RESEARCH PAPER
The purchase sources of and price paid for cigarettes in six European countries: Findings from the EUREST-PLUS ITC Europe Surveys
 
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1
Smoking or Health Hungarian Foundation (SHHF), Budapest, Hungary
2
Cancer Prevention Unit and WHO Collaborating Centre for Tobacco Control, German Cancer Research Center (DKFZ), Heidelberg, Germany
3
Medical Faculty, Heidelberg University, Heidelberg, Germany
4
Department of Psychology, University of Waterloo (UW), Waterloo, Canada
5
European Network for Smoking and Tobacco Prevention (ENSP), Brussels, Belgium
6
University of Crete (UoC), Heraklion, Greece
7
Health Promotion Foundation (HPF), Warsaw, Poland
8
European Observatory of Health Inequalities, President Stanisław Wojciechowski State University of Applied Sciences, Kalisz, Poland
9
Maria Skłodowska-Curie Institute-Oncology Center (MSCI), Warsaw, Poland
10
Catalan Institute of Oncology (ICO), University of Barcelona, Barcelona, Spain
11
Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
12
UK Centre for Tobacco and Alcohol Studies, King’s College London (KCL), London, United Kingdom
13
Department of Health Promotion, Maastricht University, Maastricht, the Netherlands
14
Netherlands Expertise Center for Tobacco Control (Trimbos Institute), Utrecht, the Netherlands
15
National and Kapodistrian University of Athens (UoA), Athens, Greece
16
University of Medicine and Pharmacy ‘Grigore T. Popa’ Iasi, Iasi, Romania
17
Aer Pur Romania, Bucharest, Romania
18
Ontario Institute for Cancer Research, Toronto, Canada
19
School of Public Health and Health Systems, University of Waterloo (UW), Waterloo, Canada
CORRESPONDING AUTHOR
Piroska A. Kovács   

Smoking or Health Hungarian Foundation (SHHF), Fiumei u. 18/B IV. lph. 1/2, 1044 Budapest, Hungary
Publish date: 2019-03-26
 
Tob. Induc. Dis. 2018;16(Suppl 2):A16
KEYWORDS
TOPICS
*EUREST-PLUS consortium members: European Network on Smoking and Tobacco Prevention (ENSP), Belgium: Constantine I. Vardavas, Andrea Glahn, Christina N. Kyriakos, Dominick Nguyen, Katerina Nikitara, Cornel Radu-Loghin, Polina Starchenko University of Crete (UoC), Greece: Aristidis Tsatsakis, Charis Girvalaki, Chryssi Igoumenaki, Sophia Papadakis, Aikaterini Papathanasaki, Manolis Tzatzarakis, Alexander I. Vardavas Kantar Public (TNS), Belgium: Nicolas Bécuwe, Lavinia Deaconu, Sophie Goudet, Christopher Hanley, Oscar Rivière Smoking or Health Hungarian Foundation (SHHF), Hungary: Tibor Demjén, Judit Kiss, Piroska A. Kovács Catalan Institut of Oncology (ICO); Bellvitge Biomedical Research Institute (IDIBELL), Spain: Esteve Fernández, Yolanda Castellano, Marcela Fu, Sarah O. Nogueira, Olena Tigova Kings College London (KCL), United Kingdom: Ann McNeill, Katherine East, Sara C. Hitchman Cancer Prevention Unit and WHO Collaborating Centre for Tobacco Control, German Cancer Research Center (DKFZ), Germany: Ute Mons, Sarah Kahnert National and Kapodistrian University of Athens (UoA), Greece: Yannis Tountas, Panagiotis Behrakis, Filippos T. Filippidis, Christina Gratziou, Paraskevi Katsaounou, Theodosia Peleki, Ioanna Petroulia, Chara Tzavara Aer Pur Romania, Romania: Antigona C. Trofor, Marius Eremia, Lucia Lotrean, Florin Mihaltan European Respiratory Society (ERS), Switzerland; Goethe University Frankfurt, Germany: Gernot Rohde, Tamaki Asano, Claudia Cichon, Amy Far, Céline Genton, Melanie Jessner, Linnea Hedman, Christer Janson, Ann Lindberg, Beth Maguire, Sofia Ravara, Valérie Vaccaro, Brian Ward Maastricht University, the Netherlands: Marc Willemsen, Hein de Vries, Karin Hummel, Gera E. Nagelhout Health Promotion Foundation (HPF), Poland: Witold A. Zatoński, Aleksandra Herbeć, Kinga Janik-Koncewicz, Krzysztof Przewoźniak, Mateusz Zatoński University of Waterloo (UW); Ontario Institute for Cancer Research, Canada: Geoffrey T. Fong, Thomas K. Agar, Pete Driezen, Shannon Gravely, Anne C. K. Quah, Mary E. Thompson
ABSTRACT
Introduction:
Tobacco tax policies have been proven to be effective in reducing tobacco consumption, but their impact can be mitigated through price-minimizing behaviours among smokers. This study explored the purchase sources of tobacco products and the price paid for tobacco products in six EU member states.

