Contrasting Smokers' and Snus Users' Perceptions of Personal Tobacco Behavior in Norway

Lund, Marianne; Lund, Karl Erik; Halkjelsvik, Torleif

doi:10.1093/ntr/ntu109

Cited by 15 publications

(13 citation statements)

References 40 publications

(44 reference statements)

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“…Other contributing factors for the marked shift might be the price difference between the two products (which is quite narrow), the implementation of increasingly stricter indoor smoking regulations in a country with a harsh climate for outdoor smoking, and the growing anti-smoking sentiment that follows policy implementation. The symbolic meaning of snus use is not considered in the same negative way as smoking in Norway [31,32], and may have promoted snus use, even if risk perceptions are stable. Admittedly, however, little is known about such possible causes.…”

Section: Discussionmentioning

confidence: 99%

Relative Risk Perceptions between Snus and Cigarettes in a Snus-Prevalent Society—An Observational Study over a 16 Year Period

Lund

Vedøy

2019

IJERPH

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Background: Most studies on perceived risks of smokeless tobacco products (SLT) have been conducted in the U.S., and the vast majority conclude that perceptions of the relative harmfulness of SLT versus cigarettes in the population are inconsistent with epidemiologically-based risk estimates, and typically conflated to that of cigarettes. We tested whether such inaccuracies also existed in Norway, where SLT-products are less toxic (Swedish snus) and SLT use is more prevalent than in the U.S. Methods: Over a 16 years period (2003–2018), 13,381 respondents (aged 16–79 years) answered questions about risk perceptions in Statistics Norway’s nationally representative survey of tobacco behavior. We applied an indirect measure of comparative harm where risk beliefs for eight nicotine products were assessed independently of other products and then compared the answers. The wording of the question was: “We will now mention a variety of nicotine products and ask you how harmful you think daily use of these are. Use a scale from 1 to 7, where 1 is slightly harmful and 7 is very harmful”. Mean scores with 95% confidence intervals were calculated. Results: The overall risk score for cigarettes was 6.48. The risk score for snus was 5.14–79.3% of the risk score of cigarettes. The relative risk scores for e-cigarettes (3.78) and NRT products (3.39) was 58.4% and 52.3% when compared to cigarettes. Perceptions of risk were stable over time. A strong association was observed between perceived risk of snus and having used snus in attempts to quit smoking. Conclusion: Perceptions of relative risk between snus and cigarettes is inconsistent with estimates from medical expert committees, which assess the overall health risk from use of Swedish snus to be minor when compared to the risk from smoking. Like the situation in the US, incorrect beliefs about SLT risks seem to be prevalent also in the snus-prevalent Norwegian setting. Accurate information on differential harms needs to be communicated. Future research should try to identify reasons why health authorities in the US and Scandinavia allow these well-documented misconceptions to persist.

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Section: Discussionmentioning

confidence: 99%

Relative Risk Perceptions between Snus and Cigarettes in a Snus-Prevalent Society—An Observational Study over a 16 Year Period

Lund

Vedøy

2019

IJERPH

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“…In Sweden, Norway and in the United States dual usage is relatively uncommon, but the pattern is more frequent among young adults and adolescents [7, 19, 20]. Recent studies also show increased awareness, openness and readiness for consuming non-cigarette tobacco products [11, 20–25].…”

Section: Introductionmentioning

confidence: 99%

Alarming development of dual snus and cigarette usage among young Finnish males

et al. 2019

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Background The consumption of tobacco products has evolved to include more complex combinations of different products. We investigated the tobacco habits of a representative population of young Finnish male conscripts in order to evaluate the prevalence of dual use of cigarettes and snus as well as the transition from one tobacco product to another. In addition, we evaluated the correlation between the level of education and the use of cigarettes and snus. Methods A questionnaire-based survey was carried out in three out of 17 garrisons among conscripts during their first week of service in 2014. A total of 1971 male conscripts were selected by simple random sampling of the 9013 males in the selected garrisons. Of them 1916 participated and filled in the questionnaire. The response rate was 97.2%. The questionnaire consisted of 25 questions including age, gender, basic education, use of tobacco products as well as questions assessing nicotine dependency. Results The amount of dual users of cigarettes and snus was 21%. There was a higher probability of dual use of cigarettes and snus among smokers compared to snus users (p < 0.001). One third (35%) of former smokers reported daily snus use and over 40% of the former snus users smoked daily. One third (34%) of the participants reported snus usage and 14% of the study subjects used snus daily. 40% of the study population were smokers and over 25% smoked daily. Of the participants with basic educational background 57% smoked daily (p < 0.001), however, no association between snus and level of education was found (p = 0.69). Conclusions This study provides better understanding of the complex tobacco habits of young adult males. The simultaneous usage of multiple tobacco products as well as the high tendency to transition from one tobacco product to another should be taken into consideration when planning cessation interventions in health care settings and tobacco control policies at societal levels.

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“…In addition, daily smoking has become more and more associated with low social status. There are indications of social marginalisation and a stronger association between smoking and mental health problems (Lund, 2015;Lund, Lund, & Halkjelsvik, 2014;Talati, Keyes, & Hasin, 2016). This situation has activated an ethical debate in tobacco control, where social inequality in smoking behaviour becomes both an argument for and against strong TC strategies (Bayer, 2008;Burris, 2008).…”

Section: Discussionmentioning

confidence: 99%

Exploring smokers' opposition to proposed tobacco control strategies

Lund

2016

Nordic Studies on Alcohol and Drugs

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BACKGROUND -Tobacco control (TC) advocates are searching for new TC strategies to decrease smoking rates further. AIMS -The aim of this study is to explore smokers' opposition to 16 TC strategies, including the attitudes in the sample as a whole. The results are discussed in relation to the importance of public versus smoker support, and the need for legitimate TC strategies. METH-ODS -An Internet panel with 35,000 registered users was accessed to invite participants to join a survey on attitudes towards TC strategies. In addition, 1253 participants were recruited directly from mobile phone lists. Of the 5543 participants recruited, 5250 adults aged 20 years or older were eligible for analysis. Respondents' attitudes were measured on a five-point Likert scale, and mean values, standard deviations and percentages of those who opposed TC regulations were reported. RESULTS -In the total sample, there was some support for regulating smoking in specific outdoors areas. Smokers opposed all of the proposed strategies except banning smoking in cars carrying children, increasing the age limit for purchasing cigarettes and banning smoking at transportation stops. Smokers seemed to accept regulations that protected others from the health risks of smoking, but defended their right to smoke in some specific outdoor areas. CONCLU-SIONS -Smokers opposed most of the proposed TC strategies. Smokers' support may be more important in TC areas that aim to denormalise smoking and where enforcement is more complex.

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Contrasting Smokers' and Snus Users' Perceptions of Personal Tobacco Behavior in Norway

Cited by 15 publications

References 40 publications

Relative Risk Perceptions between Snus and Cigarettes in a Snus-Prevalent Society—An Observational Study over a 16 Year Period

Relative Risk Perceptions between Snus and Cigarettes in a Snus-Prevalent Society—An Observational Study over a 16 Year Period

Alarming development of dual snus and cigarette usage among young Finnish males

Exploring smokers' opposition to proposed tobacco control strategies

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