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 use triples in 2 years –

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Figures released by health charity ASH show that the number of adults in Britain using the devices has risen from an estimated 700,000 in 2012 to 2.1 million this year.

Nearly two thirds of users said they also smoked regular cigarettes, with the other third being ex smokers, an increase in the proportion of former smokers compared to previous years.

Just 1% of those asked who never smoked said they had tried electronic cigarettes.

The YouGov survey found that more than half of ex smokers (51.7%) say that they have tried electronic cigarettes, compared with just 8.2% in 2010.

It showed there has been a consistent rise in the number of current or former smokers who use electronic cigarettes on a regular basis up from 2.7% in 2010 to 17.7% this year.

Just over a third (35%) of British adults believe that electronic cigarettes are good for public health while just under a quarter (22%) disagree, the survey said.

The main reason given by ex smokers for using electronic cigarettes were “to help me stop smoking entirely” (71%) and “to help me keep off tobacco” (48%).

And the biggest reason for current smokers was to “help me reduce the amount of tobacco I smoke, but not stop completely” (48%) followed by “to save money compared with smoking tobacco” (37%) and “to help me stop smoking entirely” (36%).

For the first time, the Ash YouGov survey also asked about the type of electronic cigarette commonly used, with just under half (47%) using rechargeable e cigarettes with pre filled cartridges and 41% using rechargeable devices with a separate tank. Just 8% said they most often use disposable e cigarettes.

Deborah Arnott, chief executive of Ash said “The dramatic rise in use of electronic cigarettes over the past four years suggests that smokers are increasingly turning to these devices to help them cut down or quit smoking. Significantly, usage among non smokers remains negligible.

“While it is important to control the advertising of electronic cigarettes to make sure children and non smokers are not being targeted, there is no evidence from our research that e cigarettes are acting as a gateway into smoking.”

The YouGov survey questioned 12,269 adults online last month.

A separate ongoing survey the Smoking Toolkit Study carried out in England has also found that smokers are increasingly using electronic cigarettes as an aid to quitting, overtaking use of medicinal nicotine products such as patches and gum.

The proportion of smokers who have quit in the last year has increased and smoking rates in England are continuing to fall.

Professor Robert West, who led the study, said “Despite claims that use of electronic cigarettes risks renormalising smoking, we found no evidence to support this view. On the contrary, electronic cigarettes may be helping to reduce smoking as more people use them as an aid to quitting.”

Charles Hamshaw Thomas, legal and corporate affairs director of e cigarette company E Lites, said “Study after study is showing that scaremongering that e cigarettes are luring people into tobacco is baseless nonsense. The reverse is going on smokers are switching into e cigarettes as the way to reduce the harm from tobacco.

“As a result tobacco sales are falling in the UK. And so too are sales of nicotine replacement products (gum and patches) which, as academic research shows, have had limited success.”

He added “The phenomenal growth of e cigarettes as the most popular alternative to smoking is accelerating the delivery of government targets on reducing tobacco consumption.

“The big e cigarette companies like E Lites are keen to work together with government to draw up codes on advertising, bans on sales to children, product quality and safety and continuing research.”