Poorer smokers may favour "roll your own" and many falsely believe that use of loose tobacco is less dangerous than factory-made cigarettes, according to a University of Otago public health researcher writing in the British Medical Journal.
A recent campaign in south-west England has prompted the suggestion that specific interventions may be needed to encourage roll-your-own (RYO) cigarette smokers to quit.
According to University of Otago Wellington Professor of Public Health Richard Edwards, the campaign suggested some aspects of RYOs merit particular concern. This includes evidence that RYO cigarettes are as harmful as their factory rolled counterparts even though many falsely believe them to be more 'natural' and less dangerous.
His personal view article has been published on bmj.com today.
Professor Edwards says the evidence suggests that many smokers believe that RYO cigarettes are more "natural" and less of a health hazard than pre-rolled cigarettes.
For example in Canada, the United States, Australia, the UK and New Zealand, between 21% and 40% of RYO smokers reported that they thought they were healthier. However, evidence shows that RYO cigarettes are at "least as hazardous" as any other type of cigarette, and that they have a much greater concentration of additives than manufactured cigarettes.
Professor Edwards notes that in New Zealand the "concentration of additives is higher in loose tobacco at about 18% […] compared with 0.5% for factory-made cigarette".
Prevalence has been increasing greatly in some jurisdictions, for example in the UK, use of RYO cigarettes among smokers older than 16 increased from 2% to 23% among women and from 18% to 39% among men between 1990 and 2010. Professor Edwards says the high use among youth "further suggests that they may have a specific role in facilitating initiation of smoking".
Evidence also shows that there is a high rate of RYO cigarettes in disadvantaged groups in many countries with higher usage among black South Africans, Maori in New Zealand and smokers of lower socioeconomic status in Australia, the UK, the US and Canada. In New Zealand, RYO cigarette smokers are more likely to have been diagnosed as having "mental health, drug use, and alcohol related disorders and to have hazardous drinking patterns".
Professor Edwards says there is mixed evidence as to whether reducing prevalence among RYO cigarette smokers is more difficult than for other smokers. He suggests that tobacco control interventions "need to be formulated with an awareness of the extent of use of RYO cigarettes".
He suggests that tobacco tax regimes correct differences in tobacco prices, as New Zealand did in 2010. Another measure might also be to tailor mass media campaigns and pack warnings to correct misinterpretations that RYO cigarettes are less hazardous to health or more natural.
Professor Edwards concludes that a "more radical move" would be to ban the sale of loose tobacco altogether.