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Preference for Loose Tobacco Among an Ethnically Diverse Low Socioeconomic Urban Population

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Preference for Loose Tobacco Among an Ethnically Diverse Low Socioeconomic Urban Population THE NEW ZEALAND MEDICAL JOURNAL Journal of the New Zealand Medical Association The use of the ‘rollie’ in New Zealand: preference for loose tobacco among an ethnically diverse low socioeconomic urban population Vili Nosa, Marewa Glover, Sandar Min, Robert Scragg, Chris Bullen, Judith McCool, Anette Kira Abstract Aim To examine the prevalence of and reasons for smoking roll-your-own (RYO) cigarettes in a population of South Auckland adults. Method Cross-sectional survey of the parents of 2,973 children at four South Auckland Intermediate Schools in 2007–2009. Result Just over a quarter (813; 27%) of parents were smokers. Most (82%) were Māori or Pacific peoples (47% and 34% respectively) of whom 47% smoked only factory-made (FM) and 38% smoked only RYO cigarettes. Exclusive RYO smoking was more common among European (53%) than Māori (40%), Pacific (38%) and Asian ethnic groups (23%). The most common reasons for preferring RYO over FM cigarettes were lower cost (50%), lasting longer (42%), and taste (8%). A few chose RYO because they perceived them to be less harmful (5%). Conclusion Reducing the cost benefit of RYO should lessen the potential use of RYOs as an alternative to quitting. Health education campaigns are needed to counter incorrect beliefs surrounding RYO. Such programmes should include awareness in schools, churches and Pacific communities. Despite several decades of comprehensive tobacco control efforts, tobacco use remains the largest preventable cause of death and disease in New Zealand (NZ).1 Population-wide tobacco control interventions appear to be most effective for groups with already low smoking prevalence. 2 Increasing the cost of tobacco using tax has been found to be effective in reducing smoking in the general population. 3 Youth are reported to be particularly price sensitive 4 and lower socioeconomic status (SES) smokers may similarly be responsive to tobacco tax increases. 5,6 Indicators of SES include income, occupation, education, access to a telephone, access to a car, income support received, living space and home ownership. 7 Large differences exist in smoking prevalence between ethnic groups and between socioeconomic groups, 2,8 contributing to substantial health inequalities between ethnic and socioeconomic groups.9 In particular, M āori suffer from marked negative health and economic consequences of smoking. 10 Māori have higher rates than non-Māori of cardiovascular disease (CVD), many cancers, a number of respiratory diseases, and adverse pregnancy outcomes all causally linked to smoking. 10 Reducing smoking among Māori is therefore an important means to substantially reduce ethnic health inequalities. NZMJ 8 July 2011, Vol 124 No 1338; ISSN 1175 8716 Page 25 URL: http://www.nzma.org.nz/journal/124-1338/4762/ ©NZMA Past tobacco tax increases resulted in a drop in consumption among smokers, 11 and a corresponding shift to use of loose tobacco over the subsequent years. Whereas in 1990, only 16% of smokers exclusively used roll-your-own (RYO) cigarettes (‘rollies’), 12 by 2005 41% of smokers were in this group.13 In 2009, nearly 60% of smokers used RYO, either exclusively or in combination with factory-made (FM) cigarettes. 14 Nationally 15 and internationally, 12,16 the most likely reason for the shift to RYO cigarettes was price. 15,17 The excise tax was lower for RYO than FM cigarettes. Taste was also cited as a reason for switching from FM to RYO in a Scottish study. 16 A recent national NZ cross-sectional study, asking participants to select from a list of reasons, found that the most common reasons for smoking RYO was lower cost (83%), taste (73%), and greater satisfaction (63%). 17 Type of tobacco used differs across groups. The NZ Tobacco Use Survey 2010 reported that RYO use is especially common among Māori and European smokers (71% and 61% respectively). 14 There is also a correlation between RYO use and socioeconomic status, where the most deprived smokers are most likely to use RYO (70% for most deprived versus 48% for least deprived). 14 Previous research has found that Māori smokers from low SES areas have high prevalence of smoking RYO, but the reasons for smoking RYO has not been investigated for this specific group. Our study also differs from previous research by using open-ended qualitative questions, as opposed to choosing from a list of reasons for smoking RYO. This paper describes a cross-sectional survey of Māori and Pacific smokers from a predominantly lower socioeconomic area in South Auckland. The aim was to investigate tobacco type preference and reasons for smoking RYO. Methods The study described in this paper was part of Keeping Kids Smokefree (KKS), a quasi-experimental trial which aimed to assess the effect of a programme designed to change smoking behaviour and attitudes of parents of children aged 11 and 12 in order to reduce smoking uptake (described elsewhere). 