In their interesting paper, Joossens and Raw1 showed that, over the last decade, Italy, Spain and the United Kingdom reduced at least part of the illicit trade in tobacco products. In particular, in Italy smuggling had accounted for 10% to 30% of cigarette sales in the early 1990s.1^–3 Available information suggests that this phenomenon had substantially decreased one decade later. Using data from a relatively large population-based Italian survey we found that in 2004 cigarette smuggling accounted for less than 5% of total tobacco.3 As previously shown,2 4 this reduction has been confirmed by annual variations of sales in areas more or less affected by smuggling, and by data on annual seizures by the Guardia di Finanza.

Here we update information on cigarette smuggling in Italy, using data from four surveys conducted annually between 2005 and 2008. Each survey included more than 3000 individuals, aged 15 years or over, who were representative of the general Italian population.5^–8 The data were collected by appropriately trained interviewers, using a structured questionnaire in the context of a computer-assisted personal interview at home. Data were collected on smoking status, and, for current smokers, on the frequency of use of various channels of cigarette distribution.

Overall, 23.9% of the Italian population aged 15 or over described themselves as current cigarette smokers. Smoking prevalence progressively decreased from 25.6% in 2005 to 22.0% in 2008. Of the total of cigarettes smoked, 90.9% had been bought from tobacco shops, 6.9% from vending machines, 0.7% from smugglers, 0.0% from the internet and 1.5% from peers (table 1). The proportion of smuggled tobacco consumption appeared to be greater in heavy smokers (using χ² test, p for trend  = 0.05), while no significant difference was found according to sex, age group, geographical area, education and survey. Among 2893 current smokers, only 46 subjects (1.6%) bought their cigarettes through illicit trade. Of these, 11 (0.4%) bought cigarettes exclusively from smugglers. Only two subjects, both in 2008, reported purchasing cigarettes from the internet.

Our figures were based on self-report, and are therefore probably underestimates.3 Indeed, the validity of self-reports remains open to discussion, in particular for socially unacceptable issues such as direct questions on tobacco purchase from illicit trade. Still, our data confirm that in Italy smuggling now contributes only a small proportion of total tobacco and that the internet is not yet used as source of cigarette sales, in contrast to data from the United States, where online cigarette purchase has been increasing over the last few years.9 10

Joossens and Raw described the causes of the reduction in smuggled cigarettes in Italy.1 However, the NATO intervention in Kosovo—with the first block of navigation in the Adriatic Sea in 24 March−9 June 1999—the corresponding stricter control of the Italian coast to prevent the landing of illegal immigrants, and the enforcement action by custom authorities in the early 2000s should also be taken into account to understand the reasons for the reduction of smuggling in Italy.2 4

In conclusion, we confirm that controlling the supply chain of cigarettes has contributed to substantially reduced large-scale organised smuggling in Italy, as well as in other large and relatively isolated countries, including Spain and the United Kingdom.1