Prevalence and attributes of roll-your-own smokers in the International Tobacco Control (ITC) Four Country Survey

Smokers' strategies to reduce tobacco spending: self-reported use and differences across subgroups. Findings from the International Tobacco Control (ITC) Netherlands Survey

BACKGROUND

The cost of tobacco is one of the most reported reasons for smoking cessation. Rather than quitting, smokers can use also strategies to reduce tobacco expenditure while continuing smoking, such as smoking less or using price-minimising strategies. The Netherlands announced to increase the price of a pack cigarettes from seven (2018) to ten euros (2023), to reduce tobacco prevalence and consumption. This study explores the self-reported strategies to reduce tobacco spending among Dutch smokers, and whether this differed per age, income, and education. Additionally, we analysed among quitters in these subgroups whether price played a role in their decision to quit.

METHODS

Cross-sectional survey data from the International Tobacco Control (ITC) Netherlands Wave 2 (September-November 2020, N = 1915) was used. Strategies to reduce spending among smokers (N = 1790) were: reducing consumption, bulk buying, switching to cheaper products or buying from low-taxed sources. These were collapsed into: reducing consumption (solely or in combination with other behaviours), solely price-minimising behaviours (such as buying cheaper brands), or no strategies to reduce spending. Associations between strategies and characteristics were analysed through multinomial and binary logistic regression models. Second, we explored which subgroups were more likely to report that price played a role in their decision to quit among quitters (N = 125).

RESULTS

The majority of smokers used strategies to reduce tobacco spending: 35.6% reduced consumption and 19.3% used solely price-minimising strategies. 82.1% of quitters reported that price played a role in their decision to quit. Low-income individuals were more likely to report price as a reason for quitting and reduce consumption, but also to buy cheaper products. Highly nicotine dependent smokers were more likely to use price-minimising behaviours, and less likely to reduce consumption.

CONCLUSIONS

The majority reported using strategies to reduce spending or that price played a role in their decision to quit. Reducing consumption was the most reported strategy. Low-income smokers were more likely to reportedly reduce consumption, buy cheaper products, or quit. Price policies have the potential to reduce socioeconomic inequalities in smoking. To discourage price-minimising behaviours, such as switching to cheaper products, reducing price differences between products should be prioritized.

Reasons for Using Roll-Your-Own Tobacco and Perceptions of Health-Promoting Pack Inserts: A Focus Group Study with Roll-Your-Own Tobacco Smokers in Scotland

INTRODUCTION

Use of roll-your-own (RYO) tobacco is increasing in most regions, but few qualitative studies have explored why RYO smokers use this product, and no study has considered their views of health-promoting pack inserts.

METHODS

Eight focus groups were conducted with 18-35-year-old RYO smokers (n = 50) in Greater Glasgow (Scotland) in February-March 2020 to explore reasons for using RYO and perceptions of health-promoting inserts. Participants were shown four inserts adapted from those required in cigarette packs in Canada, with all encouraging quitting, and two RYO-specific inserts explaining that RYO is not less harmful than cigarettes.

RESULTS

Lower price, better taste, the pleasure of rolling and ability to customize roll-ups, and the belief that RYO was less harmful than cigarettes were drivers for use. There were mixed perceptions of the extent to which inserts would capture attention if included in RYO packs. The positive messaging used on the Canadian inserts was considered motivational and inspirational, and contrasted with the on-pack warnings. The messaging on the RYO inserts, in comparison, was viewed unfavorably and generally dismissed. Participants, most of whom were not interested in quitting, did not feel that inserts would lead them to change their smoking behavior. However, some felt that the Canadian inserts could be helpful for those thinking about quitting and young people contemplating smoking.

CONCLUSIONS

Inserts with positive messaging about quitting, rather than messaging explicating the harms of RYO, were preferred by RYO smokers. What, if any, RYO-specific messaging resonates with RYO smokers merits further attention.

IMPLICATIONS

Aside from price, taste, and the pleasure associated with rolling and ability to individualize roll-ups, the erroneous belief that RYO is less harmful than cigarettes was a key reason for use. While inserts with positive messaging about quitting, as used on the Canadian inserts, were viewed as potentially helpful, inserts that challenged the idea that RYO was not less harmful than cigarettes were generally dismissed. Research is needed to understand what types of RYO-specific messaging could most effectively be used on inserts, or indeed in other media, to challenge the misperceptions that many RYO smokers hold.

Prevalence and correlates of roll-your-own cigarette smoking among South African adults during 2010–2011 and 2017–2018

INTRODUCTION

The increasing use of roll-your own (RYO) cigarettes has been documented globally, but there are no recent data from South Africa, particularly among youths and low-income groups. We assessed changes in prevalence and correlates of RYO smoking among South African adults during 2010–2011 and 2017–2018, and explored expenditure differences between daily smokers of RYO and manufactured cigarettes.

METHODS

Nationally representative data of South Africans aged ≥16 years used in this study were from the South African Social Attitudes Survey (SASAS) for 2010–2011 (n=6116), and 2017–2018 (n=5799). Current RYO cigarette use included daily and non-daily use. Annual expenditures were estimated based on typical usage patterns for daily users. Descriptive and multivariable analyses were performed using Stata Version 15 with the level of statistical significance set at p<0.05.

RESULTS

The prevalence of ever RYO cigarette use increased from 6.5% (95% CI: 5.6–7.5) during 2010–2011, to 8.5% (95% CI: 7.0–10.0) during 2017–2018 (p=0.026). Current RYO cigarette use prevalence however remained largely unchanged when we compared 2010–2011 to 2017–2018 (5.2% vs 6.3%, p=0.544). During 2017–2018, current RYO cigarette use prevalence was highest among men (11.6%), those who self-identified as Coloreds (11.1%), people aged 25–34 years (7.8%), those with no schooling (7.5%), and those unemployed (9.8%). Annual expenditures associated with typical patterns of daily RYO cigarette smoking were substantially less than for smoking of manufactured cigarettes.

CONCLUSIONS

The prevalence of ever RYO cigarette use increased between 2010–2011 and 2017–2018. Current RYO cigarette use during 2017–2018 was more prevalent among Coloreds, Black Africans, youths, those with lower education, and the unemployed. This study’s findings highlight the need to harmonize taxation of cigarettes and RYO cigarettes, and to intensify implementation of evidence-based tobacco control and prevention interventions in South Africa.

Review of cigars and cigar-type products as potential sources of consumer exposure to heavy metals

The popularity of cigars, growing since 1993, has not gone hand in hand with the increased interest of researchers in these products. Although the literature widely describes the harmfulness of tobacco and the content of toxic substances in tobacco products, the topic is often treated selectively as relating primarily to cigarettes and rarely extends to other products of the broadly defined tobacco industry. However, there is no reason to marginalize the harmful effects of other nicotine products, (which include tobacco products such as cigars). The study analyzed the available literature on the content of selected heavy metals in cigar tobacco. Among the heavy metals, the following contents of elements in tobacco were recorded in cigars: Fe (420-2200 µg/g), Mn (100-370 µg/g), Zn (14-180 µg/g), Cu (15-140 µg/g), Pb (not detected-32 µg/g), Cd (nd-19 µg/g), Ni (nd-13 µg/g), Cr (nd-10 µg/g), Co (0.65-1.0 µg/g), As (nd-0.66 µg/g), Hg (18-25 ng/g). Importantly, the values often differ between cigars of different origins and types, indicating the need for more extensive research.

The ecological impacts of discarded cigarette butts

Cigarette butts, one of the most littered items globally, present a unique challenge to ecosystems due to their ubiquity, persistence, and potential for harm. Over 35 studies have examined the toxicity of cigarette butts in biota from aquatic and terrestrial habitats from microbes to mice, but many organisms and habitats have not been tested. Two-thirds of studies are on aquatic organisms, and lethal effects were common. Research on the impacts on terrestrial life is lagging behind. Cigarette butts can affect the growth, behaviour, and reproductive output of individual organisms in all three habitats, but research on wider effects on biodiversity and ecosystem functioning is lacking. Here, we summarise the ecotoxicological concerns and identify important knowledge gaps for future research.

Trends in Attempts to Quit Smoking in England Since 2007: A Time Series Analysis of a Range of Population-Level Influences

AIM

To quantify population-level associations between quit attempts and factors that have varied across 2007-2017 in England.

METHODS

Data from 51 867 past-year smokers participating in the Smoking Toolkit Study (a monthly cross-sectional survey of individuals aged 16+) were aggregated over an 11-year period. Time series analysis was undertaken using ARIMAX modeling. The input series were: (1) prevalence of smoking reduction using (a) e-cigarettes and (b) nicotine replacement therapy; (2) prevalence of roll-your-own tobacco use; (3) prevalence of (a) smoking and (b) non-daily smoking; (4) mass media expenditure; (5) average expenditure on smoking; (6) characteristics in the form of (a) prevalence of high motivation to quit, (b) average age, (c) proportion from lower social grades, and (d) average number of cigarettes smoked; and (7) implementation of tobacco control policies.

