Access to cheaper cross‐border cigarettes may decrease smoking cessation intentions in Germany

When cigarette prices increase, some smokers reduce the number of cigarettes they smoke or try to quit, whereas others switch to cheaper brands or tobacco products.¹,²,³,⁴ Another way of avoiding an increase in cigarette price is to purchase cigarettes in other countries where prices are lower. Cross‐border shopping of cigarettes is attractive for smokers in Germany because it is centrally located in Europe and cigarettes are more expensive in Germany compared with some neighbouring countries. In December 2004 and September 2005, the German government increased cigarette excise tax by € 1.2 cent per cigarette in each case. The purpose of this study was to test the hypothesis that access to cheaper cigarettes through cross‐border shopping may decrease smokers' intention to change smoking behaviour before these price increases.

Computer‐assisted face‐to‐face interviews with a representative sample of the German population were carried out. A total of 6126 people aged 14–93 years were interviewed in November 2004 and August 2005 before each tax increase. As the surveys were identical, both samples were analysed together. The mean sample age was 47.27 years (standard deviation 17.69), with 53.59% women and 1868 (30.49%) reporting to be smokers.

Smokers were asked whether the upcoming tax increase would be a reason to reflect on their smoking behaviour, whether they intended to reduce smoking, quit smoking, switch to a cheaper brand or not to change their behaviour, and where they purchased cigarettes. Those who reported purchasing cigarettes in foreign countries were classified as cross‐border shoppers.

In all, 231 (12.37%) smokers reported cross‐border shopping of cigarettes. They did not differ significantly from smokers with no cross‐border shopping by sex, age, education, employment status, family status, household size, income or the average number of cigarettes smoked daily (ie, nicotine dependence).⁵,⁶,⁷ They were more likely to live in a German Bundesland (State) near countries with cheaper cigarettes—that is, Luxemburg, Poland and the Czech Republic (χ² (15) = 145.67; p<0.001). Significantly fewer cross‐border shoppers reflected on their smoking behaviour because of the upcoming tax increase: 79 (34.20%) with access to foreign cigarettes versus 771 (47.10%) with no access (χ² (1) = 13.58; p<0.001). Smokers with access to cross‐border shopping differed significantly in their intention to change behaviour before the cigarette excise tax increases (χ² (3) = 19.29; p<0.001). Significantly fewer smokers with access to foreign cigarettes intended to reduce or quit smoking and significantly more did not intend to change their smoking behaviour (table 1). There was almost no difference for the intention to switch to a cheaper brand.

Table 1 Intention to change behaviour before the cigarette excise tax increases in Germany (n = 1860 owing to 8 missing values).

Access to foreign cigarettes (cross‐border shopping)	Intention to reduce smoking	Intention to quit smoking	Intention to switch to cheaper brand	No intention for behaviour change	Σ
No	512 (31.43%)	187 (11.48%)	260 (15.96%)	670 (41.13%)	1629 (87.58%)
Yes	54 (23.38%)	13 (5.63%)	38 (16.45%)	126 (54.55%)	231 (12.42%)
Σ	566 (30.43%)	200 (10.75%)	298 (16.02%)	796 (42.80%)	1860 (100%)
χ2 (df = 1)	5.98, p<0.05	7.11, p<0.01	0.05, NS	15.35, p<0.001

As intentions are an important predictor for behaviour change, we may assume that access to cheaper cigarettes across the border also decreases the effect of tobacco tax increases on cessation and reduced consumption. Effective tobacco control measures to reduce the availability of different ways of evading price increases, such as cross‐border shopping, are urgently needed to realise the full potential effect of tobacco tax increases.