BACKGROUND: The tobacco market in Jordan poses significant public health and economic challenges, as highlighted by a national household smoker pack examination survey. With one of the highest smoking prevalence rates globally, Jordan faces a crisis exacerbated by the widespread availability of illicit cigarettes. This study aimed to assess the tobacco market comprehensively, focusing on socio-demographic factors, smoking behaviors, and the extent of illicit cigarette use.
METHODS: This study conducted a national household smoker pack examination survey across three governorates in Jordan using multistage cluster sampling. Data collection involved self-reports on smoking behaviors and cigarette characteristics, combined with physical pack examinations to validate compliance with local regulations. Packs were classified as illicit based on QR code absence, tax stamp violations, and missing health warnings.
RESULTS: Among the 463 participants (smokers), 22.2% reported purchasing illicit cigarettes in their most recent purchase. A higher proportion of males (24.4%) reported buying illicit cigarettes compared to females (10.8%). The results show significant differences in the proportion of smokers who purchase illicit cigarettes based on various socio-demographic factors. Males reported a significantly higher rate of illicit cigarette purchases (24.4%) compared to females (10.8%) (p = 0.010). Smokers aged 26-35 were the most likely to buy illicit cigarettes (30.0%), whereas those aged ≤25 were the least likely (11.0%) (p <0.001). Married individuals had a higher tendency to purchase illicit cigarettes (28.0%) compared to single individuals (11.7%) (p <0.001). Only 12.6% of illicit cigarette packs displayed proper health warning images (p=<0.001).
CONCLUSIONS: The findings highlight the need to tackle the high smoking prevalence and illicit cigarette trade in Jordan. With 22.2% of illicit cigarettes, regulatory lapses and socio-economic factors significantly contribute to the problem. The absence of health warnings and tax stamps on illicit packs undermines public health initiatives and results in substantial revenue loss for the government.