Julie Stratton, Manager, Epidemiology Peel Public Health Determining the proportion of illicit (contraband) cigarettes in a local public health jurisdiction Julie Stratton, Manager, Epidemiology Peel Public Health

Background Self report surveys: Most smokers buy their cigarettes legally 1% of Canadians might have purchased smuggled cigarettes (CTUMS) 13% of Canadians buy cigarettes from a First Nations reserve (23% of Ontarians)

Background Cigarette Butt Studies Canadian Convenience Store Association 26% in Ontario youth (2008) 38% in Peel youth (2008) Ontario Convenience Store Association 21% in Ontario residents (2014) 22% in Brampton residents (2014) Post-secondary campuses in Ontario – 14%

Peel Region 1.3 million residents (20,000 people added each year) West of Toronto 1.3 million residents (20,000 people added each year) 15% of Peel residents smoke

Research Questions What proportion of cigarettes in the Region of Peel are illicit (untaxed?) Are there differences in the proportion of illicit cigarettes by location of collection?

Methods – Sampling Frame 4 types of locations within Peel Region Regional hospitals (3 locations) Regional buildings serving the public (2 locations) College campuses (2 locations) and university campus (1 location) Secondary schools (random selection of 10 locations)

Methods – Pilot Study Piloted process from one location from each venue Collection Identification

Methods – Sample Size Required 1,209 butts per venue Parameters Estimated number of cigarettes smoked per day Estimated per cent of contraband based on pilot study Adjustment factor 1/0.7 - 1 Precision of the estimate = 3% Statistical power = 80% Type 1 error rate = 5% Cigarette butt discard rate based on results of pilot study

Methods – Collection and Storage Hand collection from the ground or dumped from cigarette disposal bins Collected butts until quota was met Collected on non-rainy days Stored in a fire proof cabinet in plastic bins at an off-site location

Classification - Testing Brand name or symbol Existence of a dry patch within the plug wrap Number of rows and type of ventilation holes Type of filter (acetate or polypropylene) Resources: www.cigarettespedia.com  

Classification – Brand Name Examples du Maurier Player’s Matinee Viceroy Export A

Classification – Plug Wrap and Dry Patch Dry patch (area with no glue) Plug wrap

Classification – Ventilation Holes

Laser Electrostatic Mechanical

Classification - Filter Polypropylene vs acetate Some illegal cigarettes use polypropylene filters Do not dissolve in acetone

Classification Legal branded International Legal native Contraband (illegal) Discards Unknown or other

Classification – Legal Native Putters DKS Sago Ménage Podium

Classification – Contraband Examples Canadian Playfair Unbranded

Results Total Collected and Discard Rate Location Total collected Total discards Discard Rate (per cent) Hospitals 3,140 449 14.3 Regional Buildings 2,804 370 13.2 College/university campuses 4,808 670 13.9 Secondary schools 3,280 562 17.1 TOTAL 14,032 2,051 14.6

Results – Overall Classification Number Per Cent Legal branded 10,663 89.0 International 144 1.2 Native legal 530 4.4 Contraband (Illegal) 629 5.3 Unknown or other 15 0.1 Note: Excludes discards

Results - Native Legal and Contraband by Venue Population Representing Venue Per Cent Native Legal Per Cent Contraband Youth Secondary schools 3.1 8.6 Young adult College/ university campuses 1.4 2.8 General population Hospitals, Regional buildings 7.6 5.5

Conclusion Lower percentage of contraband cigarette butts than reported in other studies (5.3%) The percentage of contraband cigarette butts varied by venue (highest in secondary schools) Contraband rates are low - Peel will focus on other aspects of tobacco control

Implications for Public health practice Collection of cigarette butts to assess percentage of contraband cigarettes can easily be replicated in the field Peel Health has developed the following protocols which can be shared: Cigarette Butt Study protocol Cigarette Butt Collection Protocol Cigarette Butt Identification Protocol Cigarette Butt Photo Library

For more information Julie Stratton, Manager, Epidemiology, Peel Public Health, julie.stratton@peelregion.ca Dr. Megan Ward, Associate Medical Officer of Health, Peel Public Health, megan.ward@peelregion.ca

Limitations International and some contraband cigarettes might have been classified as legal Selection of venues