Attitudes and Exposure to Illicit Tobacco in England, 2022.

Introduction: The United Kingdom has achieved reductions in illicit tobacco (IT) market size and share. However, there remains a 17.7% tobacco duty gap, contributing to health inequalities. In January 2024, the UK government announced a new strategy to control IT, along with provision of new funding.

Methods: A representative cross-sectional survey of adults in England ran in April 2022 to evaluate attitudes and exposure to IT. Tobacco smokers were asked questions about encounters with IT, while all participants answered questions on knowledge and perspectives on IT.

Results: Of 262 tobacco smokers, 18.3% (95% CI 13.8% to 23.6%) had come across IT in the past year. Men had four times the odds of encountering IT recently than women. Among 1767 adults responding to questions on IT, two-thirds agreed IT harmed children, and more than half agreed IT was linked to organized crime. Younger adults, smokers, and those in lower socioeconomic groups were less likely to agree IT was harmful.

Conclusions: Exposure to IT, especially among younger males, remains a concern. While most of the public acknowledge its harm, this is not universal, and some population groups are less likely to do so.

Implications: The study highlights persistent exposure to IT in England, especially among younger males, and varying perceptions of IT harm across socioeconomic groups. Tackling IT requires collaboration between health and enforcement agencies, independent of the tobacco industry's influence. Strategies should include components that shift demand for IT and denormalize its presence in communities, particularly in lower socioeconomic areas with higher smoking prevalence.