Background:
Tobacco industry estimates the share of illegal cigarettes in India at more than 20% of the total cigarette market and claims it has doubled over the past 10 years. However, there is a paucity of independent and scientifically verifiable estimates of illicit trade in cigarettes in India. This study, for the first time, intends to fill that void.

Methods:
The study employed a modified approach to cigarette pack analysis. Empty cigarette packs from a single day's sale were collected at close of business directly from retail cigarette vendors in four metro cities and four smaller towns covering the length and breadth of India. Ten areas based on pin codes were randomly selected from each city/town and all shops selling cigarettes within one kilometer were surveyed. The study considered a cigarette pack to be illicit if it had at least one of the following attributes: (a) has a duty free sign; (b) has no graphic health warnings; (c) has no textual health warnings; or (d) has no mention of "price inclusive of all taxes" or similar text.

Results:
A total of 11,063 empty cigarette packs were collected from 1,727 retailers and 2.73% of these cigarette packs were classified as illicit. The estimates varied substantially across locations with the highest prevalence of illicit packs being in Aizawl (36%). The share of illicit was found to be much higher (13.77%) among the cheapest cigarette brands. Illicit cigarettes are primarily distributed via more structured general stores compared to relatively informal tea/pan shops.

Conclusions:
Our estimate of the illicit cigarette market share of 2.73% casts serious doubt on the tobacco industry estimates. It appears that any concerns of illicit cigarette trade in India should not hinder the government from raising tobacco taxes.