RESULTS

There was a decline in the prevalence of quit attempts from 44.6% to 33.8% over the study period. The partial point-of-sale ban was associated with a temporary increase in quit attempt prevalence (Badjusted = 0.224%; 95% confidence interval [CI] 0.061 to 0.388). Quit attempts were positively associated with the prevalence of high motivation to quit (Badjusted = 0.165%;95% CI 0.048 to 0.282) and negatively associated with the mean age of smokers (Badjusted = -1.351%; 95% CI -2.168 to -0.534). All other associations were nonsignificant.

CONCLUSION

Increases in the prevalence of high motivation to quit was associated with higher prevalence of attempts to quit smoking, while an increase in the mean age of smokers was associated with lower prevalence. The introduction of the partial point-of-sale ban appeared to have a temporary positive impact.

IMPLICATIONS

This study provides insight into how monthly changes in a wide range of population-level factors are associated with changes in quit attempts over an extended time period in a country with a strong tobacco control climate. The findings suggest a need for intervention or policy to stimulate quit attempts in older smokers. Otherwise, increases in the mean age of a smokers appears likely to undermine wider efforts to promote quit attempts in a population.

The Underminers: Booming Illicit Trade of Roll Your Own and Waterpipe Tobacco in Turkey

OBJECTIVES

The aim of this study is to specify the reasons and extents of illicit Roll-Your-Own (RYO) and waterpipe tobacco (WPT) markets which broke out in Turkey and to determine the destruction of these markets over the effectiveness of main tobacco control measures, the effect of this destruction on increase in tobacco use and the measures that can be taken.

MATERIALS AND METHODS

Reliable data about illicit trade are quite limited. This study was prepared through using the recommended methods on illicit trade in "Methods for Evaluating Tobacco Control Policies" published by the International Agency For Research On Cancer (IARC) and "Understand, Measure, and Combat Tobacco Smuggling" published by the World Bank.

RESULTS

RYO and WPT markets are almost totally illicit in Turkey. These markets serve to tobacco outbreak by increasing total tobacco use far beyond the official data through its size surpassing 30% of total consumption and they have begun to invalidate all of the principle tobacco control measures by hindering and undermining them.

CONCLUSION

In order to implement tobacco control measures effectively in Turkey, these illicit markets must be included in system by doing necessary regulations promptly. It is strongly needed that illicit RYO and WPT production and trade should be described as newly emerged threat areas in tobacco control literature, since other countries may suffer from similar problems.

Transitions from and to roll-your-own tobacco, perceptions and health beliefs among smokers: findings from the EUREST-PLUS ITC Europe Surveys

BACKGROUND

The prevalence of roll-your-own tobacco (RYO) in Europe has been increasing. The aim of this study was to investigate transitions between factory-made (FM) cigarettes and RYO in a longitudinal sample of European smokers, and their perceptions of relative harmfulness and knowledge of health effects.

METHODS

We used data collected from the EUREST-PLUS ITC 6 European Country (6E) Surveys in 2016 (n = 6011 smokers) and in 2018 (n = 6027) in Germany, Greece, Hungary, Poland, Romania and Spain. A total of 3195 cohort respondents were interviewed in both years. Use of RYO and FM, knowledge of health effects of smoking as well as perceptions about RYO were assessed. We used logistic regression models to explore sociodemographic correlates of transitions from one product to the other, of perceptions and knowledge related to smoking health effects.

RESULTS

Approximately 7.4% of exclusive FM smokers transitioned to RYO and 29.5% of exclusive RYO smokers transitioned to FM cigarettes from 2016 to 2018. RYO use in 2018 was more frequent among smokers of low education and income, but none of these factors were associated with transitions. Most RYO smokers perceived RYO as cheaper than FM and 21.7% of them considered RYO to be less harmful than FM. Knowledge of the health effects of smoking was not associated with type of product smoked.

CONCLUSIONS

RYO is popular among European smokers; its lower cost seems to be a major factor for RYO users; reasons for transitions to and from RYO are less clear and need to be further investigated.

Trends in and Correlates of Use of Roll-Your-Own Cigarettes: A Population Study in England 2008-2017

INTRODUCTION

Understanding the use of cheaper roll-your-own (RYO) cigarettes may have implications for tobacco tax policy. We examined trends in RYO cigarette use in England between 2008 and 2017, and characterized users' sociodemographic and smoking profiles.

METHODS

We used data from 211 469 respondents to a survey representative of the adult (≥16 years) population. In current smokers across the entire study period (n = 43 389), we assessed multivariable associations between cigarette type (RYO or factory-made [FM]) and sociodemographic and smoking characteristics. Among current smokers in 2008 and 2017 (n = 7685), we tested interactions between year and cigarette type to assess the stability of each characteristic.

RESULTS

Between 2008 and 2017, FM cigarette use declined from 15.3% to 9.2% whereas RYO use increased from 6.7% to 8.1%. Greater odds of RYO use were observed among younger, male smokers from lower social grades, who were more addicted and used electronic cigarettes (ORrange = 1.28-1.86, p < .001). Lower odds of RYO use were observed among nondaily smokers, those with high motivation to stop, and higher spending on smoking (ORrange = 0.46-0.89, p ≤ .001). The RYO smoker profile was relatively stable between 2008 and 2017. However, compared with FM use, RYO use increased in younger (p < .001) and female (p = .019) smokers, and there was a relatively smaller decline in the proportion cutting down or trying to quit (p = .004).

CONCLUSION

In England, RYO use increased when overall smoking prevalence and FM use decreased. The profile of RYO smokers remained relatively stable, with users typically younger, male, more addicted, deprived, spending less on smoking, and less inclined to quit than FM smokers.

IMPLICATIONS

This population-based study provides novel insight into recent trends in RYO use in England, providing an up-to-date understanding of the profile of RYO smokers. Without the consistent application of tax across the range of combustible products, smokers who are more dependent are able to capitalize on the lower cost of RYO in order to continue smoking, undermining the potential benefit of taxation on cessation.

Population-level predictors of changes in success rates of smoking quit attempts in England: a time series analysis

AIMS

To quantify associations between the success of smoking quit attempts and factors that have varied throughout 2007-2018 at a population level.

DESIGN

time series analysis using Autoregressive Integrated Moving Average with Exogeneous Input (ARIMAX) modelling.

SETTING AND PARTICIPANTS

Data were aggregated from 54 847 past-year smokers taking part in the Smoking Toolkit Study which involves monthly repeated cross-sectional household surveys of individuals aged 16+ in England.

MEASUREMENTS

The input series were: (1) attempts at smoking reduction using (a) e-cigarettes and (b) nicotine replacement therapy (NRT); (2) use during a quit attempt of (a) e-cigarettes, (b) NRT over-the-counter, (c) medication on prescription and (d) face-to-face behavioural support; (3) use of roll-your-own tobacco; (4) prevalence of (a) smoking and (b) non-daily smoking; (5) tobacco control mass media expenditure; (6) expenditure on smoking; (7) smoker characteristics in the form of (a) high motivation to quit, (b) average age, (c) socio-economic status and (d) cigarette consumption; (8) implementation of tobacco control policies; and (9) quit attempt rate.

FINDINGS

The licensing of NRT for harm reduction was associated with a 0.641% [95% confidence interval (CI) = 0.073-1.209, P = 0.027] increase in the mean point prevalence of the success rate of quit attempts. For every 1% increase in the mean point prevalence of e-cigarette use and use of prescription medication during a quit attempt, the mean point prevalence of successful quit attempts increased by 0.106% (95% CI = 0.011-0.201, P = 0.029) and 0.143% (95% CI = 0.009-0.279, P = 0.038), respectively. For every 1% increase in the mean expenditure on tobacco control mass media, the mean point prevalence of successful quit attempts increased by 0.046% (95% CI = 0.001-0.092, P = 0.046). Other associations were not statistically significant.

CONCLUSION

In England between 2007 and 2018, licensing of nicotine replacement therapy for use in harm reduction, greater use of e-cigarettes and prescription medications during a quit attempt and higher expenditure on tobacco control mass media were all associated with higher success rates of quit attempts.

Roll-your-own cigarette smoking among youth experiencing homelessness

INTRODUCTION

Roll-your-own (RYO) cigarette smoking is uncommon among young smokers in the U.S. but may be more widespread among those experiencing homelessness as it is a less expensive source of cigarettes. This study examines the prevalence and correlates of RYO use among young cigarette smokers experiencing homelessness.