Methods:
Data from Wave 1 of the EUREST-PLUS ITC Europe Survey collected from nationally representative samples of adult smokers in Germany, Greece, Hungary, Poland, Romania and Spain (ITC 6E Survey) were used. The ITC 6E Survey sample, conducted in 2016, randomly sampled 6011 adult cigarette smokers aged 18 years or older. Information on purchase sources of tobacco was examined by country. The difference in reported purchase price by purchase location (store vs non-store/other) was analysed using linear regression for each country.

Results:
Tobacco purchasing patterns and sources varied widely between countries. Non-store/other purchases were very rare in Hungary (0.1%) while these types of purchases were more common in Germany (5.1%) and Poland (8.6%). Reported prices of one standard pack of 20 cigarettes were highest in Germany (4.80€) and lowest in Hungary (2.45€). While nonstore purchases were only made by a minority of smokers (>10% in all countries), the price differential was considerable between store and non-store/other sources, up to 2€ per pack in Greece and in Germany.

Conclusions:
The results suggest a huge variation of purchasing sources and price differentials between store and non-store purchasing sources across the six EU member states examined. While the cross-sectional data precludes any causal inference, supply chain control through licensing as introduced in Hungary and the lack of such measures in the other countries might nevertheless be a plausible explanation for the large differences in the frequency of non-store purchases observed in this study.

ACKNOWLEDGEMENTS
EUREST-PLUS is a Horizon 2020 project conducted by researchers throughout Europe from six participating countries as well as other institution partners within Europe and abroad. Partnering organizations include the European Network on Smoking Prevention (Belgium), Kings College London (United Kingdom), German Cancer Research Centre (Germany), Maastricht University (The Netherlands), National and Kapodistrian University of Athens (Greece), Aer Pur Romania (Romania), European Respiratory Society (Switzerland), the University of Waterloo (Canada), the Catalan Institute of Oncology (Catalonia, Spain), Smoking or Health Hungarian Foundation (Hungary), Health Promotion Foundation (Poland), University of Crete (Greece), and Kantar Public Brussels (Belgium).
CONFLICTS OF INTEREST
The authors declare that they have no competing interests, financial or otherwise, related to the current work. K Przewoźniak reports grants and personal fees from the Polish League Against Cancer, outside the submitted work. CI Vardavas reports that he is the Strategic Development Editor of TID and that there are no conflicts of interest with this current work. The rest of the authors have also completed and submitted an ICMJE form for disclosure of potential conflicts of interest.
FUNDING
The EUREST-PLUS project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 681109 (CIV) and the University of Waterloo (GTF). Additional support was provided to the University of Waterloo by the Canadian Institutes of Health Research (FDN-148477). GTF was supported by a Senior Investigator Grant from the Ontario Institute for Cancer Research. EF and MF are partly supported by Ministry of Universities and Research, Government of Catalonia (2017SGR319), EF is partly supported by the Instituto de Salud Carlos III, Government of Spain (INT16/00211 and INT17/00103), co-funded by the European Regional Development Fund (FEDER).
PROVENANCE AND PEER REVIEW
Commissioned; externally peer reviewed.
 
REFERENCES (20)
1.
Peto R, Lopez AD, Boreham J, Thun M. Mortality from Smoking in Developed Countries, 1950-2010. https://tobaccocontrol.bmj.com.... Updated 2011. Accessed August 1, 2018.
 
2.
Doll R, Peto R, Boreham J, Sutherland I. Mortality in relation to smoking: 50 years' observations on male British doctors. BMJ. 2004;328(7455):1519. doi:10.1136/bmj.38142.554479.ae
 
3.
European Comission. Special Eurobarometer 458. Attitudes of Europeans towards tobacco and electronic cigarettes. https://publications.europa.eu.... Published May, 2017. Accessed August 1, 2018.
 
4.
World Health Organization, Regional Office for Europe. Fact Sheet. Tobacco Taxation. Copenhagen, Denmark: World Health Organization, Regional Office for Europe; 2014. http://www.euro.who.int/__data.... Accessed August 1, 2018.
 
5.
U.S. National Cancer Institute and World Health Organization. The Economics of Tobacco and Tobacco Control. National Cancer Institute Tobacco Control Monograph 21. NIH Publication No. 16-CA-8029A. Bethesda, MD: U.S. Department of Health and Human Services, National Institutes of Health, National Cancer Institute; and Geneva, CH: World Health Organization; 2016.
 
