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Countering the Demand For, and Supply Of, Illicit Research paper Tob Control: first published as 10.1136/tobaccocontrol-2013-050957 on 19 August 2013. Downloaded from Countering the demand for, and supply of, illicit tobacco: an assessment of the ‘North of England Tackling Illicit Tobacco for Better Health’ Programme Ann McNeill,1 Belinda Iringe-Koko,2 Manpreet Bains,3 Linda Bauld,4 Geoffrey Siggens,5 Andrew Russell6 1Addictions Department, ABSTRACT at local, regional, national and international levels. Institute of Psychiatry, UK Background Illicit tobacco (IT) undermines the Those involved in the IT market are often involved Centre for Tobacco Control Studies, King’s College effectiveness of tobacco control strategies. We assessed in other forms of illegal activity as well, with London, London, UK the implementation and impact of a new programme tobacco offering what is often a particularly high 2Department of Epidemiology designed to reduce demand for, as well as supply of, IT, profit, low-risk activity; in some cases, tobacco and Public Health, University in the north of England, where IT was prevalent. smuggling has funded terrorist activity.45The role College London, London, UK Methods ‘Mixed methods’ research was undertaken. of the tobacco multinationals in the illicit market 3Division of Epidemiology and Public Health, University of Qualitative methods included stakeholder interviews (at both internationally and in the UK is also well 67 Nottingham, Nottingham, UK outset and 1 year later) and ethnographic research. documented. Like any other consumer market, 4Socio-Management, University Indicators reflecting those supply and demand issues for IT is driven by both supply and demand factors. of Stirling, UK Centre for which data were available were identified and The illegality of IT makes it difficult to measure. Tobacco Control Studies, ’ fi ’ Stirling, UK monitored, including relevant items on two cross- In the UK, Custom sofcers (Her Majesty s 5NEMS Market Research Ltd, sectional surveys carried out in 2009 and 2011 with Revenue and Customs (HMRC)) assess IT use by Billingham, UK over 4000 individuals from which a social marketing comparing tax receipts from legitimate sales with 6 Department of Anthropology, campaign was also developed. IT reports to two existing smoking prevalence figures collected by national Durham University, Durham, hotlines, promoted through the programme, were surveys which assess smoking prevalence and con- UK assessed. sumption. In 2000, with illicit cigarettes constitut- Correspondence to Results Initially, concerns abounded about the different ing an estimated 20% of the market and Professor Ann McNeill, philosophies and ways of working of local and national hand-rolled tobacco 63%, the UK government copyright. Professor of Tobacco Addiction, enforcement and health agencies, but these were much introduced a new comprehensive strategy Tackling Addictions Department, reduced at follow-up. A protocol was developed which Tobacco Smuggling,8 which was updated and Institute of Psychiatry, UK 9 1 10 Centre for Tobacco Control greatly facilitated the flow of intelligence about IT expanded in 2006, 2009 and 2011. Legally Studies, King’s College supply. A social marketing campaign was developed binding agreements to reduce IT are also now in London, London SE58AF, UK; highlighting two messages: IT makes it easier for place between the UK Government and tobacco [email protected] children to start smoking and brings crime into the companies.11 Significant decreases in the volume of 10 Received 1 January 2013 community, thereby avoiding misleading messages about IT have been measured by HMRC since 2004 ; http://tobaccocontrol.bmj.com/ Revised 30 June 2013 relative harms of illicit and licit tobacco. Public and latest figures indicate the illicit share to be approxi- Accepted 21 July 2013 stakeholder awareness of IT increased as did calls to mately 9% of cigarettes and 38% of hand-rolling Published Online First both hotlines. tobacco, costing the exchequer around £2 billion 19 August 2013 Conclusions A partnership of agencies, with per annum.12 The IT market is complex, dynamic competing values, was established to tackle IT, a and rapidly evolving. Seizures in the UK have complex public health issue and, inter alia, implemented changed over the last decade from predominantly a social marketing campaign using novel messages. This smuggled legally manufactured tobacco to counter- improved the flow of intelligence about the supply of IT feit and ‘illicit whites’ (cigarette brands produced and increased awareness of IT. by smaller, overseas manufacturers purely for smug- gling to the UK and elsewhere), although seizures are not necessarily representative of the IT market on September 30, 2021 by guest. Protected INTRODUCTION