Role of snus (oral moist snuff ) in smoking cessation and smoking reduction in Sweden

Abstract

AimsTo assess to what extent snus has been used as an aid to stop smoking among Swedish smokers. Design A random telephone retrospective survey of Swedish smokers and ex-smokers. Setting Survey conducted in November-December 2000. Participants A national sample of 1000 former and 985 current daily smokers aged 25-55 years. Measurements Smoking status, date and method of quitting by self-report. Findings Thirty-three per cent of former smokers and 27% of current smokers had ever used snus . The difference was larger among men (55% versus 45%, P = 0.003). Current smokers who made use of snus smoked on average fewer cigarettes per day than non-users of snus . The mean duration of abstinence among former smokers was not influenced by snus use. Conditionally on age, education and use of nicotine replacement therapy there was an increased probability of being a former rather than a current smoker with ever use (OR 1.72, 95% CI = 1.30-2.28) or current use (OR 1.81, 95% CI = 1.31-2.53) of snus . Having used snus at the latest quit attempt increased the probability of being abstinent by about 50% (OR 1.54, 95% CI = 1.09-2.20). Conclusions Our study suggests that by using snus , Swedish male smokers may increase their overall chances of abstinence. However, 71% of the men in this sample who quit smoking did so without using snus and the duration of abstinence was not affected by snus use. This suggests that snus is not a necessary component of smoking cessation at the population level. Snus use was very rare among women.

Cancer and mortality among users and nonusers of snus

“…However, since individuals who combine smoking with snus use may be exposed to a lower smoking dose and may increase their overall chances of subsequent abstinence compared to those who only smoke, 21 residual negative confounding from total cumulative smoking dose is an important concern. Indeed, while a Swedish case-control study found no significant relation between use of snus and overall risk of head and neck cancer, snus use among never-smokers (where this residual confounding is more likely to have been eliminated) was associated with an increased risk of 4.7 (95% CI 1.6-13.8).…”

Cigarette Smokers’ Use of Unconventional Tobacco Products and Associations With Quitting Activity: Findings From the ITC-4 U.S. Cohort

“…Zhu et al (2009) found no advantage in cessation for men who switched to smokeless tobacco. However, several studies conducted in Sweden, where use of snus is relatively common among men, have concluded that males who use snus have greater odds of quitting cigarette smoking than those who do not use snus (Furberg et al, 2005;Gilljam & Galanti, 2003;Ramström & Foulds, 2006).…”

Commentary on Lund et al. (2011): Consolidating the evidence on effectiveness of snus for smoking cessation - implications for public health

“…However, as the delivery speed is slower in snus use, the strength of nicotine dependence could be assumed to decrease [10]. Indeed, a substantial number of switchers eventually quit snus use as well and become tobacco-and nicotine-free [3,4].…”

“…In this context there has been a good deal of discussion regarding the effectiveness of snus, the Swedish type of low-toxicity smokeless tobacco. In Sweden this product has been used extensively for smoking cessation and a high degree of effectiveness has been demonstrated, both for men and women [3][4][5].…”