title: Trends and socioeconomic differences in roll-your-own tobacco use: findings from the ITC Europe Surveys.
abstract: OBJECTIVE
  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.
authors.affiliation: Division of Marketing, Nottingham Business School, Nottingham Trent University, Nottingham, UK.
authors.forename: Abraham K
authors.initials: AK
authors.lastname: Brown
authors.affiliation: Department of Health Promotion, Maastricht University (CAPHRI), Maastricht, The Netherlands Dutch Alliance for a Smokefree Society, The Hague, The Netherlands.
authors.forename: Gera E
authors.initials: GE
authors.lastname: Nagelhout
authors.affiliation: Department of Communication, University of Amsterdam (ASCoR), Amsterdam, The Netherlands Trimbos Institute, Netherlands Institute for Mental Health and Addiction, Utrecht, The Netherlands.
authors.forename: Bas
authors.initials: B
authors.lastname: van den Putte
authors.affiliation: Department of Health Promotion, Maastricht University (CAPHRI), Maastricht, The Netherlands Dutch Alliance for a Smokefree Society, The Hague, The Netherlands.
authors.forename: Marc C
authors.initials: MC
authors.lastname: Willemsen
authors.affiliation: Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany Unit Cancer Prevention, German Cancer Research Center (DKFZ), Heidelberg, Germany.
authors.forename: Ute
authors.initials: U
authors.lastname: Mons
authors.affiliation: French Institute for Health Promotion and Health Education (INPES), Saint-Denis, France.
authors.forename: Romain
authors.initials: R
authors.lastname: Guignard
authors.affiliation: Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Canada.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Thompson
mesh_terms: D000328:Adult; D003132:Commerce / Q000191:economics* / Q000639:trends; D005060:Europe; D005260:Female; D006801:Humans; D007182:Income / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D012907:Smoking / Q000191:economics* / Q000639:trends; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D062789:Tobacco Products / Q000191:economics*