18 The data for this paper were drawn from parent questionnaires collected at the beginning or end of the school year for each year of the study. Parent in this study refers to the caregiver who filled out the questionnaire for their household. In brief, four low decile South Auckland schools were selected for their large rolls and high proportion of Māori and Pacific students. Decile indicates the extent to which the school draws its students from low socioeconomic communities. Decile 1 represents the most deprived 10% of the population, while decile 10 represents the least deprived 10% of the population. 19 Roll numbers across the intervention schools totalled about 1300 per year and 1600 across the control schools. The questions relevant to this paper were asked during year 1 follow-up (October–November 2007) and year 2 (February–March 2008) and 3 (February–March 2009) baseline. A total of 2,973 parents were surveyed. Parents were asked general demographic questions, such as ethnicity, what type of tobacco they smoked, preferred brand name and if they smoked RYO cigarettes to state why. Gender was not asked in the survey so this variable was not included in the analysis. We did not ask brand name in year 1 follow-up. We used descriptive statistics for prevalence estimates and calculated the relative risks with 95% confidence intervals of smoking RYO using a log-binomial model in Stata version 9 software. The free-text responses were entered in to an Excel file and categorised according to themes using a general inductive approach. 20 Answers with more than one reason were broken down into distinct meaning units, for example, if a participant had answered “cost and RYO last longer”, that was categorised under “cost” and “lasting longer”. Parents who had not provided ethnicity information or who smoked both RYO and FM were excluded from this analysis. NZMJ 8 July 2011, Vol 124 No 1338; ISSN 1175 8716 Page 26 URL: http://www.nzma.org.nz/journal/124-1338/4762/ ©NZMA Ethics approval for the study was obtained from the University of Auckland Human Participants Ethics Committee. Results Of the 4222 households that were sent a questionnaire, 2,973 responded, making the response rate 70%. Of those who responded, 813 (27%) were smokers and responded to the question stating their preference for RYO or FM cigarettes and 382 responded to the question asking reasons for smoking RYO. 691 (23%) responded to the ethnicity question and of these there were 327 (47.3%) Māori , 236 (34.2%) Pacific people, 39 (5.6%) Asian and 89 (12.9%) European/Others participants. Forty-seven percent (382) smoked only FM cigarettes, 38% (310) smoked only RYO and the rest (15%) smoked both. Tobacco type use varied by ethnicity (Table 1). Smoking only RYO was most common (53%) among European/others. For the other ethnic groups, FM use was more common than RYO. Using Māori and Pacific smokers as the comparator the relative risk of smoking RYO was significantly higher for European and others and significantly lower in Asians (Table 2). Table 1. Cigarette type by ethnicity (n=691) Ethnicity Factory RYO Both Total Māori n 133 131 63 327 % 41 40 19 100 Pacific peoples* n 117 89 30 236 % 50 38 13 100 Asian n 28 9 2 39 % 72 23 5 100 European & others n 30 47 12 89 % 34 53 13.5 100 Total n 308 276 107 691 % 45 40 15.5 100 *Mostly of Samoan, Tongan, Niuean, or Cook Islands origin. Table 2. Relative risk of exclusively smoking RYO, by ethnicity Ethnicity FM RYO Total Relative risk (95% CI) Māori & Pacific 250 (53.2%) 220 (46.8%) 470 1.00 Asian 28 (75.7%) 9 (24.3%) 37 0.52 (0.29, 0.92) European & others 30 (39.0%) 47 (61.0%) 77 1.30 (1.06,1.60) Total 308 (52.7%) 276 (47.3%) 584 Reasons for smoking RYO Participants’ reasons for smoking RYO are listed in Table 3. NZMJ 8 July 2011, Vol 124 No 1338; ISSN 1175 8716 Page 27 URL: http://www.nzma.org.nz/journal/124-1338/4762/ ©NZMA Table 3. Participants’ reasons for smoking RYO (n=382) Reasons n (%) Price (cheaper) 192 (50) Last longer 62 (42) Taste 31 (8) Less toxic/less harmful than FM 21 (5) Perceived strength 16 (4) Reduce overall smoking consumption 20 (5) Smoke less with RYO (extra time factor – to roll) 3 (1) Most participants, who had answered the question why they smoke RYO, stated that the reason for smoking RYO were because RYO “are cheaper” (192, 50%) and/or “last longer” (62, 42%): “Roll-your-own cigarettes are cheaper.” “Because some tailor made cigarettes are [sic] don't last long and roll-your-own may last up to 2 - 3 weeks.” Of the participants who has stated that RYO last longer, 32 stated that smokers can determine how much tobacco is in a RYO cigarette (20%) and/or 14 stated that RYO only burn when actively smoked (9%): “Because I can use less tobacco in one smoke.” “Roll-your owns stop burning [sic] when you stop puffing on it, whereas tailor mades keep burning [sic] right to the butt.” The taste of RYO was another relatively common category of responses (31, 8%) and perceived strength (16, 4%).
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