We found the highest level of any RYO use is in the UK, followed by Australia, Canada and the USA, confirming and extending our earlier findings [3
]. Consistent with our hypotheses, any use of RYO is increasing in the UK and probably in the USA, but is falling in Canada. RYO use relative to FM use is changing in quite different ways in the four countries under study, albeit with some core similarities. Understanding such a complex dynamic requires a systemic approach to the issue [25
] to elucidate the dynamic relationships between countries, economic drivers, cultural norms, tobacco industry strategies, access to alternatives to RYO, tobacco control policies, and other factors.
Predominant use of RYO increased as a proportion of any RYO use in all four countries, most markedly in the USA, and increased as a proportion of total cigarette smoking in the USA and the UK. Compared to sometime RYO users, predominant users were more likely to have low-income, tended to be older, were disproportionately male and far more likely to cite “taste” as a reason for smoking RYO. However, young smokers experiencing financial stress were more likely to be sometime users than predominant users, and this interaction was independent of country.
We analysed the results to establish the extent to which they are consistent with price and financial need being the primary drivers of RYO use. Smokers themselves say that saving money is the main reason for RYO use, as this and other studies have found [1
]. Further, use is highest in low income groups, especially predominant use. We assume that the typical pattern is for smokers to start using RYO on an occasional basis and only progress to predominant use if there are sufficient reasons for doing so (e.g., financial stress). Once this happens they begin to espouse different rationales for their RYO use (e.g., taste).
The clearest increases in predominant use were in the USA and UK: the two countries that arguably have been hardest hit by the GFC [14
]. It is noteworthy that in Waves Six (2007) and Seven (2008), RYO smokers in the USA were more likely than FM smokers to say they were experiencing financial stress. One could speculate that in light of the financial pressures, in the USA smokers may have switched to RYO to reduce expenditure. The high, and increasing, level of UK RYO use reported by other studies [11
] was replicated. It is clear that RYO is a stable, mainstream market segment in the UK and easy access to duty-free RYO as well as a favourable tax regime [13
] makes it relatively easy to reduce tobacco-related expenditure via RYO use.
Even before the GFC, the US industry was forecasting growth in the RYO segment, with cigarette manufacturers moving to take over existing niche manufacturers like Lane and Santa Fe. By 2004 Reynolds/Brown & Williamson thereby controlled 36% of the market, with Republic controlling an equivalent proportion [30
]. Furthermore, as economic conditions deteriorated, manufacturers introduced tubes with longer filters (saving tobacco), and extra slim rolling papers, filter tips, and rolling machines [31
The predominant use of RYO in Australia is relatively stable, but is increasing as a proportion of all RYO smoking, with use of sometime RYO falling substantially from Wave One to Wave Seven. The GFC affected Australia less than the USA and the UK and this may be partially responsible for the flat profile of predominant use compared to the clear increases in prevalence observed in the latter two countries.
The pattern of RYO use in Canada was the most distinct. Both predominant and sometime RYO use fell significantly (although sometime use fell proportionally more). The use of cheap contraband FM cigarettes among Canadians, especially the young [18
], and the burgeoning share of discounted or cheap brands of cigarettes in that country, which had risen from 2% of the total market in 2002 to 42.8% in 2005 [32
], are all factors that could help explain the decline. The net prevalence of RYO smokers (relative to FM smokers) saying they have been experiencing financial stress has been falling. It is likely that many of those experiencing substantial financial stress are using contraband tobacco or other low-cost alternatives that are available in Canada.
RYO cigarettes are an effective way of continuing to smoke at lower cost. This results in less revenue to government, made worse when the RYO tobacco is smuggled or otherwise taxed at lower rates. Of particular concern is the likelihood that this low-cost tobacco reduces incentives for smokers to quit. Similarly, there are concerns that RYO smoking might incur greater harm to health [7
]. All these are good reasons for governments to act to reduce RYO use as part of an overall tobacco control strategy which could also include initiatives to support disadvantaged smokers (e.g., augmented programs of smoking cessation assistance and transfer of additional tax revenues to the poorest sectors of society).
Even though the proportion believing that RYO is healthier than FM use is a minority, that any group of smokers should hold such misconceptions is concerning. From a public health perspective, there is no justification for allowing tobacco companies to add “value” to RYO tobacco through messages about it being “natural” and “less harmful.”
In light of the prevalence of the health reason, we would argue that RYO smokers (especially the young) should not only be subject to the same health messages as other smokers but in addition, warnings on packaging and elsewhere should also stress that smoking RYO is at least as harmful as smoking FM. However, this needs to be qualified by the observation that peer-group pressure among young people is strong, and where a young peer group regularly uses RYO and reinforces use with myths about relative safety, health messages will need to be carefully framed. Clearly, research with such groups should be a prerequisite as part of adopting such a strategy.
Consideration also needs to be given to raising taxes on RYO to make its cost-point more comparable to FM cigarettes. This has been recommended previously [1
] and a differentially higher one-off increase in excise tax on RYO tobacco has been imposed in New Zealand to help to stem rising RYO usage in that country (i.e., a tax of 24% on RYO versus 10% for FM cigarettes). This went some way toward equalizing RYO and FM cigarettes, but not entirely in terms of cost per cigarette, based on what is known about the weight of RYO cigarettes in NZ [4
However, price-related interventions need to acknowledge that smokers will try to maximize the amount of nicotine they get from their delivery device, and research is needed to see if smokers respond by smoking their RYO cigarettes harder, something with the potential to increase harms. In considering tax equalization strategies, evidence from the UK that RYO tobacco is easier to smuggle means that such suggestions need to be carefully researched and backed up by increased resources to undermine trafficking of illicit tobacco.
Finally, trying to stop for-profit companies attempting to value-add to their products in search of increased sales is a futile exercise unless well-designed and enforced regulation is used. Governments need to confront the contradiction that allows companies to market products for profit that it is their avowed policy to discourage [33
] and do this for all forms of smoked tobacco. They should also do so in ways that minimize smuggling and other illicit supply, recognizing that this may be harder to stop for RYO tobacco than for FM cigarettes.
This study has several limitations. First, the relatively small number of RYO smokers in any given wave, especially in the USA, meant that following those smokers who stayed in the sample to monitor their choices of RYO versus FM cigarettes was impractical. In this situation the GEE technique enabled us to monitor aggregate changes in tobacco use and, at the same time, allow for interwave correlation. Second, it is extremely difficult, if not impossible, to quantify the links between exogenous drivers (e.g., the GFC, access to contraband, state/provincial tax regimes) using regression-based models like GEE.