Roll your own cigarettes are less natural and at least as harmful as factory rolled tobacco.

TheWise-Up to Roll-Ups campaign in the south west of England has brought to the fore a facet of tobacco smoking that receives far less attention than it should. The campaign publicised that some aspects of use of roll your own (RYO) tobacco merit particular concern. The most common reason (over 80% in most studies) given for smoking RYO cigarettes is that they are cheaper. 3 Indeed, even when the price per weight of tobacco is similar for RYO and factory made cigarettes, smokers of RYO cigarettes can potentially keep smoking andmaintain sufficient nicotine intake by rolling thinner cigarettes. This may help smokers to continue to smoke despite rising tobacco taxes, undermining this key tobacco control intervention. A perception that could encourage the use of loose tobacco and discourage quitting is that RYO cigarettes might be considered to be more “natural” and less of a health hazard than pre-rolled cigarettes. For example, in Canada, the United States, Australia, the United Kingdom, and New Zealand, between 21% and 40% of RYO smokers have reported that a reason they smoked RYO cigarettes was because they thought that they were healthier than manufactured cigarettes. 4 However, this perception is false. Epidemiological evidence shows that RYO cigarettes are at least as hazardous as any other type of cigarette, and animal research suggests increased addictiveness. Any notion that loose tobacco is more “natural” is severely undermined by evidence that the concentration of additives is higher in loose tobacco, at about 18% of dry weight, compared with 0.5% for factory made cigarettes (for British American Tobacco products), as calculated using legally mandated data from tobacco companies operating in New Zealand. Some of these additives, including sweeteners such as honey, sugar, dextrose, and sorbitol, often at much higher concentrations than in factory made cigarettes, potentially make the product more acceptable to children. The high concentration of other additives would probably surprise RYO cigarette smokers. For example, RYO tobacco in New Zealand is up to 7.5% propylene glycol by dry weight. Among the 139 individual additives listed for loose tobacco are the less than wholesome sounding trans-benzaldehyde, ethyl butyrate, and phenylcarbinol. Smoking RYO cigarettes that are made from loose tobacco is common in many jurisdictions though prevalence varies widely. For example, in the International Tobacco Control (ITC) Project four-country study, the prevalence of predominant use of RYO cigarettes among smokers in 2008 was 31% in the UK, 15% in Australia, 9% in Canada, and 6% in the US. It was 38% in the New Zealand ITC cohort. Prevalence has been increasing greatly in some jurisdictions. For example, in the UK, predominant 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. Use of loose tobacco is not restricted to developed countries. For example, the proportion of smokers smoking RYO cigarettes exclusively or in combination with manufactured cigarettes was 29% in South Africa, 58% in Thailand, and 17% inMalaysia. The high prevalence of use of RYO cigarettes among youth, 12 further suggests that they may have a specific role in facilitating initiation of smoking. Evidence shows that use of RYO cigarettes contributes to high rates of smoking observed among disadvantaged groups inmany countries. For example, use of RYO cigarettes is reportedly higher among black South Africans, Maori in New Zealand, and smokers of lower socioeconomic status in Australia, the UK, the US, and Canada. 4 8 In New Zealand RYO cigarette smokers are alsomore likely than conventional cigarette smokers to have been diagnosed as having mental health, drug use, and alcohol related disorders, and to have hazardous drinking patterns. There is mixed evidence about whether reducing prevalence among RYO cigarette smokers is more difficult than for other smokers. In the ITC Project studies, RYO cigarette smokers