Roll-ups ‘as hazardous as factory made cigarettes’

“Rollies vs Straights: Roll-your-own ‘at least as hazardous as any other type of cigarette’,” reports The Independent.

“Roll-ups” (cigarettes made using rolling tobacco and paper), have been associated with poverty – they have been seen as a tobacco product for people who couldn’t afford tailor-made cigarettes. In recent decades the popularity of rolling tobacco has increased – probably due to its price – rolling tobacco is considerably cheaper than a pack of cigarettes.

In an opinion piece in the BMJ, Professor Edwards, professor of public health in New Zealand, highlights a series of misconceptions and dangers associated with roll your own (RYO) cigarettes.

He reports that there is a misperception amongst people who smoke roll-ups that it is more natural, but this is not the case. If anything, RYO products could actually be more harmful than factory-made cigarettes.

Many RYO products contain more additives than are found in cigarettes and an animal study has shown that the additives can increase the addiction.

He calls for increased measures to make RYO less accessible.

Where did the story come from?

The opinion piece was written by Richard Edwards, professor of public health from the University of Otago, Wellington, New Zealand. No funding was reported and it was not commissioned.

The personal view was published in the British Medical Journal (BMJ). Most of the content in the BMJ is externally peer-reviewed but this opinion piece was an exception.

The Independent covered the story responsibly and provided expert comments from the anti-smoking charity ASH which included the message that rollups are “not any more healthy, and you’re not going to die any less quickly if you smoke hand-rolled tobacco”.

What kind of research was this?

This was a personal view, backed up by 13 relevant articles which included surveys, and information on tobacco and cigarette additives. Surveys included the International Tobacco Control (ITC) Four-Country Survey which followed 19,456 people from the UK, US, Canada and Australia.

Another ITC survey used a sample of 1,376 people from New Zealand.

However, this was not a systematic review, as it did not perform a systematic search to identify all relevant evidence or have explicit criteria for selecting and appraising evidence. Therefore, we don’t know if there is other evidence relevant to this topic which hasn’t been included.

As with any opinion piece, there is always the risk that “cherry-picking” has taken place, where the author includes evidence that backs his or her argument and ignores evidence that doesn’t.

However, it is already widely accepted that smoking is bad for your health.

What did the research involve?

Professor Edwards wrote the piece using information from surveys and legally mandated data from tobacco companies operating in New Zealand. The article was reviewed by two colleagues, also professors from the Department of Public Health, University of Otago, Wellington, New Zealand. It was not externally peer-reviewed.

What were the basic results?

The ITC surveys showed that in Canada, the US, Australia, the UK, 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.

However, they often contain more additives than are found in cigarettes. The article reports that “the concentration of additives is higher in loose tobacco, at about 18% of dry weight, compared with 0.5% for factory made cigarettes” – though this varies between products.

The article also reports that epidemiological evidence shows that “RYO cigarettes are at least as hazardous as any other type of cigarette”, which was based on a case-control study which found smokers of hand-rolled cigarettes had an increased risk of cancer of the mouth and pharynx (odds ratio (OR) =2.5, 95% confidence interval (CI) 1.2 to 5.2) and laryngeal cancer (OR=2.7, 95% CI 1.3 to 5.7).

A further reason why RYO are no healthier than ready made cigarettes is, according to Prof Edwards, that “animal research suggests increased addictiveness”. This evidence came from a study of 76 rats which found that RYO ingredients were more reinforcing and produced a different profile of reward-related behaviour compared with just nicotine or cigarette ingredients.

The ITC surveys found that RYO cigarette smokers were mostly less likely to be planning or thinking about quitting and in a South African study, RYO cigarette smokers were less confident in their ability to quit.

The ITC four-country surveys found that the major reason for using RYO is cost.

How did the researchers interpret the results?

Prof Edwards concludes that “tobacco control interventions need to be formulated with an awareness of the extent of use of RYO cigarettes, and where this is substantial, specific interventions targeting use of RYO cigarettes may be justified.”

He suggests these interventions include:

• introducing greater increases in excise for loose tobacco
• mass media campaigns to correct misperceptions that RYO cigarettes are less hazardous to health or more natural
• to ban the sale of loose tobacco

Conclusion

This was a valid opinion piece highlighting the dangers of smoking roll-up cigarettes. Though it is not a systematic review of all of the available evidence, it is backed up by selected relevant surveys and product information. It highlights the need to view any type of tobacco smoking as dangerous.

All forms of smoking damage your health and increase your risk of cancer and other smoking-related diseases. If you are still smoking, contact the NHS Stop Smoking support service who can help you to quit.

Analysis by Bazian. Edited by NHS Choices.

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Links To The Headlines

Rollies vs Straights: Roll-your-own ‘at least as hazardous as any other type of cigarette’. The Independent, February 12 2014

Links To Science

Edwards R. Roll your own cigarettes are less natural and at least as harmful as factory rolled tobacco. BMJ. Published online February 11 2014