6.
Yeh CY, Schafferer C, Lee JM, Ho LM, Hsieh CJ. The effects of a rise in cigarette price on cigarette consumption, tobacco taxation revenues, and of smoking-related deaths in 28 EU countries - applying threshold regression modelling. BMC Public Health. 2017;17(1):676. doi:10.1186/s12889-017-4685-x
 
7.
World Health Organization. WHO Framework Convention on Tobacco Control. Geneva: World Health Organization; 2003. https://apps.who.int/iris/bits.... Accessed August 1, 2018.
 
8.
Loring B. Tobacco and inequities. Guidance for Addressing Inequities in Tobacco-Related Harm. Copenhagen, Denmark: World Health; 2014. http://www.euro.who.int/__data.... Accessed August 1, 2018.
 
9.
Council of the European Union. Council Directive 2011/64/EU of 21 June 2011 on the structure and rates of excise duty applied to manufactured tobacco. Official Journal of the European Union. 2011;176:24-36. https://eur-lex.europa.eu/LexU.... Accessed August 1, 2018.
 
10.
World Health Organization. WHO report on the global tobacco epidemic, 2017: monitoring tobacco use and prevention policies. Geneva: World Health Organization; 2017. https://apps.who.int/iris/bits.... Accessed August 1, 2018.
 
11.
Cornelius ME, Driezen P, Hyland A, Fong GT, Chaloupka FJ, Cummings KM. Trends in cigarette pricing and purchasing patterns in a sample of US smokers: findings from the ITC US Surveys (2002-2011). Tob Control. 2014;24(Suppl3):iii4-iii10. doi:10.1136/tobaccocontrol-2013-051376
 
12.
Huang J, Zheng R, Chaloupka FJ, Fong GT, Li Q, Jiang Y. Chinese smokers' cigarette purchase behaviours, cigarette prices and consumption: findings from the ITC China Survey. Tob Control. 2014;23(Suppl1):i67-i72. doi:10.1136/tobaccocontrol-2013-051057
 
13.
Hyland A, Laux FL, Higbee C, et al. Cigarette purchase patterns in four countries and the relationship with cessation: findings from the International Tobacco Control (ITC) Four Country Survey. Tob Control. 2006;15(Suppl3):iii59-iii64. doi:10.1136/tc.2005.012203
 
14.
Partos TR, Gilmore AB, Hitchman SC, Hiscock R, Branston JR, McNeill A. Availability and Use of Cheap Tobacco in the United Kingdom 2002-2014: Findings From the International Tobacco Control Project. Nicotine Tob Res. 2018;20(6):714-724. doi:10.1093/ntr/ntx108
 
15.
World Health Organization, Regional Office for Europe. Tobacco taxes save lives. Copenhagen, Denmark: World Health Organization, Regional Office for Europe; 2014.
 
16.
Vardavas CI, Bécuwe N, Demjén T, et al. Study Protocol of European Regulatory Science on Tobacco (EUREST-PLUS): Policy implementation to reduce lung disease. Tob Induc Dis. 2018;16(Suppl 2:A2). doi:10.18332/tid/93305.
 
17.
ITC Project. ITC 6 European Country Survey. Wave 1 (2016) Technical Report. Brussels, Belgium: University of Waterloo and European Network on Smoking and Tobacco Prevention; 2017. https://www.itcproject.org/fil.... Accessed August 1, 2018.
 
18.
Gallus S, Lugo A, Ghislandi S, La Vecchia C, Gilmore AB. Roll-your-own cigarettes in Europe: use, weight and implications for fiscal policies. Eur J Cancer Prev. 2014;23(3):186-192. doi:10.1097/cej.0000000000000010
 
19.
World Bank. Curbing the epidemic. Governments and the economics of tobacco control. Washington, DC: World Bank; 1999. http://documents.worldbank.org.... Accessed August 1, 2018.
 
20.
World Health Organization. Guidelines for implementation of Article 6 of the WHO FCTC. WHO Framework Convention on Tobacco Control. https://www.who.int/fctc/guide.... Published 2014. Accessed August 1, 2018.
 
 
CITATIONS (1):
1.
Correlates of the support for smoke-free policies among smokers: A cross-sectional study in six European countries of the EUREST-PLUS ITC EUROPE SURVEYS
Marcela Fu, Yolanda Castellano, Olena Tigova, Ute Mons, Thomas Agar, Christina Kyriakos, Anne Quah, Geoffrey Fong, Antigona Trofor, Krzysztof Przewoźniak, Witold Zatoński, Tibor Demjén, Yannis Tountas, Constantine Vardavas*, Esteve Fernández*, on behalf of the EUREST-PLUS Consortium**
Tobacco Induced Diseases
 
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