METHODS

The analytic sample consisted of 433 unaccompanied homeless youth who reported past month use of factory-manufactured cigarettes. Participants were sampled from 25 street and service sites in Los Angeles County, and completed a survey on their tobacco-related behaviors and cognitions.

RESULTS

RYO use was reported by 43% of cigarette smokers. Among those who filled RYOs with tobacco, 87% rolled them with used tobacco (typically mixed with new tobacco). Most RYO smokers reported engaging in high-risk smoking practices, such as smoking discarded cigarettes. Although RYO smokers were more likely than other smokers to perceive RYOs as less risky in general, these groups did not differ in the perceived relative harm, expense, and ease of access of RYOs compared to regular cigarettes. Multivariable analyses indicated that RYO use was associated with older age, less perceived riskiness of RYOs, greater exposure to RYO smokers, and stronger future intentions to smoke.

CONCLUSION

RYOs may encourage continued tobacco use among youth experiencing homelessness and pose additional health risks despite users' beliefs to the contrary. Future research is needed to obtain more detailed information on RYO practices and motivations for use, as well as how to address RYOs in efforts to reduce tobacco use in this population.

Roll-your-own cigarette use in Italy: sales and consumer profile-data from PASSI surveillance, 2015-2016

OBJECTIVES

The use of roll-your-own (RYO) cigarette has substantially increased in most high-income countries recently. This work aims to update Italian trends on loose tobacco sales and to describe the consumer profile of predominant RYO users.

METHODS

Data from the Italian Agency of Customs and State Monopolies and from PASSI (Italian behavioral risk factor surveillance system) were used. Information on 16,858 interviews to current smokers aged 18-69 was analyzed.

RESULTS

Sales of loose tobacco increased more than sevenfold between 2004 and 2017. In 2015-2016, 11.6% of smokers reported smoking predominantly RYO cigarettes, with higher percentages among the youngest where a significant association between use of RYO and education was observed, unlike what happened in older adults. The association between economic difficulties and use of RYO was observed only in older adults.

CONCLUSIONS

A growing trend in RYO cigarette sales was registered between 2004 and 2017. In young smokers, the greater use of RYO was observed among the most educated regardless of financial strain, while in older ones among those with economic difficulties.

Roll-your-own cigarette use and smoking cessation behaviour: a cross-sectional population study in England

OBJECTIVES

Roll-your-own (RYO) cigarettes have become popular in the UK and reduce the cost of smoking, potentially mitigating the impact of tax increases on quitting. We examined whether RYO cigarette use was associated with reduced motivation to quit smoking, incidence of quit attempts and quit success.

DESIGN

Cross-sectional survey.

SETTING

England.

PARTICIPANTS

38 590 adults who reported currently smoking or having stopped within the past 12 months.

MAIN OUTCOME MEASURES

Motivation to quit smoking, quit attempt in the last year, motives for quitting and quit success were regressed onto RYO cigarette use, adjusting for sociodemographic variables and level of cigarette addiction. Mediation by weekly spending on smoking was tested.

RESULTS

Compared with manufactured cigarette smokers, RYO smokers had lower odds of high motivation to quit (OR=0.77, 95% CI 0.73 to 0.81) or having made a quit attempt (OR=0.87, 95% CI 0.84 to 0.91). Among those who had attempted to quit smoking, quit success did not differ by cigarette type (OR=1.00, 95% CI 0.89 to 1.12), but RYO smokers were less likely to report cost of smoking as a motive to quit (OR=0.68, 95% CI 0.61 to 0.74). Spending on smoking mediated the association between RYO use and quit attempts (β=-0.02, SE=0.003, 95% CI -0.03 to -0.02).

CONCLUSIONS

In England, compared with smokers of manufactured cigarettes, RYO cigarette smokers appear to have lower motivation to quit and lower incidence of quit attempts but similar success of quit attempts. The lower cost of RYO smoking appears to mediate the lower incidence of quit attempts among RYO users.

Keeping smoking affordable in higher tax environments via smoking thinner roll-your-own cigarettes: Findings from the International Tobacco Control Four Country Survey 2006-15

BACKGROUND

Roll-Your-Own tobacco (RYO) use is increasingly popular in many countries: it is generally cheaper than factory-made cigarettes (FM), and smokers can further reduce costs by adjusting the amount of tobacco in each cigarette. However, the level of risk of RYO compared with FM cigarettes is similar and does not meaningfully change with cigarette weight. We assessed the weight of tobacco in RYO cigarettes across jurisdictions with differing tobacco taxes/prices and over time.

METHOD

Six waves of the International Tobacco Control 4 Country longitudinal study of smokers and recent ex-smokers, providing 3176 observations from exclusive RYO users covering 2006-15, are used to calculate the weight of tobacco used in RYO cigarettes in the US, Canada, Australia, and the UK. Multilevel regression analyses were used to compare weights across countries, socio-demographic factors, and over time.

RESULTS

Smokers in the UK and Australia, where tobacco is relatively expensive, show higher levels of exclusive RYO use (25.8% and 13.8% respectively) and lower mean weights of tobacco per RYO cigarette (0.51 g(sd 0.32 g) and 0.53 g(0.28 g)), compared with both Canada and especially the US (6.0% and 3.5%, and 0.76 g(0.45 g) and 1.07 g(0.51 g)). Smokers in the UK and Australia also exhibited a statistically significant year-on-year decrease in the mean weight of each RYO cigarette.

CONCLUSIONS

Taxation of RYO should increase considerably in the UK and Australia so that RYO and FM cigarettes are taxed equivalently to reduce RYO attractiveness and inequalities. Other measures to reduce the price differentials, including taxing RYO solely on weight, are also discussed.

Prevalence and characteristics of young adult smokers in the U.S. in the precontemplation stage of smoking cessation

INTRODUCTION

The precontemplation stage of smoking cessation refers to having no intention to quit smoking in the next six months. We aimed to estimate the prevalence of and characteristics associated with the precontemplation stage of smoking cessation among U.S. young adult smokers to inform the development of targeted interventions.

METHODS

We analyzed data in 2017 from the 2013-2014 National Adult Tobacco Survey. Young adult (18-29 years old) daily and non-daily smokers were included (n = 1809). We applied weighted multiple logistic regression models to examine the associations between demographics, tobacco use behaviors, exposure to pro- and anti-tobacco messages, and the precontemplation stage of smoking cessation.

RESULTS

59.0% of U.S. young adult smokers are in the precontemplation stage of smoking cessation. Unemployment was positively associated with being in the precontemplation stage of smoking cessation (AOR = 1.42 95% CI = 1.05, 1.91). Smoking every day (vs. some days), more cigarettes smoked per day, using roll-your-own cigarettes (vs. manufactured cigarettes only), currently smoking cigars, and signing up for promotional offers were positively associated with being in the precontemplation stage of smoking cessation (p < 0.05). Non-Hispanic Black was negatively associated with precontemplation stage (AOR = 0.40, 95% CI = 0.27, 0.59). Not smoking after viewing a health warning on a cigarette pack was negatively associated with the precontemplation stage of smoking cessation (AOR = 0.36, 95% CI = 0.25, 0.51).

CONCLUSIONS

Many U.S. young adult smokers classify as being in the precontemplation stage of smoking cessation. Interventions to motivate these smokers to quit smoking with considerations of their specific characteristics (e.g., being unemployed) are warranted.

Gender and Time-Related Differences in a Large Cohort of Heavy Smokers Applying for Treatment to a Tobacco Centre in Italy

Introduction: Attempts to quit smoking have increased in recent years, but the patterns of variations over time are unknown. We aimed at describing time- and sex-related changes in a population of 2,231 subjects who adhered to a smoking-cessation programme lasting 13 years in Italy.

Methods: We measured baseline expired carbon monoxide (expired-CO), Fagerstrom nicotine dependence, Q-MAT test, Zung depression and anxiety scale, Hospital anxiety and depression scale (HADS).

Results: Study population included 1,278 men and 953 women who smoked a median of 25 (interquartile range, IQR: 20–32) and 20 (IQR: 20–30) cigarettes/day, respectively (p < 0.001). The proportion of female smokers increased from 37.5% in 2001–2003 to 46.9% in 2010–2013 (p = 0.003). There was a significant time-related reduction of median daily cigarette consumption, with a more noticeable decrease in men. Median expired-CO (parts per million (ppm)) increased only in women, from 18 (IQR: 14–23) in 2001–03 to 20 (IQR: 14–28) in 2010–13 (p = 0.001), whereas Fagerstrom test for nicotine dependence did not vary. Differences in psychological characteristics in the last 3 years showed that women were more clinically depressed than men (16.6% versus 7.6%, p < 0.001).

Conclusions: Despite a decrease in the number of daily cigarettes with time, expired-CO tends to increase in women, who are also more clinically depressed and anxious than men. A personalised approach to specific subgroups of smokers, with special emphasis on a psychological support for women, seems appropriate.

