Trends in cross-border and illicit tobacco purchases among people who smoke in England, 2019–2022

Abstract

ObjectivesThe last 5 years have seen substantial changes in England’s social and economic landscape as a result of Brexit, the COVID-19 pandemic and cost of living crisis. We aimed to examine changes in cross-border and illicit tobacco purchasing over this period.DesignNationally representative monthly cross-sectional survey.SettingEngland, 2019–2022.Participants11 232 adults (≥18 years) who smoked in the past year.Main outcome measuresWe estimated time trends in the proportion reporting purchasing tobacco from (1) cross-border and (2) illicit sources in the past 6 months.ResultsBetween February 2019 and October 2022, there was a non-linear increase in the proportion of participants reporting cross-border tobacco purchases (from 5.2% to 16.1% overall; prevalence ratio (PR)=3.10, 95% CI 2.03–4.73). Prevalence first increased from 5.2% to 15.4% between February 2019 and April 2020, before falling to 7.8% between April 2020 and September 2021 during the COVID-19 pandemic, and then increasing again to 16.1% by the end of the period. Changes in cross-border tobacco purchasing were more pronounced among participants from more advantaged (from 6.6% to 23.3%; PR=3.52, 95% CI 2.05–5.91) compared with less advantaged (4.4% to 11.5%; PR=2.61, 95% CI 1.17–5.20) social grades (pinteraction=0.034). There was no overall change in the proportion reporting illicit tobacco purchases (from 9.2% to 8.5%; PR=0.92, 95% CI 0.70–1.21), nor any significant difference in trends by social grade (pinteraction=0.783).ConclusionsDespite a fall in cross-border tobacco purchasing during the first year of the COVID-19 pandemic among adults in England who smoke, the proportion reporting cross-border tobacco purchases is now three times higher than it was at the start of 2019. The proportion reporting illicit tobacco purchases has not changed substantially.