Led by Dr. Anthony So, director of Global Health and Technology Access at the Sanford School of Public Policy, the study aims to help Southeastern Asian governments improve their tobacco control policies. The partnership is funded by a grant from the National Institutes of Health, and researchers are working with the American Cancer Society and the Southeast Asia Tobacco Control Alliance. Illicit tobacco, which refers to counterfeit and contraband cigarettes that evade tobacco taxes imposed by the governments, tends to be lower-priced and can directly affect both public health and economies in countries within the region.
“The greater availability, affordability and demand for cigarettes obviously means more consumers might be harmed because of the increased smoking that results,” So said. “The second direct effect is of course the financial tax revenue losses to government...the taxes are not being paid on that product.”
So said the illicit trade can also indirectly affect how national policies on tobacco are formed. Tobacco industry lobbyists within Southeast Asian countries contend that higher tobacco taxes lead to higher illicit trade and loss of revenue for the government, thus hindering more stringent tobacco control. But So disagrees, saying that there is little evidence to suggest a high correlation.
“The reason why is, there are many mitigating factors that a country can take to prevent illicit trade of tobacco, including using the taxes of tobacco to ensure there’s adequate enforcement of the law,” he said.
So met with the SATCA in Thailand in February to continue their work. Members present during the conference discussed their research methods as well as their initial results from their household surveys of smoking in Vietnam, Thailand and Indonesia. An important part of the conference was creating transparent research methodology, which would allow researchers in the region to pursue further independent projects long after So’s work is completed.
“These estimates we hope will be useful alongside others who put forth, particularly from the industry, sources of such estimates that we cannot independently verify,” So said. “We [cannot] be sure of whether or not they are exaggerating the magnitude of illicit trade of tobacco, or if there are particular special interest purposes.”
Elizabeth Turner, assistant professor of biostatistics and bioinformatics and global health, was also present at the conference as a statistical research consultant. During the conference, Turner provided training in the use of statistical software and advised some secondary research questions.
“These secondary questions were related to the primary research question discussed at the workshop, which seeks to determine what demographic characteristics of smokers are related to whether smokers purchase illicit cigarettes,” Turner wrote in an email Sunday.
James Bowling, research associate professor at the Gillings School of Global Public Health at the University of North Carolina at Chapel Hill, has led the statistical analyses for the project for about five years. Bowling designed the surveys conducted in the three countries, using methods that were comparable to surveys used by the Centers for Disease Control and Prevention to look at smoking prevalence.
“We had interviewers go to the household to interview them and collect data on a questionnaire, but also to ask if they had a pack of cigarettes in the house that they were currently smoking,” Bowling said. “We purchased the pack from each of the households and then sent it to a central location in each country to make a determination of whether… the pack was illicit.”
Although the group meets annually to review the progress of their work, Bowling said that the conference in Thailand was focused this time on combining their data from the initial household surveys for publication, for which he will be conducting the necessary data analysis.
The language of the text used in the health warnings on some cigarette packs suggested they were smuggled in from other countries, So said. This has led to concerns of a connection between large criminal networks and the trade.
So said he believes the work they have done will be able to guide the local government in creating newer policies on tobacco. In addition to improving the public health quality in these countries, So said they have created a legacy for further research to take place.
“Obviously the struggle for tobacco control will take decades,” So said. “We wanted to ensure that we’ve left behind a cadre of researchers capable of sustaining this type of local evidence, this type of work and the type of stability to do this type of research over time.”