It's not all about price: factors associated with roll-your-own tobacco use among young people - a qualitative study

Background

Smoking prevalence in Ireland is falling in all age groups, but the prevalence of roll-your-own (RYO) tobacco use is rising among young people. This qualitative study aims to explore and understand the factors associated with young people’s use of RYO products.

Methods

Semi-structured individual and focus group interviews were conducted with young people aged 16–22 years. Participants were recruited from a higher education institution and youth organisations working with early school leavers across Dublin. In total, there were 62 participants in the study, consisting of 22 individual interviews and eight focus group interviews with 40 participants. Categoric and thematic data analysis was used to generate the findings.

Results

We identified two broad themes, incentivising and disincentivising factors. The lower cost of RYO products compared to pre-manufactured cigarettes was the most important incentive for users. However, other product characteristics, such as the artisanal factors associated with RYO products were also found. Social and environmental influences were apparent, in which certain groups and environments facilitated and normalised RYO practices. Amenities and facilities often provided smokers with normalised spaces which could be dedicated to the enactment of rolling practices and to the creation and maintenance of social bonds with other users. Disincentives included negative features related to the product itself, adverse health effects, and the effects of tobacco denormalisation.

Conclusions

While the lower cost of RYO products is very important for young smokers, other product characteristics and influences also incentivise and disincentivise use. A more comprehensive understanding of the multi-dimensional appeal of these products will assist policymakers to target strategies to reduce the attractiveness to young smokers of these products.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-5921-8) contains supplementary material, which is available to authorized users.

Who uses rollies? Trends in product offerings, price and use of roll-your-own tobacco in Australia

Objective

We examined the roll-your-own (RYO) tobacco product market in Australia from 2001 to 2016. Trends in use of RYO tobacco among Australian adults were examined for 2004–2016.

Methods

Changes in brand availability, pouch sizes and lowest priced products were noted from trade magazines. Prevalence of smoking of RYO and factory-made (FM) cigarettes among those 18 years and older was obtained from five consecutive waves of a large (n>21 000) nationally representative triennial survey from 2004 to 2016. Trends in cigarette use were examined using logistic regression.

Results

Changes in the Australian RYO market from 2001 to 2016 included a doubling in the number of brands, progressively smaller pouch sizes with smaller increases in price than in traditional RYO and comparable FM products. While use of FM cigarettes declined between 2004 and 2016, the proportion of adults exclusively using RYO tobacco linearly increased with each survey wave (OR 1.03, 95% CI 1.02 to 1.05, p<0.001), from 1.2% in 2004 to 1.7% in 2016. Exclusive RYO use among current smokers increased more among females than males, and young adults compared with those aged 30 years or older, but did not differ by socioeconomic status.

Conclusions

In contrast to substantial declines in FM cigarette use, exclusive use of RYO cigarettes increased in Australians since 2004, particularly among females and young adults. This has corresponded to a period of substantial changes to the RYO market, including progressively smaller and relatively more affordable products. Policy action to reduce price-related marketing and correct consumer misinformation about RYO tobacco are urgently required.

Differences in nicotine dependence, smoke exposure and consumer characteristics between smokers of machine-injected roll-your-own cigarettes and factory-made cigarettes

BACKGROUND

Consumption of machine-injected roll-your-own (RYO) filtered cigarettes made from pipe tobacco increased almost 7-fold from 2008 to 2011 in the United States.

METHODS

We used data from the Pennsylvania Adult Smoking Study to compare the differences in sociodemographic, smoking topography, nicotine dependence, and cotinine levels between 280 smokers using factory made (FM) cigarettes and 68 smokers using RYO cigarettes.

RESULTS

RYO smokers were older (41 vs. 37, P = 0.053), had significantly lower levels of income (P < 0.001) and education (P = 0.007), and were less likely to be fully employed (P = 0.009). RYO smokers consumed more cigarettes per day [CPD] (21 vs. 15, P < 0.001), and had a higher mean score on the Fagerström Test for Cigarette/Nicotine Dependence (5.2 vs. 4.1, P < 0.001). The main reasons for choosing RYO cigarettes were the lower cost (68%) and believed they are less harmful (12%). The average cost per pack of FM cigarettes was $5.74 vs. $1.13 for RYO. In multiple regression analyses, RYO smokers had significantly lower cotinine levels across all levels of CPD. Among smokers of king-size cigarettes, mean interpuff interval (P < 0.05) and total smoke duration (P < 0.01) per cigarette was significantly greater in RYO smokers. In laboratory measurements, RYO cigarettes contained more tobacco by weight than FM cigarettes, but weight varied by both tobacco and cigarette tube brands.

CONCLUSIONS

Machine-injected RYO cigarettes made from pipe tobacco are cheaper than FM cigarettes but may have higher abuse liability. Smokers who might otherwise reduce their cigarette consumption or quit altogether may continue to smoke RYO cigarettes due to their affordability.

Compared characteristics of current vs. past smokers at the time of diagnosis of a first-time lung or head and neck cancer: a cross-sectional study

Background

Active smoking at the time of diagnosis of a first head & neck (H&N) or lung cancer is associated with a worse cancer outcome and increased mortality. However, the compared characteristics of active vs. former smokers at cancer diagnosis are poorly known.

Methods

In 371 subjects with a first H&N or lung cancer, we assessed: 1) socio-demographic features; 2) lifelong types of smoking; 3) alcohol use disorder identification test (AUDIT); 4) cannabis abuse screening test (CAST); and 5) Mini International Neuropsychiatric Interview (MINI). Using a multivariable regression model, we compared the profile of current smokers and past smokers.

Results

Current smokers more frequently exhibited H&N cancer (OR 3.91; 95% CI [2.00–6.51]; p <  0.0001) and ever smoking of hand-rolled cigarettes (OR 2.2; 95% CI [1.25–3.88]; p = 0.007). Among subjects with lung cancer (n = 177), current smoking was primarily associated with ever smoking of hand-rolled cigarettes (OR 2.88; 95% CI [1.32–6.30]; p = 0.008) and negatively associated with age (OR 0.92; 95% CI [0.89–0.96]; p <  0.001). Among subjects with H&N cancer (n = 163), current smokers exhibited a significantly greater AUDIT score (OR = 1.08; 95% CI [1.01–1.16]; p = 0.03).

Conclusion

At the time of diagnosis of the first lung or H&N cancer, current smoking is highly associated with previous type of smoking and alcohol drinking patterns.

Trial registration

NCT01647425; Registration date: July 23, 2012.

Have higher cigarette taxes in the United States discouraged smoking? A review of data from 1999-2013

INTRODUCTION

Cigarette smoking continues to be a leading cause of preventable morbidity and premature death in the United States. This study examined the impact of federal and state cigarette excise taxes on adult smoking between 1999 and 2013.

METHODS

Data came from the National Health Interview Survey, Behavioural Risk Factor Surveillance System and Tax Burden on Tobacco. Analyses were done from 1999-2013, 2002-6 and 2009-13. Associations between cigarette taxes, prices and smoking were examined in several states based on cigarette tax: Missouri and Virginia (low tax), Florida, Nebraska and Nevada (median tax) and New York and Rhode Island (high tax).

RESULTS

Smoking declined nationally from 22.8% (1999) to 19.0% (2013) with rates falling from 25.7% to 20.5% in men and 21.5% to 15.3% in women. Annual cigarette consumption (in millions) declined from 432,758 to 280,534 and per capita consumption from 1,621 cigarettes (1999) to 894 cigarettes (2013). Smoking declined across age, gender, race/ethnicity, education and poverty level in 2009-13 compared to 2002-6 with large reductions in states with higher cigarette taxes. Negative correlations between cigarette tax and smoking, and positive correlations between cigarette tax and price, were seen.

CONCLUSIONS

Higher cigarette taxes appear to have had a negative impact on smoking in the US. Our data suggest that states with higher cigarette taxes have lower smoking rates than states with lower taxes. Tax measures are however implemented as part of a comprehensive tobacco control package and further research is needed to assess the relative contribution of cigarette tax on smoking reductions in the states examined.

US adult tobacco users' absolute harm perceptions of traditional and alternative tobacco products, information-seeking behaviors, and (mis)beliefs about chemicals in tobacco products

INTRODUCTION

Harm perceptions about tobacco products may influence initiation, continued use, and cessation efforts. We assessed associations between adult traditional tobacco product use and absolute harm perceptions of traditional and alternative tobacco products. We also described the topics individuals looked for during their last search for information, their beliefs about chemicals in cigarettes/cigarette smoke, and how both relate to harm perceptions.

METHODS

We ran multivariable models with jackknife replicate weights to analyze data from the 2015 administration of the National Cancer Institute's Health Information National Trends Survey (N=3376).

