Comparing Harm Perception and Nicotine Dependence between Adult Roll-Your-Own and Factory-Made Cigarette Smokers in Southern Thailand

Objective: This study aimed to compare harm perception and nicotine dependence between roll-your-own (RYO) and factory-made (FM) cigarette smokers among adults in Southern Thailand. Material and Methods: A cross-sectional survey was conducted using structured questionnaires administered both online and in person to assess smoking behavior and nicotine dependence, and harm perceptions. A total of 385 adult cigarette smokers were recruited, including 191 RYO smokers and 194 FM smokers. Results: RYO smokers were generally older, married, and had lower levels of education and monthly income compared to FM smokers. The most frequently cited reasons for choosing RYO cigarettes included lower cost, taste, smell or pleasantness, and perceived lower harm. Notably, 36.1% of RYO smokers believed these cigarettes contained fewer addictive and harmful substances than FM cigarettes. Additionally, 45.5% of RYO smokers acknowledged their harmful effects, while 30.4% perceived RYO cigarettes as less harmful than FM cigarettes. The Fagerström Test revealed higher nicotine dependence among RYO smokers. Conclusion: This study highlights differences in harm perception and nicotine dependence between RYO and FM cigarette smokers. RYO smokers exhibited higher nicotine dependence and were more likely to perceive RYO cigarettes as less harmful than FM cigarettes. Men were more likely to smoke than women. Factors influencing smoking initiation included curiosity, peer pressure, social acceptance, socioeconomic conditions, and education levels.