Magnitude, structure and associated factors of illicit cigarette sales in Bangladesh:a pack analysis

INTRODUCTION: Bangladesh's cigarette smoking prevalence remained unchanged (around 14%) between 2009 and 2017. Through tax evasion and regulatory non-compliance, illicit trade might have contributed to the status quo. Little is known about the magnitude of illicit cigarettes in Bangladesh. METHODS: We analysed empty cigarette packs collected from retailers and street litter in eight districts in Bangladesh between December 2019 and January 2020. We examined tax stamps on packs to assess tax evasion and printed health warnings, retail prices, sales declarations, misleading descriptors, and duty-free signs to determine packaging law compliance. All but tax-paid and compliant packs were considered illicit. We examined associations between tax evasion and price or non-price factors. Sensitivity and specificity of packaging compliance were measured when used as a proxy for tax evasion. RESULTS: Among 24 363 cigarette packs examined from sampled districts in Bangladesh (23 207 from shops and 1156 from litter), 5.32% (95% CI: 5.04% to 5.60%) evaded taxes, while only 0.77% (95% CI: 0.4% to 1.4%) were non-compliant with packaging laws, totalling 5.62% (95% CI: 4.3% to 7.1%) illicit share. This neither differed statistically significantly between packs collected from shops (5.47%; 95% CI: 4.2% to 7.0%) and those from litter (8.13%; 95% CI: 5.7% to 11.1%) nor between urban (5.15%; 95% CI: 3.5% to 7.3%) and rural (6.16%; 95% CI: 4.2% to 8.7%) areas. Low-price cigarettes (OR: 3.48; 95% CI: 2.10 to 5.75) and those sold in unconventional shops (OR: 1.99; 95% CI: 1.12 to 3.54) were more likely to be tax evaded than high-price cigarettes and those sold in formal shops, respectively. Packaging non-compliance was not a sensitive marker for detecting tax-evaded cigarettes. CONCLUSIONS: Bangladesh has a low share of illicit cigarette packs. While surveillance of the illicit cigarette trade is essential, the government should continue to enhance cigarette taxes without concern for its effect on the illicit trade.