RESULTS

Compared to never users, individuals reported lower perceived levels of harm for products they use. Among current tobacco users, ethnicity, thinking about chemicals in tobacco, and information-seeking were all factors associated with tobacco product harm perceptions. In the full sample, some respondents reported searching for information about health effects and cessation and held misperceptions about the source of chemicals in tobacco.

CONCLUSIONS

This study fills a gap in the literature by assessing the absolute harm perceptions of a variety of traditional and alternative tobacco products. Harm perceptions vary among tobacco products, and the relationship among tobacco use, information seeking, thoughts about chemicals in tobacco products, and harm perceptions is complex. Data suggest that some individuals search for information about health effects and cessation and hold misperceptions about chemicals in tobacco products. Future inquiry could seek to understand the mechanisms that contribute to forming harm perceptions and beliefs about chemicals in tobacco products.

The relation between cigarette taxes and older adult smoking in Zhejiang and Gansu: what happened following the 2009 Chinese Tax adjustments?

Background

In May 2009, the Chinese government raised cigarette excise tax rates and adjusted standards for Grade A cigarettes and Grade B cigarettes. The present study aimed to examine the effects of the tax adjustments in 2009 on smoking behaviors and health outcomes among smokers aged above 45.

Methods

Data from the 2008 and 2012 China Health and Retirement Longitudinal Study of Zhejiang and Gansu provinces were used to estimate the influence of tax increase on the number of cigarettes smoked daily and health capital. The sample included 706 smokers who were 45 years old and older at the time of data collection in 2008. The sample group was surveyed again in 2012. The final sample size was 1366. Logit model was applied.

Results

Cigarette tax adjustment in 2009 resulted in the decrease in the likelihood of smoking 0–10 cigarettes per day by 1.06%; the increase in the likelihood of those smoking 11–20 cigarettes per day by 0.44%; and, those smoking 20 cigarettes or more by 0.63%; the decrease in the likelihood of good health by 0.47%; the increase in the prevalence of chronic disease by 1.34%.

Conclusions

The smoke tax adjustment in 2009 worsened individual unhealthy smoking behaviors and health outcomes. The proposed cigarette tax levied at the retail level can reduce the State Tobacco Monopoly Administration’s control overall and each price and increase the influence of the market on cigarette consumption in China.

Chinese immigrant men smokers' sources of cigarettes in Canada: A qualitative study

Background

Immigrants often experience economic hardship in their host country and tend to belong to economically disadvantaged groups. Individuals of lower socioeconomic status tend to be more sensitive to cigarette price changes. This study explores the cigarette purchasing patterns among Chinese Canadian male immigrants.

Methods

Semi-structured in-depth interviews were conducted with 22 Chinese Canadian immigrants who were smoking or had quit smoking in the last five years.

Results

Because of financial pressures experienced by participants, the high price of Canadian cigarettes posed a significant challenge to their continued smoking. While some immigrants bought fully-taxed cigarettes from licensed retailers, more often they sought low-cost cigarettes from a variety of sources. The two most important sources were cigarettes imported during travels to China and online purchases of Chinese cigarettes. The cigarettes obtained through online transactions were imported by smoking or non-smoking Chinese immigrants and visitors, suggesting the Chinese community were involved or complicit in sustaining this form of purchasing behavior. Other less common sources included Canada-USA cross border purchasing, roll your-own pouch tobacco, and buying cigarettes available on First Nations reserves.

Conclusions

Chinese Canadian immigrant men used various means to obtain cheap cigarettes. Future research studies could explore more detailed features of access to expose gaps in policy and improve tobacco regulatory frameworks.

Changes in cigarette expenditure minimising strategies before and after a cigarette tax increase

BACKGROUND

Smokers use cigarette expenditure minimising strategies (CEMS) to alleviate the effect of tax increases on their cigarette expenses. We examined changes in smokers' CEMS use before and after a 2013 Minnesota $1.75 cigarette tax increase.

METHODS

Data were from representative samples of smokers who participated in the Minnesota Adult Tobacco Survey 2010 (n=948) and 2014 (n=1229). Participants indicated CEMS used in the past year from a list. Weighted multiple logistic regressions were used to examine changes in prevalence of each CEMS use over time adjusting for demographics and cigarette consumption. Characteristics associated with CEMS use in 2014 were examined.

RESULTS

Between 2010 and 2014, more smokers tried to save money on cigarettes by rolling their own cigarettes (from 19% to 29%), using other tobacco products (from 13% to 25%), and buying cigarettes from cheaper places (from 48% to 55%). Yet, fewer smokers used coupons/promotions (from 63% to 50%) and bought cigarettes by the carton (from 39% to 32%). These changes varied somewhat by race/ethnicity and education, for example, more smokers with <high school education used discount brands over time than more educated smokers. CEMS use in 2014 varied by demographics, for example, smokers with lower education were more likely than those with higher education to purchase discount brands, roll their own cigarettes, use coupons/promotions and cut back on smoking (p<0.05).

CONCLUSIONS

Socially disadvantaged smokers were most likely to use CEMS and continue smoking after a cigarette tax increase. Regulations that would reduce CEMS use could boost the effectiveness of cigarette tax increases.

How effective has tobacco tax increase been in the Gambia? A case study of tobacco control

OBJECTIVES

The objective of the present study was to evaluate how effective tobacco tax increase has been in increasing price of tobacco products and reducing tobacco consumption in the Gambia. In addition, it tests the hypothesis that tobacco tax revenue grows while tobacco consumption decreases as a result of tax and price increase.

SETTING

The study is designed at the macroeconomic level to examine the import of tobacco products and revenue collected from tobacco taxation in a low-income setting.

PARTICIPANTS

The participants of this study are the government officials employed in the Ministry of Finance and Economic Affairs (MoFEA), the Gambia and the Gambia Revenue Authority, who are in charge of planning and implementing the tobacco tax policy in the Gambia.

INTERVENTIONS

The study includes 2 consecutive interventions in tobacco tax policy in the Gambia. The first intervention was moving the tax base for the uniform specific excise tax on cigarettes from weight to pack of cigarettes in 2013. The second intervention involved increasing the excise and the environmental tax on tobacco products in 2014.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome measures were the cost, insurance and freight value and the price of tobacco products. The secondary outcome measures included the import of tobacco products and tobacco tax revenue.

RESULTS

In 2013-2014, the Gambia MoFEA raised the specific excise rate, which increased price, reduced consumption and generated significantly more government revenue from tobacco products. This is a clear evidence of the win-win outcome of raising tobacco tax. In addition, the Gambia has set the example of harmonising tax rates between tobacco products that reduces the substitution between tobacco products.

CONCLUSIONS

The Gambia presents the best practice in tobacco taxation. There is need for documenting more country-specific evidence on the win-win outcome of raising tobacco tax.

Trends and socioeconomic differences in roll-your-own tobacco use: findings from the ITC Europe Surveys

OBJECTIVES

To examine if exclusive Roll-Your-Own (RYO) tobacco use relative to factory-made (FM) cigarette use has been rising over time, to determine the extent to which economic motives and perceptions that RYO cigarettes are less harmful act as primary motivations for use, and to examine the association of income and education with the level of RYO tobacco use among smokers in four European countries.

METHODS

Data were obtained from the International Tobacco Control (ITC) Europe Surveys, and a cohort sample of 7070 smokers from the Netherlands, Germany, France and UK were interviewed between June 2006 and December 2012. Generalised estimating equations (GEE) were used to assess trends in RYO use, and whether RYO consumption varied by socioeconomic variables.

RESULTS

Exclusive RYO use over the study period has increased significantly in the UK from 26.4% in 2007 to 32.7% in 2010 (p<0.001); France from 12.2% in 2006 to 19.1% in 2012 (p<0.001); and Germany from 12.7% in 2007 to 18.6% in 2011 (p=0.031), with increased borderline significantly in the Netherlands (31.7% to 34.3%, p=0.052), from 2008 to 2010. Over three-quarters of users in each of the study countries indicated that lower price was a reason why they smoked RYO. Just over a fourth of smokers in the UK, less than a fifth in France, and around a tenth in Germany and the Netherlands believed that RYO is healthier. Compared with exclusive FM users, exclusive RYO users were more likely to have lower incomes and lower education.

CONCLUSIONS

Effective tobacco tax regulation is needed in the European Union and elsewhere to eliminate or reduce the price advantage of RYO tobacco. Additional health messages are also required to correct the misperception that RYO tobacco is healthier than FM cigarettes.

The use of legal, illegal and roll-your-own cigarettes to increasing tobacco excise taxes and comprehensive tobacco control policies: findings from the ITC Uruguay Survey

BACKGROUND

Little research has been done to examine whether smokers switch to illegal or roll-your-own (RYO) cigarettes in response to a change in their relative price.

