Availability and use of cheap tobacco in the United Kingdom 2002-2014: Findings from the International Tobacco Control Project

Introduction
Raising tobacco prices is the most effective population-level intervention for reducing smoking, but this is undermined by the availability of cheap tobacco. This study monitors trends in cheap tobacco use among adult smokers in the UK between 2002-2014 via changes in product type, purchase source, and prices paid.
Methods
Weighted data from 10 waves of the International Tobacco Control policy evaluation study were used. This is a longitudinal cohort study of adult smokers with replenishment; 6169 participants provided 15812 responses. Analyses contrasted 1) product type: roll-your-own (RYO) tobacco, factory made packs (FM-P), and cartons (FM-C); 2) purchase source: UK store-based sources (e.g. supermarkets, convenience stores) with non-UK/ non-store sources representing tax avoidance/ evasion (e.g. outside the UK, duty free, informal sellers); and 3) prices paid (inflation-adjusted to 2014 values). Generalised Estimating Equations tested linear changes over time.
Results
1) RYO use increased significantly over time as FM decreased. 2) UK store-based sources constituted approximately 80% of purchases over time, with no significant increases in tax avoidance/ evasion. 3) Median RYO prices were less than half that of FM, with FM-C cheaper than FM-P. Non-UK/ non-store sources were cheapest. Price increases of all three product types from UK store-based sources from 2002 - 2014 were statistically significant, but not substantial. Wide (and increasing for FM-P) price ranges meant each product type could be purchased in 2014 at prices below their 2002 medians from UK store-based sources.
Conclusions
Options exist driving UK smokers to minimise their tobacco expenditure; smokers do so largely by purchasing cheap tobacco products from UK stores.