BACKGROUND: Brazil ratified the Protocol to Eliminate Illicit Trade in Tobacco Products; however, the consumption of illegal cigarettes remains a concern in the country. This study aimed to estimate the consumption of illegal cigarettes according price, country of origin, and presence of health warnings.
METHODS: Two methods were used: (1) Collection of discarded cigarette packs from the streets of five capitals (São Paulo, Rio de Janeiro, Belo Horizonte, Campo Grande, and João Pessoa); and (2) Household survey with in-person interviews with a representative sample of smokers in the cities of Rio de Janeiro and São Paulo. The study was conducted from January to April 2019, with an analysis of 8753 packs and 1278 interviews.
RESULTS: The proportion of illegal cigarettes ranged from 30.4% in Rio de Janeiro to 70.1% in Campo Grande. Most illegal cigarettes were from Paraguay (99.7%) and displayed health warnings that did not meet Brazilian standards, with low-quality images and foreign language text. Illegal cigarettes were significantly cheaper than legal ones. The average price of illegal cigarettes in the last purchase was approximately 25% lower than the minimum price set by Brazilian regulations (R$5.00).
CONCLUSIONS: The study highlight the need for effective implementation of the Protocol to Eliminate Illicit Trade in Tobacco Products, with increased collaboration between Brazil and Paraguay to combat smuggling and reduce the impact of smoking. While Brazilian cigarettes are already cheaper than those from other countries, the even lower price of illegal cigarettes increases accessibility, boosting consumption among the poorest and making control policies more difficult.