Smokers turning to roll-up cigarettes are being warned they harm the body just as much as manufactured smokes.
British public health officials have found that the number of male smokers using hand-rolled cigarettes had more than doubled, from 18 per cent in 1990 to 40 per cent in 2013.
The number of women smoking mainly roll-ups has gone from just two per cent to 23 per cent, despite warnings they're just as harmful.
The figures come ahead of a new hard-hitting campaign by Britain's health board warning smokers of the damage caused by their habit.
Professor Dame Sally Davies, chief medical officer with Public Health England, said: "Significant numbers of smokers are now using roll-ups without realising that gram for gram of tobacco they are just as unsafe as ordinary cigarettes.
"The research we have got suggests that people think it's safer to smoke a roll-up up. But they are wrong. It is not safe.
"No tobacco is safe and, gram for gram, it is as harmful as ordinary cigarettes."
PHE's new digital campaign and billboard ads remind smokers of the damage cigarettes do to the brain, bones and muscles, teeth and eyes.
Smokers are 59 per cent more likely to develop Alzheimer's and have a 53 per cent greater risk of suffering cognitive impairment, according to PHE.
They also heal slower and have increased risk of back and neck pain, with a 79 per cent increase in chronic back pain and 114 per cent increase in disabling lower back pain.
Smokers have a 25 per cent increased risk of fracture and a 40 per cent increase in their probability of breaking a hip.
Damage to the eyes includes an increased risk of age-related macular degeneration of 78 per cent to 358 per cent, and an increased likelihood of age-related cataracts.
"This is our third hard-hitting campaign. The first was about cancer, the second was about heart attacks and strokes, and this one is about the general rot that tobacco does to your body," Dame Sally said.
"We have evaluated the other two campaigns and they have had real impact on the public and that has then fed through into orders for quit kits and people stopping smoking."
Although smoking rates have declined to an all-time low of 18.4 per cent, the habit is still the biggest cause of preventable illness and premature death in England, with almost 80,000 people dying annually.
One in every two long-term smokers will die prematurely from a smoking-related disease unless they quit.
The PHE's new campaign features a graphic anti-smoking advert, showing a father lighting a hand-rolled cigarette full of rotting flesh.
"Whilst many smokers know the damage cigarettes do to their hearts and lungs, they are much less likely to be aware of how harmful smoking is to the body - essentially 'rotting' it from the inside out, and roll-ups are no exception.
"January is a time when many people make New Year's resolutions to improve their health and try to stop smoking. Millions of people have used Smokefree support and we are hoping that this year, even more will take advantage of the free expertise and resources on offer," Dame Sally said.
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