent of illicit tobacco trade in the Philippines, despite its potential to inform policies for controlling the supply of illicit cigarettes, has been limited. This study provides an estimate of the size of the illicit tobacco market in the Philippines from 1998 to 2018. It employs gap analysis comparing an estimate of the survey-based adult cigarette consumption with legally sold cigarettes in the Philippines. The illicit trade estimates are contrasted with the evolution of tax changes. The results show that the illicit cigarette market share dropped by 42% from 2003 to 2008 and by an additional 79% from 2008 to 2013. In spite of the large tax increases by the Philippine government through the Sin Tax Law starting from 2013 until 2018, the illicit share in 2018 remains similar to its 1998 level of 16% of the total market. Hence, our study finds no evidence of a positive relationship between tobacco taxes and size of illicit cigarette market in the Philippines.

Measuring the illicit cigarette market in the absence of pack security features: a case study of South Africa.

There are several ways to measure the illicit cigarette market. In South Africa, different methods were used to triangulate results. The aim of this paper is to assist researchers to decide which method is most suitable to their context, especially for countries that do not have security features on cigarette packs (eg, tax stamps). We analysed the methods and results from three published articles that used various approaches to measure cigarette illicit trade in South Africa: (1) gap analysis, (2) price threshold method using secondary data from a national survey, and (3) price threshold method using primary data collected in low socioeconomic areas. We provide methodological insights and background information. We discuss the advantages and disadvantages of each method. The method chosen by researchers will depend on data availability, the existence or absence of security features on cigarette packs and funding. Researchers investigating illicit trade should use more than one method to increase confidence in the obtained results.

Effect of cigarette prices on cigarette consumption in Ghana.

Introduction: Noncommunicable diseases are on the rise globally, with tobacco consumption being a major risk factor. Reducing tobacco consumption is an important step towards reducing the incidence and prevalence of many noncommunicable diseases. Tax and price measures have been proposed as tobacco control tools. This study investigated the link between cigarette prices and cigarette consumption in Ghana. Methods: Annual time series data for the period 1980-2016 were used. The data came from diverse sources, including WHO, World Bank, and tobacco industry documents. Dynamic Ordinary Least Squares (DOLS), cointegration techniques, and three-stage least squares (3SLS) were used to analyze the data. Results: After controlling for education, income, and population growth, we estimated that the price elasticity of cigarette demand is between -0.35 and -0.52 and statistically significant at 1% level. In the short run, the price elasticity is -0.1. Another variable that significantly reduced cigarette consumption during the period was education, with an elasticity between -1.7 and -2.7. Conclusion: Cigarette demand in Ghana is influenced by cigarette prices and education. We conclude that tobacco taxes that significantly raise retail prices of cigarettes and higher education (including health education) will help reduce cigarette consumption.

The Economic Cost of Smoking in South Africa, 2016.

INTRODUCTION: Chronic, noncommunicable diseases are on the rise globally, with tobacco consumption being an important contributing risk factor. These increases result in significant economic costs due to increased healthcare costs, productive lives lost, and productive days lost due to illness. Estimates of these economic costs are scarce in low- and middle-income countries. METHODS: Drawing on a diverse range of data sources, direct healthcare costs, and productivity losses due to illness and premature deaths were estimated using the cost-of-illness approach. The present value of lifetime earnings was used to estimate productivity losses from premature deaths. RESULTS: We estimate that 25 708 deaths among persons aged 35-74 in 2016 are smoking-attributable. The economic cost of smoking was R42 billion (US$2.88 billion), of which R14.48 billion was for healthcare costs (hospitalization and outpatient department visits). The economic cost of smoking amounted to 0.97% of the South African GDP in 2016, while the healthcare cost of smoking-related diseases was 4.1% of total South African health expenditure. The costs are lower for women because of their lower smoking prevalence. CONCLUSION: The economic burden of smoking calls for a further scaling-up of tobacco-control interventions in South Africa. IMPLICATIONS: This article addresses the paucity of research on the detailed economic costs of smoking in low-and middle-income countries, including South Africa. Our calculations, based on an extensive range of recent data, provide the most detailed estimate to date and include quantification of the direct and indirect costs of smoking in South Africa. We found that the magnitude of the costs related to smoking in South Africa is larger than in the previous estimates and that for every Rand received in the form of cigarette tax, society loses 3.43 Rands. This article provides an economic case for evidence-based tobacco control in South Africa.

Estimating the Magnitude of Illicit Cigarette Trade in Bangladesh: Protocol for a Mixed-Methods Study.

The illicit tobacco trade undermines the effectiveness of tobacco tax policies; increases the availability of cheap cigarettes, which, in turn, increases tobacco use and tobacco related deaths; and causes huge revenue losses to governments. There is limited evidence on the extent of illicit tobacco trade particularly cigarettes in Bangladesh. The paper presents the protocol for a mixed-methods study to estimate the extent of illicit cigarette trade in Bangladesh. The study will address three research questions: (a) What proportion of cigarettes sold as retail are illicit? (b) What are the common types of tax avoidance and tax evasion? (c) Can pack examination from the trash recycle market be considered as a new method to assess illicit trade in comparison to that from retailers and streets? Following an observational research method, data will be collected utilizing empty cigarette packs from three sources: (a) retailers; (b) streets; and (c) trash recycle market. In addition, a structured questionnaire will be used to collect information from retailers selling cigarettes. We will select post codes as Primary Sampling Unit (PSU) using a multi-stage random sampling technique. We will randomly select eight districts from eight divisions stratified by those with land border and non-land border; and within each district, we will randomly select ten postcodes, stratified by rural (five) and urban (five) PSU to ensure maximum geographical variation, leading to a total of eighty post codes from eight districts. The analysis will report the proportions of packs that do not comply with the study definition of illicit. Independent estimates of illicit tobacco are rare in low- and middle-income countries such as Bangladesh. Findings will inform efforts by revenue authorities and others to address the effects of illicit trade and counter tobacco industry claims.