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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Los angeles approves sweeping e-cigarette restrictions –

On a 14 0 vote, lawmakers outlawed “vaping” the practice of inhaling the vapors produced by e cigarettes in most work sites and many public places, including parks and certain beaches.

Lawmakers voted to continue allowing e cigarette use in so called vaping lounges, where patrons can try the various e juices that are loaded into the battery powered devices. And they narrowly defeated a push by the e cigarette industry to let the practice continue in 21 and over establishments, such as bars and nightclubs.

The debate saw lawmakers share their own experiences with tobacco and the hazards that come with it. Councilman Mitch O’Farrell, who pushed for the new restrictions, spoke of his unhappiness at breathing secondhand smoke during his days as a waiter in the early 1990s.

Councilman Joe Buscaino spoke of a relative’s decision to turn to e cigarettes after years of smoking. And Council President Herb Wesson, in the most passionate speech of the day, described his decades long addiction to cigarettes, a habit he told his colleagues would almost certainly kill him one day.

Wesson said he began smoking because he wanted to be cool.

“When you re 15, you want to be cool,” he said. “And I will not support anything anything that might attract one new smoker.”

The debate brought to light the strong views on each side of the e cigarette debate. Backers of the battery powered devices portray them as a godsend for those looking to quit conventional smoking. They also warned the research has not yet proven that second hand emissions from e cigarettes are harmful to others.

Buscaino introduced an amendment to allow bars and nightclubs to be removed from the new regulations. But his measure received only six votes two shy of the amount needed for passage.

E cigarettes “are not tobacco,” he said. “And I don t think they should be regulated exactly the same way.”

Foes of e cigarettes said they threaten to make smoking socially acceptable after years of public opinion campaigns to discourage the habit. Young people who get hooked on the nicotine in e cigarettes may then turn to tobacco use, said Jonathan Fielding, director of the Los Angeles County Department of Public Health.

“We don’t want to risk e cigarettes undermining a half century of successful tobacco control,” he said.


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