Background:
Iran and Iraq are the two main target markets for tobacco smuggling in the Eastern Mediterranean Region. Tow cigarette pack survey in Tehran, were done in 2009 and 2015 which were showed that illicit cigarettes used rate were 20.9% and 15.4% respectively. We designed this study to update trends in the illicit cigarette trade in Tehran.

Methods:
A cross-sectional study of 2331 smokers aged 15 years and over was conducted in Tehran in January 2018. The sampling method was the same as previous studies. Smokers were asked to show the interviewers their current pack of cigarettes, which was categorised as either: (1) legal cigarettes: displaying governmental pictorial warning and hologram or (2) illegal cigarettes: with no governmental labeling. The packs were also categorised as either domestic (a Persian brand name) or foreign (a foreign brand name).

Results:
The sample included 1827 males (78.3%) and had a mean age of 40.3±12.1 years. In total, 1427 smokers (61.2%) had foreign and 904 (38.8%) had domestic cigarettes; 2072 (88.9%) had legal cigarettes and 259 (11.1%) had smuggled cigarettes. There was a statistically significant difference in the use of smuggled cigarettes and foreign cigarette by younger smokers (36.8±3.1vs 42.9±5.3 years) (p<0.001). Marlboro was the only smuggled cigarette brand (259 packs; 100%).

Discussion:
The lower prevalence of illicit cigarettes in Tehran in 2018 compared to previous studies may be due to the control and monitoring on legal cigarettes distribution. All other foreign cigarette brands except Marlboro were imported legally or had legal joint production.