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Introduction
Until 1990, all cigarettes sold in Albania were produced by a state monopoly and were of poor quality. With economic liberalisation and the freedom to travel after the fall of communism, Albanians' exposure to the outside world dramatically increased the demand for Western-type products including cigarettes. Foreign products symbolised prestige and a promise of future economic prosperity. Cigarette smoking among women, considered socially unacceptable during the communist regime, became a sign of emancipation and a modern lifestyle, especially among the younger generations. The fall of communism created a favourable climate for foreign investment and trade, which led to higher incomes, which encourage higher consumption.
International tobacco companies seized the opportunity to profit from the increased purchasing power and limited tobacco control policies, and flooded the market with foreign cigarettes. At the same time cigarettes became heavily advertised while taxes collected on them remained low. During the 1990s, domestic cigarette production was privatised, but could not compete with foreign imports. 1 For example, between August 2008 and July 2009, domestic production was only 200 metric tons (conversation between Vice Minister of Finance Mima Florion and H Ross, Tirana, 2009), while imports clearing customs reached 4037 metric tons. 2 However, not all cigarettes were legally imported. In 2001, the tobacco industry estimated that illicit cigarettes occupied about 72% of the total market. 3 The WHO reported that between 40% and 50% of cigarettes consumed in Albania were illicit in 2007. 4
In response to alarming trends in smoking prevalence, 5 the Albanian government began to embrace tobacco control policies. In 2000 it adopted a set of 'National Tobacco Control Provisions' which consisted of a ban on tobacco advertising on television, radio, the printed media and billboards; public information campaigns on the dangers of tobacco use; health warnings and the disclosure of tobacco product ingredients; and restrictions on smoking in public places such as educational and healthcare facilities, government buildings and public transport. The government signed in 2004 and ratified in 2006 the Framework Convention for Tobacco Control (FCTC). However, advertising on billboards and at the point of sale and other promotional activities were still allowed. In 2006, Albania increased cigarette taxes, and in May 2007 banned all outdoor tobacco advertisements including billboards, prohibited smoking in all...