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4% to 4.6% in women (figure 3). However, the proportion of all smokers who use HRT increased considerably between 1974 and 2010, both among males and females (from 13% to 39%, and from 1% to 23%, respectively). Figure?3 Overall smoking prevalence and prevalence of smoking of hand-rolling tobacco (HRT) among men and women in Great Britain, 1974�C2010. The estimated number of people smoking any tobacco product also fell Oxygenase substantially between 1974 and 2010, from 25.3 to 12.4 million, while the number smoking HRT increased from 1.4 to 3.2 million, in part because of the increase in prevalence of HRT use among women, and in part because of UK's population growth. Total UK consumption of HRT also increased progressively, from 4170?ton in 1990 to 11?500?ton in 2009. There was a strong correlation between the number of people smoking HRT and price of MPPC cigarettes (Spearman R=0.91; p price of cigarettes has increased substantially, but the adjusted price of the less-expensive HRT products has remained relatively stable. During this period, the overall prevalence of smoking has fallen, but the proportion and number of smokers who smoke HRT, and the consumption of HRT, has increased markedly. We also found a strong correlation between MPPC cigarette prices and the total number of people using HRT. Although several factors could have contributed to the increased use of HRT, and the correlation between these variables in an observational study does not establish causation, our data are strongly consistent with the hypothesis that the marked price differential relative to manufactured cigarettes is an important driver of HRT use. While some of the previous research investigates changes and trends in HRT use over time in relation to tobacco prices in various countries,24 26 there is limited evidence on how HRT use is related to changes in cigarette prices in the UK. Previous research suggests that flat rates of HRT use can be explained by downtrading, by the fact that quit rates are lower among smokers of cheap tobacco products, and new smokers choosing to smoke HRT.27 Although increases in tobacco prices encourage smokers, and particularly those with low disposable incomes, to reduce or stop smoking,14 28�C30 switching to HRT is a logical alternative for those unable or unwilling to quit. The effectiveness of price rises as a smoking prevention policy is, therefore, reduced substantially if smokers have an option to downtrade either to lower cost manufactured cigarettes,16 or to the even lower cost alternative of HRT.