The sale of single cigarettes in Brazil from 2008 to 2019: one more cause of concern?

In Brazil, the sale of cigarettes is only allowed in closed packages with 20 units. The evolution over time of the proportion of adult smokers who purchased single manufactured cigarettes in their last purchase was evaluated. Data from the Global Adult Tobacco Survey conducted in 2008 and the Brazilian National Health Survey conducted in 2013 and 2019 were used. A generalized linear model was used to calculate the differences in the proportion of single cigarette purchases between the survey years, adjusted for sociodemographic and smoking behavior variables. Considering 2013 as the reference year, the relative differences in the proportions were, respectively, -15.3% (adjusted p-value ≤ 0.05) when compared to 2008, and +13.3 (adjusted p-value = 0.08) when compared to 2019. Approximately 20% of young adult smokers reported buying single cigarettes in 2019 and the difference in the proportion of single cigarette purchases between individuals aged 18 to 24 and those older likely increased from 2013 to 2019 (adjusted interaction p-value = 0.08). There are reasons for concern, as the strengthening of tax policy from 2008 to 2013 was accompanied by an increase in the proportion of purchases of single cigarettes. Despite the decrease in the real price of cigarette packs from 2017, a context of low effectiveness of implementation of other anti-smoking measures likely accentuated the difference in the proportion of purchase of single cigarettes between young people and adults. The continued presence of single cigarettes as a mode of acquisition contributes to economically vulnerable population subgroups becoming and/or remaining dependent on smoking behavior.