OBJECTIVE

This paper explores how relative prices between three cigarette forms (manufactured legal, manufactured illegal and RYO cigarettes) are associated with the choice of one form over another after controlling for covariates, including sociodemographic characteristics, smokers' exposure to antismoking messaging, health warning labels and tobacco marketing.

METHODS

Generalised estimating equations were employed to analyse the association between the price ratio of two different cigarette forms and the usage of one form over the other.

FINDINGS

A 10% increase in the relative price ratio of legal to RYO cigarettes is associated with a 4.6% increase in the probability of consuming RYO cigarettes over manufactured legal cigarettes (p≤0.05). In addition, more exposure to antismoking messaging is associated with a lower odds of choosing RYO cigarettes over manufactured legal cigarettes (p≤0.05). Non-significant associations exist between the manufactured illegal to legal cigarette price ratios and choosing manufactured illegal cigarettes, suggesting that smokers do not switch to manufactured illegal cigarettes as prices of legal ones increase. However, these non-significant findings may be due to lack of variation in the price ratio measures. To improve the effectiveness of increased taxes and prices in reducing smoking, policymakers need to narrow price variability in the tobacco market. Moreover, increasing antismoking messaging reduces tax avoidance in the form of switching to cheaper RYO cigarettes in Uruguay.

Smokers' strategic responses to sin taxes: evidence from panel data in Thailand

In addition to quitting and cutting consumption, smokers faced with higher cigarette prices may compensate in several ways that mute the health impact of cigarette taxes. This study examines three price avoidance strategies among adult male smokers in Thailand: trading down to a lower-priced brand, buying individual sticks of cigarettes instead of packs, and substituting roll-your-own tobacco for factory-manufactured cigarettes. Using two panels of microlevel data from the International Tobacco Control Southeast Asia Study, collected in 2005 and 2006, we estimate the effects of a substantial excise tax increase implemented throughout Thailand in December 2005. We present estimates of the marginal effects and price elasticities for each of five consumer behaviors. We find that, controlling for baseline smoking characteristics, sociodemographics, and policy variables, quitting is highly sensitive to changes in cigarette prices, but so are brand choice, stick-buying, and use of roll-your-own tobacco. Neglecting such strategic responses leads to overestimates of a sin tax's health impact, and neglecting product substitution distorts estimates of the price elasticity of cigarette demand. We discuss the implications for consumer welfare and several policies that mitigate the adverse impact of consumer responses.

Roll-your-own cigarettes in Europe: use, weight and implications for fiscal policies

Excise duties on roll-your-own (RYO) tobacco, which are generally based on RYO cigarettes containing 1 g of tobacco, are lower than duties on factory-made (FM) cigarettes. This provides a price incentive for smokers to switch to RYO, the use of which is increasing across Europe. To effectively approximate duties on the two types of products, accurate data on the weight of RYO cigarettes are required. We provide updated information on RYO use and RYO cigarette weight across Europe. From a representative face-to-face survey conducted in 2010 in 18 European countries (Albania, Austria, Bulgaria, Czech Republic, Croatia, England, Finland, France, Greece, Hungary, Ireland, Italy, Latvia, Poland, Portugal, Romania, Spain and Sweden), we considered data from 5158 current smokers aged 15 years or above, with available information on daily consumption of FM and RYO cigarettes separately. In Europe, 10.4% of current smokers (12.9% of men and 7.5% of women) were 'predominant' RYO users (i.e. >50% of cigarettes smoked). This proportion was highest in England (27.3%), France (16.5%) and Finland (13.6%). The median weight of one RYO cigarette is 0.75 g (based on 192 smokers consuming exclusively RYO cigarettes). The proportion of RYO smokers is substantial in several European countries. Our finding on the weight of RYO cigarettes is consistent with the scientific literature and industry documents showing that the weight of RYO cigarettes is substantially lower than that of FM ones. Basing excise duties on RYO on an average cigarette weight of 0.75 g rather than 1 g would help increase the excise levels to those on FM cigarettes.

Characterizing Concurrent Tobacco Product Use Among Homeless Cigarette Smokers

INTRODUCTION

Cigarette smoking prevalence rates are high among homeless adults (>70%); however, little is known about concurrent tobacco or other nicotine product use (i.e., concurrent use [CU]) in this population. CU may impact smoking quit rates and confer greater risk of health problems within this vulnerable population. This study characterized CU in a sample of homeless smokers and compared cigarette-only smokers (C-OS) to concurrent users (CUs) on participant characteristics and factors known to be associated with smoking cessation.

METHODS

Participants were 178 adult conventional cigarette smokers from a homeless shelter in Dallas, TX. Sociodemographic characteristics, number of homelessness episodes, tobacco dependence, and items characterizing use of several tobacco/nicotine products over the last 30 days including use frequency, reasons for use, and perceived health risks were described. Sociodemographic characteristics, number of homelessness episodes, tobacco dependence, stress, readiness to quit (RTQ) smoking, and number of smoking quit attempts in the last year were compared between the C-OS and CUs groups using t tests and chi-square tests.

RESULTS

CU was prevalent (n = 91; 51.1%), and 49.5% of CUs reported the use of ≥2 products in addition to conventional cigarettes. Compared with C-OS, CUs were younger and had more homelessness episodes, higher expired breath carbon monoxide levels, and higher stress (ps < .05). Groups did not differ on sex, race, other dependence indicators, RTQ, or previous quit attempts.

CONCLUSIONS

CU is common among homeless smokers. CUs and C-OS did not differ in their RTQ smoking, though greater stress among the CUs may represent a hurdle for cessation.

Smoking patterns in Great Britain: the rise of cheap cigarette brands and roll your own (RYO) tobacco

BACKGROUND

In Britain, the tobacco industry segments cigarettes into four price categories-premium, mid-price, economy and ultra-low-price (ULP). Our previous work shows that tobacco companies have kept ULP prices stable in real terms. Roll your own (RYO) tobacco remains cheaper still.

METHODS

Analysis of 2001-08 General Household Survey data to examine trends in use of these cheap products and, using logistic regression, the profile of users of these products.

RESULTS

Among smokers, the proportion using cheap products (economy, ULP and RYO combined) increased significantly in almost all age groups and geographic areas. Increases were most marked in under 24 year olds, 76% of whom smoked cheap cigarettes by 2008. All cheap products were more commonly used in lower socio-economic groups. Men and younger smokers were more likely to smoke RYO while women smoked economy brands. Smokers outside London and the South East of England were more likely to smoke some form of cheap tobacco even once socio-economic differences were accounted for.

CONCLUSIONS

This paper demonstrates that cheap tobacco use is increasing among young and disadvantaged smokers compromising declines in population smoking prevalence. Thus, tobacco industry pricing appears to play a key role in explaining smoking patterns and inequalities in smoking.

Make your own cigarettes: toxicant exposure, smoking topography, and subjective effects

BACKGROUND

Despite considerable use of make your own (MYO) cigarettes worldwide and increasing use in the United States, relatively little is known about how these cigarettes are smoked and the resultant toxicant exposure.

METHODS

In a laboratory study, we compared two types of MYO cigarettes-roll your own (RYO) and personal machine made (PMM)-with factory-made (FM) cigarettes in three groups of smokers who exclusively used RYO (n = 34), PMM (n = 23), or FM (n = 20). Within each group, cigarettes were smoked in three conditions: (i) after confirmed overnight tobacco abstinence; (ii) in an intense smoking paradigm; and (iii) without restrictions. All cigarettes were smoked ad lib through a smoking topography unit.

RESULTS

Plasma nicotine significantly increased after cigarettes in all conditions except PMM in the intense smoking paradigm. Puff volume, puff duration, total puff volume, and puff velocity did not differ between cigarette types but the puffs per cigarette and time to smoke were significantly smaller for RYO compared with PMM and FM. Regardless of the cigarette, participants consumed the first three puffs more vigorously than the last three puffs.

CONCLUSIONS

Despite the belief of many of their consumers, smoking MYO cigarettes is not a safe alternative to FM cigarettes. Like FM, MYO cigarettes expose their users to harmful constituents of tobacco smoke. Despite differences in size and design their puffing profiles are remarkably similar.

IMPACT

These data are relevant to health and regulatory considerations on the MYO cigarettes.

Comparison between the mainstream smoke of eleven RYO tobacco brands and the reference tobacco 3R4F

In this study 11 commercial roll-your-own (RYO) tobacco brands sold in Spain and the reference tobacco 3R4F have been smoked and several components of the mainstream tobacco smoke have been analyzed. Cigarettes were prepared using commercial tubes, and were smoked under smoking conditions based on the ISO 3308. The gaseous and condensed fractions of the smoke from RYO brands and 3R4F have been analyzed and compared. RYO tobaccos, as opposed to 3R4F, present lower amounts of condensed products in the traps than in the filters. In general, RYO tobaccos also provide lower yields of most of the compounds detected in the gas fraction. The yield of CO is between 15.4 and 20.4 mg/cigarette. In most of the cases studied, RYO tobaccos deliver higher amounts of nicotine than the 3R4F tobacco. On average, the yield of the different chemical families of compounds appearing in the particulate matter retained in the cigarette filters tends to be around three times higher than those obtained from 3R4F, whereas similar values have been obtained in the particulate matter retained in the traps located after the filters. It can be concluded that RYO tobaccos are not less hazardous than the reference tobacco, which may be contrary to popular belief.