as a whole. Illicit tobacco (IT, a term we use to include Tax revenue data collected nationally masks smuggled, bootlegged and counterfeit tobacco,1) major geographic variations in IT consumption, undermines the effectiveness of tobacco control and the north of England was perceived informally strategies by maintaining and encouraging tobacco as something of an IT ‘hotspot’. In December use. IT is an international problem accounting for 2007, a summit meeting acknowledged the need 11.6% of cigarette trade at a cost to governments for better understanding of IT use and insights into of over US$40 billion in lost revenue.2 In the UK, how to tackle demand for, and supply of, the evolv- Open Access the availability of tobacco products, particularly ing IT market in the region. The ‘North of England Scan to access more ’ free content among deprived communities, at sometimes less Tackling IT for Better Health programme (here- than half the price of legal tobacco weakens the after referred to as the Programme) was a response economic disincentive for tobacco use that paid to this need.13 This pilot Programme, launched duty provides.3 IT products frequently lack officially in 2009, received pump-priming funding To cite: McNeill A, Iringe- adequate health warnings, increase the potential for of £1 million from the English Department of Koko B, Bains M, et al. Tob young people to start smoking through unregulated Health (DH), divided equally between the three – Control 2014;23:e44 e50. sales, and contribute to crime and criminalisation DH regions involved: the northeast (NE, 2.5 m e44 McNeill A, et al. Tob Control 2014;23:e44–e50. doi:10.1136/tobaccocontrol-2013-050957 Research paper Tob Control: first published as 10.1136/tobaccocontrol-2013-050957 on 19 August 2013. Downloaded from people), northwest (NW, 6.8 m) and Yorkshire and Humber indicators reflecting those supply and demand issues for which (Y&H, 5.1 m). If the pilot appeared effective, additional data were available were identified and monitored, building on a funding was to be sought from elsewhere to enhance or con- logic model developed by Programme staff (figure 1). tinue the work. The main aim was to increase the health of the population by reducing smoking prevalence through (a) redu- Ethnographic research – cing the supply and availability of IT, thus keeping tobacco Collaborative ethnographic research14 16 was carried out to elu- prices high, and (b) reducing the demand for IT by building on cidate gaps in understanding and to contextualise better what existing tobacco control measures such as media campaigns was happening. Methods used included participant observation (figure 1). A multiagency partnership was established, which at meetings, events and Programme activities, approximately 50 brought together health, national and local enforcement agen- informal interviews conducted on an opportunistic basis with cies (including HMRC) and marketing representatives to stakeholders and members of communities in disadvantaged combat the IT trade. Other key Programme activities over time areas targeted by the Programme, analysis of documents pre- are listed in table 1. Hitherto, IT had primarily been the policy pared for and by Programme stakeholders, and two in-depth responsibility of HMRC with a focus on supply, therefore, this locality studies (the researcher spent 1 week in each area). Programme represented the first large-scale attempt in the UK Analysis involved reviewing the information contained in each (and to our knowledge, internationally) to reduce both IT of the sources and coding by themes which were cross-checked supply and demand. We were commissioned in 2009 to carry with other data sources to identify important metathemes. out formative, process and outcome evaluation where feasible, Findings from the ethnographic research were fed back to the of the Programme, up to September 2011. Programme, provided valuable context, and informed the design of the stakeholder and consumer research described below. METHODS ‘Mixed methods’ research was undertaken (table 1). Financial Stakeholder interviews constraints precluded new quantitative research beyond that Semistructured interviews were conducted with key stakeholders commissioned by the Programme; qualitative methods included at the outset (November/December 2009) and again 1 year stakeholder interviews and ethnographic research. The later. The focus was on the Programme Governance Board (GB) Programme could not be expected to have an appreciable comprising representatives from local and national enforcement impact on prevalence during the assessment period, so agencies, regional health agencies, and marketing and copyright. http://tobaccocontrol.bmj.com/ on September 30, 2021 by guest. Protected Figure 1 Logic model for
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