Patterns of Dual Use of Snus and Cigarettes in a Mature Snus Market

Abstract

Introduction:We examine the prevalence of dual use of snus and cigarettes among Norwegian men by categorizing dual use into four categories according to the frequency of use of each product, considering the order of uptake of both products, and examining reasons for additional snus use. We compare dual users and exclusive cigarette smokers with respect to their smoking intensity, plans for quitting smoking, and future smoking identity.Methods:We used a data pool of six cross-sectional, national representative surveys conducted annually in the period 2005–2010 containing a total of 3,524 males aged 16–74.Results:6.8% of men had some kind of current concomitant use of snus and cigarettes—but only 1% reported a daily consumption of both products. The most typical pattern of dual use was a combination where daily use of one product was paired with occasional use of the other. Dual users consumed significantly fewer cigarettes per week (56.6; n = 226; SD, 53.82) than smokers who had either quit snus (79.6; n = 108; SD, 61.47) or single smokers with no history of snus use (80.2; n = 621; SD, 55.86). Only 24% with a history of dual use reported snus to be their first tobacco product, but the proportion who had initiated tobacco use with snus increased significantly with younger age. Among dual users with daily intake of snus, a majority of 53.6% reported that the purpose of their snus use was to quit smoking. A higher proportion of dual users (74.4%; 95% CI, 68.8–80.0; n = 235) than exclusive smokers (61.3%; 95% CI, 57.6–65.0; n = 658) reported that they most definitely or probably would be totally smoke-free 5 years into the future.Conclusions:In the mature snus market of Norway, the magnitude of dual use of cigarettes and snus is relatively small. Dual users consume fewer cigarettes, and a higher proportion portray themselves as smoke-free in the future than do exclusive cigarette smokers.

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

“…Smoking is now considered to be in the final phase of the cigarette epidemic, and sales statistics and tobacco surveys indicate that snus consumption is gradually taking over the cigarette market in Norway (K. E. Lund & McNeill, 2013;Norwegian Directorate of Health, 2013b). Smokers express high degree of user dissatisfaction reflected by negative self-evaluative emotions, negative social and moral norms and agreement regarding health gains from quitting.…”

“…The use of snus has been increasing in Norway, and the current pattern of snus use seems to displays many of the characteristics typical of stage II in the descriptive model of the diffusion of cigarettes (K. E. Lund & McNeill, 2013). In stage II, there is a rapid increase in smoking prevalence among men, and the prevalence in women lags behind but is increasing (Lopez et al, 1994).…”

Tobacco harm reduction in the real world: has the availability of snus in Norway increased smoking cessation?

“…A consistent finding across studies in Scandinavia is that a great majority of dual users have started with cigarettes, while typically below 25% report snus to be their first tobacco product (Ramström & Foulds, 2006;Lund & McNeill, 2012b (Tomar et al, 2009). Although the US Tobacco Bill prohibits the industry to advertise snus to smokers on the basis of lower health, snus is advertised for situational use when smokers cannot smoke due to smoke-free policies (Timberlake et al, 2011).…”

“…Lund & McNeill (2012b) used data from a time-series covering the period 1985-2010, a period in which the market share of snus increased from 5% to above 30%. Among men the segment of dual users of cigarettes and snus varied in a narrow range between 4%-7% for the whole period.…”

“…Several studies from Norway (Lund et al, 2010 a+b;Lund & McNeill, 2012b) and Sweden (Ramström & Foulds, 2006;Norberg et al, 2011b), show that former smokers make up the largest segment among daily snus users and former snus users. In accordance with this, Lund & McNeill (2012b) found that a majority of 54% of dual users with a daily intake of snus reported that the purpose of their snus use was to quit smoking.…”