Impact of reduced ignition propensity cigarette regulation on consumer smoking behavior and quit intentions: evidence from 6 waves (2004-11) of the ITC Four Country Survey

Background

Although on the decline, smoking-related fires remain a leading cause of fire death in the United States and United Kingdom and account for over 10% of fire-related deaths worldwide. This has prompted lawmakers to enact legislation requiring manufacturers to implement reduced ignition propensity (RIP) safety standards for cigarettes. The current research evaluates how implementation of RIP safety standards in different countries influenced smokers’ perceptions of cigarette self-extinguishment, frequency of extinguishment, and the impact on consumer smoking behaviors, including cigarettes smoked per day and planning to quit.

Methods

Participants for this research come from Waves 3 through 8 of the International Tobacco Control (ITC) Four Country Survey conducted longitudinally from 2004 through 2011 in the United States, United Kingdom, Australia, and Canada.

Results

Perceptions of cigarette self-extinguishment and frequency of extinguishment increased concurrently with an increase in the prevalence of RIP safety standards for cigarettes. Presence of RIP safety standards was also associated with a greater intention to quit smoking, but was not associated with the number of cigarettes smoked per day. Intention to quit was higher among those who were more likely to report that their cigarettes self-extinguish sometimes and often, but we found no evidence of an interaction between frequency of extinguishment and RIP safety standards on quit intentions.

Conclusions

Overall, because these standards largely do not influence consumer smoking behavior, RIP implementation may significantly reduce the number of cigarette-related fires and the associated death and damages. Further research should assess how implementation of RIP safety standards has influenced smoking-related fire incidence, deaths, and other costs associated with smoking-related fires.

Do consumers of manufactured cigarettes respond differently to price changes compared with their Roll-Your-Own counterparts? Evidence from New Zealand

BACKGROUND

Price-based mechanisms are an important tobacco cessation policy tool in New Zealand (NZ) and so measurement of smokers' reaction to price changes is crucial in determining efficacy of this approach. Although approximately two-thirds of NZ tobacco demand is for manufactured cigarettes (MC) and one-third is for Roll-Your-Own (RYO) tobacco, previous price elasticity estimates have ignored differences between RYO tobacco and MC consumers.

METHODS

We employ a seemingly unrelated regression econometric approach applied to quarterly data over the period 1991-2011 to estimate price elasticities of demand separately for MC and RYO tobacco.

RESULTS

Estimate of price elasticity of demand for MC is -1.033, and -0.441 for RYO tobacco. RYO tobacco is an inferior good; a 1% increase in average weekly income is associated with a 0.8% reduction in demand. RYO tobacco is a substitute for MC; a 1% increase in the price of MC is associated with a 0.867% increase in demand for RYO tobacco.

CONCLUSIONS

There is significantly different price responsiveness across the two tobacco product types. MC smokers react far more strongly to price increases compared with RYO tobacco smokers. These findings suggest that pricing mechanisms may be more effective for reducing MC demand than for RYO tobacco. However, substitution between products means that this pricing effect is muted by the uptake of RYO tobacco use. Cessation policy specific to RYO use should be designed to target this growing group.

The choice of discount brand cigarettes: a comparative analysis of International Tobacco Control surveys in Canada and the USA (2002-2005)

BACKGROUND

Increasing tobacco taxes to increase price is a proven tobacco control measure. This article investigates how smokers respond to tax and price increases in their choice of discount brand cigarettes versus premium brands.

OBJECTIVE

To estimate how increase in the tax rate can affect smokers' choice of discount brands versus premium brands.

METHODS

Using data from International Tobacco Control surveys in Canada and the USA, a logit model was constructed to estimate the probability of choosing discount brand cigarettes in response to its price changes relative to premium brands, controlling for individual-specific demographic and socioeconomic characteristics and regional effects. The self-reported price of an individual smoker is used in a random-effects regression model to impute price and to construct the price ratio for discount and premium brands for each smoker, which is used in the logit model.

FINDINGS

An increase in the ratio of price of discount brand cigarettes to the price of premium brands by 0.1 is associated with a decrease in the probability of choosing discount brands by 0.08 in Canada. No significant effect is observed in case of the USA.

CONCLUSIONS

The results of the model explain two phenomena: (1) the widened price differential between premium and discount brand cigarettes contributed to the increased share of discount brand cigarettes in Canada in contrast to a relatively steady share in the USA during 2002-2005 and (2) increasing the price ratio of discount brands to premium brands-which occurs with an increase in specific excise tax-may lead to upward shifting from discount to premium brands rather than to downward shifting. These results underscore the significance of studying the effectiveness of tax increases in reducing overall tobacco consumption, particularly for specific excise taxes.

'Roll-your-own' cigarette smoking in South Africa between 2007 and 2010

Background

The prevalence of smoking and consumption of cigarettes have decreased in South Africa over the last 20 years. This decrease is a result of comprehensive tobacco control legislation, particularly large cigarette tax increases. However, little attention has been given to the potential use of ‘roll-your-own’ cigarettes as cheaper alternatives, especially among the socio-economically disadvantaged population. This study therefore sought to determine socio-demographic correlates of ‘roll-your-own’ cigarette use among South African adults (2007–2010).

Methods

This secondary data analysis used a merged dataset from two nationally representative samples of 2 907 and 3 112 South African adults (aged ≥16 years) who participated in the 2007 and 2010 annual South African Social Attitude Surveys respectively. The surveys used a face-to-face interviewer-administered questionnaire. The overall response rates were 83.1% for 2007 and 88.9% for 2010. Data elicited included socio-demographic data, current smoking status, type of tobacco products used, past quit attempts and self-efficacy in quitting. Data analysis included chi-square statistics and multi-variable adjusted logistic regression analysis.

Results

Of the 1 296 current smokers in this study, 24.1% (n = 306) reported using roll-your-own cigarettes. Some of whom also smoked factory-made cigarettes. Roll-your-own cigarette smoking was most common among black Africans and was more common among male smokers than among female smokers (27% vs 15.8%; p < 0.01). Compared to smokers who exclusively used factory-made cigarettes, roll-your-own cigarette smokers were less confident that they could quit, more likely to be less educated, and more likely to reside in rural areas. The odds of use of roll-your-own cigarette were significantly higher in 2010 than in 2007 (OR = 1.24; 95% CI: 1.07-1.44).

Conclusions

Despite an aggregate decline in smoking prevalence, roll-your-own cigarette smoking has increased and is particularly common among smokers in the lower socio-economic group. The findings also suggest the need for a more intensive treatment intervention to increase self-efficacy to quit among roll-your-own cigarette smokers.

Cigarette price-minimization strategies by U.S. smokers

BACKGROUND

Smokers may react to cigarette excise tax increases by engaging in price-minimization strategies (i.e., finding ways to reduce the cost of cigarette smoking) rather than by quitting or reducing their cigarette use, thereby reducing the public health benefits of such tax increases.

PURPOSE

To evaluate the state and national prevalence of five common cigarette price-minimization strategies and the size of price reductions obtained from these strategies.

METHODS

Using data from the 2009-2010 National Adult Tobacco Survey, the prevalence of five common price-minimization strategies by type of strategy and by smoker's cigarette consumption level were estimated. The price reductions associated with these price-minimization strategies also were evaluated. Analyses took place in November 2012.

RESULTS

Approximately 55.4% of U.S. adult smokers used at least one of five price-minimization strategies in the previous year, with an average reduction of $1.27 per pack (22.0%). Results varied widely by state.

CONCLUSIONS

Cigarette price-minimization strategies are practiced widely among current smokers, and resulting price reductions are relatively large. Policies that decrease opportunities to effectively apply cigarette price-minimization strategies would increase the public health gains of cigarette excise tax increases.

Make your own cigarettes: characteristics of the product and the consumer

INTRODUCTION

Despite a worldwide increase in the use of Make Your Own (MYO) cigarettes, there is little research characterizing MYO smokers in the United States and the cigarettes they make.

METHODS

In a single laboratory visit, exclusive MYO smokers brought 5 MYO cigarettes they prepared at home, completed demographic and smoking history questionnaires, and prepared 25 cigarettes using their own tobacco and materials.

