• Brendan P McDonnell, Robert McCausland, Sheila Keogan, Luke Clancy, and Carmen Regan.
• Coombe Women and Infants University Hospital, Cork Street, Dublin 8, Ireland. bmcdonnell@rcsi.ie.
• Ir J Med Sci. 2021 Nov 1; 190 (4): 144514491445-1449.

BackgroundSmoking during pregnancy is associated with adverse maternal and fetal outcomes. Tobacco tax avoidance and tax evasion undermine the effectiveness of tobacco tax policies, resulting in cheaper prices for smokers and increased tobacco usage.AimsThe purpose of this study was to explore the purchasing habits of pregnant smokers with regard to tobacco expenditure and use of illicit tobacco.MethodsProspective cohort study. Face to face interviews were conducted with 90 attendees (age range 18-42 years; mean age 28 years) of a smoking cessation antenatal clinic in a large Irish tertiary level maternity hospital. Information regarding smoking habits, quantity of tobacco smoked, and location of purchase of tobacco was collected in addition to socioeconomic details. Tobacco products were examined to establish whether these were purchased from legitimate sources.Results76.6% of women smoked 10 or fewer cigarettes per day. The mean weekly spend on tobacco was €39. Seventeen women (18.8%) smoked roll-your-own tobacco. One woman (1.1%) currently possessed a pack of illicit tobacco, while another 5.5% of participants had purchased illicit tobacco in the past. Four women (4.4%) practiced tobacco tax avoidance by purchasing tobacco abroad or in Duty Free.ConclusionsUse of illicit tobacco is low and only a minority of women engaged in tobacco tax avoidance. As the average price of tobacco in Ireland increases, weekly expenditure on tobacco products is a significant financial impact on low-income women. Smoking cessation would deliver significant financial gains in addition to health benefits.© 2021. Royal Academy of Medicine in Ireland.

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