Significance: Contraband tobacco products provide price-sensitive smokers with incentives to avoid higher-taxed cigarettes. Some Canadian smokers avoid taxes by purchasing cigarettes from First Nations Reserves (FNR). This study estimated the effect of proximity to FNR on the odds of last purchasing cigarettes from FNR in Ontario (ON) & Quebec (QC), where contraband tobacco is more prevalent.

Methods: The analysis was based on current smokers aged 18+ from ON (n=2126) & QC (n=1441) who completed at least 1 of the 9 waves of the International Tobacco Control Canada Survey (2002-2014). The weighted prevalence of last purchasing from FNR was estimated using SAS version 9.4. The Euclidean distance between smokers' postal code of residence to the nearest FNR was computed using QGIS version 2.18. Weighted generalized estimating equations (GEE) tested the effect of distance on the odds of purchasing on-reserve, controlling for sociodemographics (sex, age, ethnicity, income, education) & smoking behaviors (cigarettes/day, quit intentions). GEE regression also tested if FNR purchasing was associated with past year quit attempts.

Results: In 2002, 2.4% of ON smokers last purchased cigarettes from FNR. By 2008, 22% of smokers last purchased from FNR; since then, prevalence remained stable. In QC, prevalence increased from 1.1% in 2002 to 7.3% in 2007 and declined to 3.2% in 2014. Across all waves and controlling for sociodemographics & smoking behaviors, proximity to FNR was associated with purchasing from FNR only in ON where a 10 km decrease in distance increased the odds of purchasing from FNR (OR=1.31,p<0.01). ON smokers who last purchased from FNR had significantly lower odds of trying to quit in the past year (OR=0.69;p<0.01). These relationships were not observed in QC smokers.

Conclusion: In 2008, QC took measures to curb contraband tobacco; the declining prevalence of FNR purchases since then suggests these measures are effective. The prevalence of FNR purchasing has remained stable in ON since 2007. Policies that deter non-aboriginal smokers from purchasing on reserve or ensure payment of applicable taxes if they do may curb contraband tobacco purchasing in ON.