title: Illicit cigarettes and hand-rolled tobacco in 18 European countries: a cross-sectional survey.
abstract: OBJECTIVE
  Little evidence, other than that commissioned by the tobacco industry, exists on the size of the illicit tobacco trade. This study addresses this gap by examining the level and nature of illicit cigarettes and hand-rolled tobacco in 18 European countries.
  
  
  METHODS
  Face-to-face cross-sectional survey on smoking.
  
  
  METHODS
  18 European countries.
  
  
  METHODS
  For each country, around 1000 subjects representative of the population aged 15 and over were enrolled. Current cigarette smokers were asked to show their latest purchased pack of cigarettes or hand-rolled tobacco.
  
  
  METHODS
  A comprehensive measure called an Identification of an Illicit Pack (IIP) was used to study the extent of illicit trade, defining a pack as illicit if it had at least one of the following tax evasion indicators: (1) it was bought from illicit sources, as reported by smokers, (2) it had an inappropriate tax stamp, (3) it had an inappropriate health warning or (4) its price was substantially below the known price in their market.
  
  
  RESULTS
  Overall, the proportion of illicit packs was 6.5%. The highest prevalence of IIP was observed in Latvia (37.8%). Illicit packs were more frequent among less educated smokers and among those living in a country which shared a land or sea border with Ukraine, Russia, Moldova or Belarus. No significant association was found with price of cigarettes.
  
  
  CONCLUSIONS
  This study indicates that IIP is less than 7% in Europe and suggests that the supply of illicit tobacco, rather than its price, is a key factor contributing to tax evasion.
authors.affiliation: Association of European Cancer Leagues, Foundation against Cancer, Brussels, Belgium.
authors.forename: Luk
authors.initials: L
authors.lastname: Joossens
authors.affiliation: Department of Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Lugo
authors.affiliation: Department of Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: La Vecchia
authors.affiliation: Department for Health, University of Bath, Bath, UK.
authors.forename: Anna B
authors.initials: AB
authors.lastname: Gilmore
authors.affiliation: TobaccoFree Research Institute Ireland, Dublin, Ireland.
authors.forename: Luke
authors.initials: L
authors.lastname: Clancy
authors.affiliation: Department of Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy.
authors.forename: Silvano
authors.initials: S
authors.lastname: Gallus
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003132:Commerce / Q000191:economics / Q000331:legislation & jurisprudence; D003415:Crime / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D003625:Data Collection; D005060:Europe; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012907:Smoking / Q000191:economics* / Q000331:legislation & jurisprudence; D013660:Taxes / Q000191:economics*; D019460:Tobacco Industry / Q000191:economics; D062789:Tobacco Products / Q000191:economics / Q000600:supply & distribution*; D055815:Young Adult