Trends and correlates of current use of illicitly traded tobacco in Australia: Evidence from a decade of national surveys.

BACKGROUND AND AIMS: Tobacco taxes reduce smoking, particularly among low socioeconomic groups; however, some individuals seek cheaper alternatives instead of quitting. This study estimated use of illicitly traded tobacco among Australian adults who smoke and examined associations with sociodemographic, smoking-related (including quit intentions and attempts) and other illicit substance use factors.

DESIGN: Repeated cross-sectional study using nationally representative data.

SETTING: Australia, using data from four waves (2013, 2016, 2019 and 2022-2023) of a triennial national survey.

PARTICIPANTS: A total of 12 596 individuals aged 18 years and over who reported smoking at least monthly.

MEASUREMENTS: The primary outcome was self-reported current use of illicitly traded tobacco, defined as current use of unbranded tobacco at any frequency or the purchase of one or more non-plain packaged packs in the past three months. Based on these indicators, participants were categorised into four mutually exclusive groups: no use, unbranded use only, non-plain packaged tobacco use only and use of both types. Predictor variables included survey year, age, sex, education, household income, area-level disadvantage, employment status, general health, psychological distress, cigarettes smoked per day, tobacco product type, alcohol use, past-year cannabis use and past-year non-cannabis illicit drug use.

FINDINGS: Current use and/or recent purchase of illicitly traded tobacco in Australia rose from 8.6% in 2016 to 16.5% in 2022-2023. Regular use remained relatively low in 2022-2023: 5.2% of study participants used unbranded and 4.1% non-plain packaged tobacco daily. Compared with no use of illicitly traded tobacco, unbranded tobacco use only was statistically significantly associated with being outside the labour force [adjusted odds ratio (aOR) = 1.87, 95% confidence interval (CI) = 1.36-2.59], experiencing high psychological distress (aORvery high = 1.95, 95% CI = 1.28-2.97; aORhigh = 1.94, 95% CI = 1.34-2.81, vs. low), smoking heavily (aOR11-20CPD = 2.27, 95% CI = 1.4-3.69; aORover 20 CPD = 2.66, 95% CI = 1.62-4.35, vs. non-daily) and past-year cannabis use (aOR = 2.05, 95% CI = 1.52-2.77, vs. no use). Using non-plain packaged tobacco only was statistically significantly associated with past-year non-cannabis illicit substance use (aOR = 1.46, 95% CI = 1.15-1.86, vs. no use) and already giving up smoking (aOR = 0.39, 95% CI = 0.24-0.65, vs. no intention to quit smoking). Concurrent use of both types of illicitly traded tobacco was statistically significantly associated with living in the most disadvantaged area (aOR = 3.56, 95% CI = 1.68-7.55), using any non-cannabis illicit substance use in the past year (aOR = 2.25, 95% CI = 1.45-3.49) and higher cigarette consumption (aOR11-20CPD = 6.57, 95% CI = 1.99-21.67; aORover 20 CPD = 9.12, 95% CI = 2.76-30.15, vs. non-daily).

CONCLUSIONS: While awareness and use of illicitly traded tobacco in Australia has increased in recent years, regular use remains relatively low.