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Illicit cigarette trade in the cities of Pakistan: comparing findings between the consumer and waste recycle store surveys
  1. Amina Khan1,
  2. Fiona Dobbie2,
  3. Kamran Siddiqi3,
  4. Saeed Ansaari1,
  5. S M Abdullah4,5,
  6. Romaina Iqbal6,
  7. Zohaib Khan7,
  8. Salman Sohail1,
  9. Mona Kanaan8,
  10. Rumana Huque4,5,
  11. Ziauddin Islam9,
  12. Melanie Boeckmann10,
  13. Hana Ross11
  1. 1 Public Health Department-Research, The Initiative, Islamabad, Pakistan
  2. 2 Usher Institute, University of Edinburgh, Edinburgh, UK
  3. 3 Department of Health Sciences, University of York, York, UK
  4. 4 Department of Economics, University of Dhaka, Dhaka, Bangladesh
  5. 5 Research and Development, ARK Foundation, Dhaka, Bangladesh
  6. 6 Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
  7. 7 Office of Research, Innovation,and Commercialization, Khyber Medical University, Peshawar, Khyber Pakhtunkhwa, Pakistan
  8. 8 Health Sciences, University of York, York, North Yorkshire, UK
  9. 9 Tobacco Control Cell, Pakistan Ministry of National Health Services Regulations and Coordination, Islamabad, Pakistan
  10. 10 School of Public Health, University of Bielefeld-Germany, Bielefeld, Germany
  11. 11 Department of Economics, University of Cape Town, Rondebosch, Western Cape, South Africa
  1. Correspondence to Dr Amina Khan, Public Health Department-Research, The Initiative, Islamabad 44000, Pakistan; aminakhan67{at}


Background Concerns about the magnitude of illicit cigarette trade have prevented the Government of Pakistan from increasing tobacco taxes. We estimated the proportion of illicit cigarettes sold in Pakistani cities. Moreover, we compared two methods for collecting cigarette packs and investigated if the illicit cigarette trade equates to tax evasion.

Method We analysed cigarette packs collected from 10 cities of Pakistan using two methods: consumer survey based on a two-stage random sampling strategy to recruit adult smokers and photograph their cigarette packs and waste recycle store survey to purchase used cigarette packs. Cigarettes were considered illicit if any one of the following was absent from their packs: text and pictorial health warning, underage sale prohibition warning, retail price and manufacturer’s name. From the consumer survey, we also estimated the proportion of smokers who purchased loose cigarettes (illegal) and packs below the minimum retail price. Taxation officers (n=4) were consulted to assess their level of confidence in judging tax evasion using the above criteria.

Results Out of 2416 cigarette packs in the consumer survey, 454 (17.8%; 95% CI 15.4% to 20.2%) were illicit. Similarly, out of 6213 packs from waste recycle shops, 1046 (16.8%; 95% CI 15.9% to 17.7%) were illicit; the difference was not statistically significant (p=0.473). Among consumers, 29.5% bought loose cigarettes and 13.8% paid less than the minimum retail price. The taxation officers considered the manufacturer’s name and retail price on cigarette packs as the most relevant criteria to detect tax evasion.

Conclusions One in six cigarette packs consumed in Pakistan could be illicit. These figures are far less than those propagated by the tobacco industry. Collecting packs from waste recycle stores is an efficient and valid method to estimate illicit cigarette trade.

  • illegal tobacco products
  • low/middle income country
  • taxation

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • Twitter @aminakhan67, @Kamsidd66

  • Contributors The study was conceptualised by KS, HR, ZI, FD and AK. The study protocol was developed with inputs from RI, ZK, RH and SMA. AK led the study, SS managed and supervised the field work and SA managed and curated the data. The data were analysed by SA and interpreted by MK, KS, ZI, FD, AK and HR. The manuscript was drafted by AK, KS and FD and revised and approved by all co-authors.

  • Funding The study was funded by European Union Horizon 2020, grant number 680 995. Additional support for this publication was provided by the Tobacco Control Capacity Programme (MR/P027946/2) supported by UK Research and Innovation (UKRI) with funding from the Global Challenges Research Fund.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.