RESULTS

Participants were mostly male (86.7%), average age of 41.3 years, and smoked an average of 19.5 (SD = 7.9) MYO cigarettes per day. They produced two types of cigarettes-by rolling tobacco in a paper leaf (Roll Your Own [RYO, n = 56]) and by injecting tobacco into a tube (Personal Machine Made [PMM, n = 42]). The PMM cigarettes were significantly larger than RYO cigarettes (p < .001). Home- (0.97 g) and laboratory-produced (0.95 g) PMM cigarettes did not differ by weight; however, the RYO cigarettes made at home (0.45 g) were slightly, but significantly, larger than those produced in the laboratory [0.43 g (p < .05)]. There was significant internal consistency in the weight of RYO and PMM cigarettes (intraclass correlation coefficient = 0.82, 0.84, respectively). Time to produce RYO cigarettes (53 s/cigarette) was significantly longer than that of PMM cigarettes (42 s/cigarette) (p < .01).

CONCLUSIONS

By using commercially available tobacco, tubes, and paper, experienced MYO smokers can quickly and consistently prepare cigarettes that may be useful in laboratory smoking topography and exposure experiments. Increasing the regulation of Factory Made (FM) cigarettes may lead to increased use of MYO cigarettes with unknown toxicant exposure and health risks to their consumers.

Roll-your-own tobacco use among Canadian youth: is it a bigger problem than we think?

Background

Despite the apparent decline in the popularity of roll-your-own (RYO) cigarettes over the past few decades, RYO tobacco products are widely available and used by a substantial number of adult smokers. Considering research has yet to examine the prevalence of RYO tobacco use among youth populations, this manuscript examines the prevalence of RYO tobacco use and factors associated with RYO use in a nationally representative sample of youth smokers from Canada.

Methods

This study used data collected from 3,630 current smokers in grades 9 to 12 as part of the 2008-09 Canadian Youth Smoking Survey (YSS). Descriptive analyses of the sample demographic characteristics, smoking status, cigarettes per day, weekly spending money, and frequency of marijuana use were examined by RYO tobacco ever use and RYO tobacco current use. Two logistic regression models were used to examine factors associated with RYO tobacco ever use and RYO tobacco current use.

Results

We identified that 51.2% of current smokers were RYO ever users and 24.2% were RYO current users. The prevalence of RYO current users was highest in Atlantic Canada (40.1%) and lowest in Quebec (12.3%). RYO current users were more likely to be male (OR 1.27), to be daily smokers (OR 1.75), to use marijuana once a month or more (OR 2.74), and to smoke 11 or more cigarettes per day (OR 6.52). RYO current users were less likely to be in grade 11 (OR 0.65) or grade 12 (OR 0.40) and less likely to have between $20 to $100 (OR 0.44) or more than $100 (OR 0.45) of disposable income.

Conclusions

Developing a better understanding of RYO tobacco use among youth is important for advancing population-level tobacco control prevention strategies and cessation programs. We identified that RYO tobacco use is not a negligible problem among Canadian youth. Ongoing research is needed to continue monitoring the prevalence of RYO use among youth and the factors associated with its use, but to also monitor if this more affordable tobacco product is being targeted to price sensitive youth smokers.

Patterns of alternative tobacco use among adolescent cigarette smokers

INTRODUCTION

Alternative tobacco use among adolescents who smoke cigarettes is a growing public health concern, and evidence suggests that patterns of alternative tobacco use varies with respect to cigarette consumption and frequency of cigarette use. This study aimed to examine (a) whether variations in adolescent cigarette smoking and alternative tobacco use can be explained by underlying subtypes and (b) if these subtypes differ in their demographic and psychosocial characteristics.

METHODS

Using data from the 2009 National Youth Tobacco Survey, latent class analysis (LCA) was used to identify patterns of cigarette smoking and alternative tobacco use among 2746 current (past 30-day) smokers. After identification, classes were analyzed using multinomial logistic regression to examine differences based on demographics and smoking-related characteristics.

RESULTS

Four of the six latent classes identified (non-daily light smokers, chippers, chippers-Indulgent, intermittent smokers) reflected consumption, frequency, and history of cigarette use characteristics commonly attributed to light and intermittent smokers, and the remaining two classes (daily smokers, daily smokers-Indulgent) presented cigarette use behaviors commonly attributed to daily smokers. There were clear class differences in levels of alternative tobacco product use, demographics, and psychosocial characteristics.

CONCLUSIONS

Study findings are consistent with previous work demonstrating demographic and psychosocial differences between cigarette smokers based on their alternative tobacco use. The six latent classes identified highlight the importance of including measures of alternative tobacco use when characterizing adolescent cigarette smokers as well as recognizing and tailoring interventions toward these different groups of tobacco users.

Neighborhood socioeconomic status modifies the association between individual smoking status and PAH-DNA adduct levels in prostate tissue

Interactions between smoking and neighborhood-level socioeconomic status (SES) as risk factors for higher polycyclic aromatic hydrocarbon (PAH) DNA adduct levels in prostate tissue were investigated. PAH-DNA adducts were measured by immunohistochemistry with staining intensity measured in optical density units by semiquantitative absorbance image analysis in tumor adjacent tissue from 400 prostatectomy specimens from the Henry Ford Health System in Detroit. For each subject, their U.S. Census tract of residence was classified as being of higher or lower SES using the median value of the distribution of the proportion of tract residents with a high-school education. Generalized estimating equation models were used to assess interactions between neighborhood-level SES and smoking status, adjusting for race, age, education level, tumor volume, primary Gleason grade and prostate specific antigen (PSA) at diagnosis. There was a statistical interaction (P = 0.004) between tract-level SES and smoking status. In lower SES tracts smoking status was not associated with adduct staining, but in higher SES tracts adduct staining intensity was 13% (P = 0.01) higher in ever-smokers as compared to never-smokers. Among never-smokers, living in a lower SES tract was associated with a 25% higher mean staining intensity (P < 0.001). Neighborhood SES modifies the association between individual smoking status and PAH-DNA adduct levels in prostate tissue.

Trends in roll-your-own smoking: findings from the ITC Four-Country Survey (2002-2008)

OBJECTIVE

To establish the trends in prevalence, and correlates, of roll-your-own (RYO) use in Canada, USA, UK and Australia, 2002-2008.

METHODS

Participants were 19,456 cigarette smokers interviewed during the longitudinal International Tobacco Control (ITC) Four-Country Survey in Canada, USA, UK, and Australia.

RESULTS

"Predominant" RYO use (i.e., >50% of cigarettes smoked) increased significantly in the UK and USA as a proportion of all cigarette use (both P < .001) and in all countries as a proportion of any RYO use (all P < .010). Younger, financially stressed smokers are disproportionately contributing to "some" use (i.e., ≤50% of cigarettes smoked). Relative cost was the major reason given for using RYO, and predominant RYO use is consistently and significantly associated with low income.

CONCLUSIONS

RYO market trends reflect the price advantages accruing to RYO (a product of favourable taxation regimes in some jurisdictions reinforced by the enhanced control over the amount of tobacco used), especially following the impact of the Global Financial Crisis; the availability of competing low-cost alternatives to RYO; accessibility of duty-free RYO tobacco; and tobacco industry niche marketing strategies. If policy makers want to ensure that the RYO option does not inhibit the fight to end the tobacco epidemic, especially amongst the disadvantaged, they need to reduce the price advantage, target additional health messages at (young) RYO users, and challenge niche marketing of RYO by the industry.

Fiscal and policy implications of selling pipe tobacco for roll-your-own cigarettes in the United States

BACKGROUND

The Federal excise tax was increased for tobacco products on April 1, 2009. While excise tax rates prior to the increase were the same for roll-your-own (RYO) and pipe tobacco, the tax on pipe tobacco was $21.95 per pound less than the tax on RYO tobacco after the increase. Subsequently, tobacco manufacturers began labeling loose tobacco as pipe tobacco and marketing these products to RYO consumers at a lower price. Retailers refer to these products as "dual purpose" or "dual use" pipe tobacco.

METHODS

Data on tobacco tax collections comes from the Alcohol and Tobacco Tax and Trade Bureau. Joinpoint software was used to identify changes in sales trends. Estimates were generated for the amount of pipe tobacco sold for RYO use and for Federal and state tax revenue lost through August 2011.

RESULTS

Approximately 45 million pounds of pipe tobacco has been sold for RYO use from April 2009 to August 2011, lowering state and Federal revenue by over $1.3 billion.

CONCLUSIONS

Marketing pipe tobacco as "dual purpose" and selling it for RYO use provides an opportunity to avoid paying higher cigarette prices. This blunts the public health impact excise tax increases would otherwise have on reducing tobacco use through higher prices. Selling pipe tobacco for RYO use decreases state and Federal revenue and also avoids regulations on flavored tobacco, banned descriptors, prohibitions on shipping, and reporting requirements.