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


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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E-cigarette television advertising to be investigated

Camel, marlboro, winston, salem cigarette lighters

The advertising watchdog’s probe into the advertising of e cigarettes has been welcomed by British American Tobacco (BAT), the biggest tobacco company to show a TV ad for e cigarettes in the UK.

The Committee of Advertising Practice (CAP) last week kicked off an eight week consultation which will look at introducing new rules to clear up “concern” and “confusion” in this area.

The consultation could lead to new rules protecting under 18s and it follows criticism over an e cigarette ad broadcast during ITV’s I’m a Celebrity Get Me Out Of Here! which attracted more than 1,100 complaints to the advertising watchdog.

Adverts for e cigarettes are currently subject to the general rules under the advertising code, such as whether they are harmful or offensive, in which case they could be banned.

But the advertising watchdog believes there needs to be specific rules in place in light of public concern over issues such as children taking part in “vaping”, the inhaling of vapour from e cigarettes, along with uncertainty among advertisers about the rules.

The watchdog is also mindful that e cigarettes also carry an obvious association with tobacco advertising, which has been banned on TV since 1965.

Des Naugton, managing director of BAT owned Nicoventures which makes e cigarette brand Vype, said “In the light of the differing rules today, we are supportive of the e cigarette advertising consultation which is being led by the Committees of Advertising practice (CAP and Broadcast Committee of Advertising).

“We hope that it will result in clear and consistent rules for advertising e cigarettes across all media to ensure that they are marketed responsibly, whilst giving appropriate marketing freedoms to allow this important product category to develop further.”

Shahriar Coupal, secretary of CAP which is a sister body to the Advertising Standards Authority (ASA), said “The market for e cigarettes is fast growing and the existing rules haven’t been able to give advertisers the clarity they need. By proposing new specific rules, we’re providing a clear framework for responsible advertising. Given the potential association with tobacco products and the fact that many e cigarettes contain nicotine, it’s important we put in place strong responsibility rules to make sure that the public and particularly children are protected.”

The ASA recently banned an ad from e cigarette maker VIP, which featured a woman saying “I want you to get it out. I want to see it. Feel it. Hold it. Put it in my mouth.” The ad led to 1,156 complaints.

The introduction of new rules comes as the European Union also considers the future of e cigarette advertising. It has passed rules which mean that EU member states have to decide if e cigarettes are tobacco or medicine products.

According to Mintel, the market in e cigarettes ballooned by 340% to 193m in 2013. Last month, BAT launched a campaign for its Vype electronic cigarettes the first time a big tobacco company has marketed products on TV since cigar ads were banned in 1991.

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