No Change in Illicit Tobacco Use Following the Introduction of Standardised Packaging? A Longitudinal Online Survey in the United Kingdom.

Background: The tobacco industry has argued for decades that standardised packaging would lead to an increase in illicit tobacco use, but this is not supported by current evidence. Objective: To explore longer-term associations between standardised packaging and illicit tobacco use. Design: The Adult Tobacco Policy Survey is a longitudinal online survey with people who smoke or who previously smoked aged 16 and older in the United Kingdom (UK), with one wave pre-standardised packaging (2016) and three waves post-standardised packaging (2017, 2019, 2022). Methods: Participants who smoke and who bought cigarettes or roll-your-own (RYO) tobacco were asked where they last bought, and usually buy, cigarettes or RYO tobacco to identify illicit purchasing channels. They were also asked whether they purchased potentially illicit cigarettes or RYO (with no or incorrect Warnings, Smuggled, or Fake (WSF) in the last three months and, if so, how often, why, and price paid. Results: People who smoke were less likely to report buying illicit (WSF) cigarettes or RYO in 2019 (11.2%) and 2022 (11.4%) relative to 2016 (13.2%), although this only remained significant in adjusted models in 2022. For participants that purchased or received any illicit (WSF) tobacco product, low cost, high availability and opportunism were the key reasons for doing so. In comparison, relatively few people who smoke reported 'packs looking nice' as a reason for purchasing illicit tobacco pre- and post-standardised packaging. Conclusion: Evidence from four waves of longitudinal data suggests that there was no increase in illicit tobacco use in the UK following the introduction of standardised packaging.