BackgroundIran is one of two main target markets for tobacco smuggling in the WHO's Eastern Mediterranean Region. The Iranian government has a local tobacco monopoly but there is high demand for international brands. Informal reports show about 20% of cigarette consumption is smuggled brands. This pack survey study is the first in Iran to gather validated information on use of smuggled cigarettes.MethodsA randomized cross-sectional household survey in Tehran in 2008–2009 of 1540 smokers aged 16–90 (83% men) was performed, including interviewer checking of cigarette packs.ResultsIn all, 20.9% of cigarettes and 6.7% of domestic branded cigarettes were smuggled. A total of 60.1% of smokers preferred foreign cigarettes. There was no significant difference between consumption of illegal cigarettes by sex. (Fisher exact test p=0.61) Use of smuggled cigarettes was higher among younger smokers (p=0.01)ConclusionsUse of illegal cigarettes is high. Tobacco control laws outlawing their sale are not being enforced.