How much snus do you use

The incidence of tobacco use among males in Sweden is similar to that in most other European countries, but smoking rates are relatively low, as many men prefer to use snus.

Typical usage has also been described as: Hatsukami et al. The study reported mean weight per dip of 1. The mean number of dips per day was 6. The study revealed a high level of behavioral variability among respondents. Given the lack of detailed data on current snus consumption patterns, we commissioned questionnaire surveys of adult snus users in Sweden in and to obtain data on the frequency and duration of consumption of loose and pouched snus and investigate behaviors associated with use.

These surveys have provided new insights into consumer behavior and usage patterns for loose and pouched snus in Sweden. Snus consumption patterns and usage behavior were investigated by a telephone survey of Swedish snus consumers conducted between March and April by the market research agency GfK Sverige AB. No rewards or incentives were given for participation in the survey. Individuals were selected at random from telephone directories covering all regions of Sweden.

The survey was designed to be geographically representative; the regional weighting of those contacted reflected the relative population of each region to the whole population of Sweden.

The survey was conducted in three stages as described below. Details of subject numbers are provided in Supplementary Table 1. The inclusion criteria were that the subjects normally used at least one snus portion per day and were aged between 18 and 72 years.

Any that worked in journalism, public relations, market research, advertising, or sale and manufacture of tobacco products were excluded.

A total of 3, people completed the first stage of the survey. The survey consisted of 54 questions covering various aspects of snus usage.

Consumption patterns were assessed by questions examining the types of products used, the proportion of respondents using multiple products, and the quantity and frequency of use. Usage behavior was assessed by questions examining the time of use, the position in mouth, and tendency to move product during use. A number of questions were included in the survey to check the quality of responses from participants.

After these adjustments, the number of respondents was reduced to 2,, consisting of 2, males and females. This first stage of the survey did not provide sufficient insight into the time of snus use. A large percentage of respondents were found to use the product for more than 35 min, but all usage times greater than this time period were simply recorded in the questionnaire as more than 35 min rather than a specific estimated time.

Therefore, two follow-up questionnaires were conducted, each focusing exclusively on either pouched or loose snus users second and third stages of the survey , to provide more accurate information on time of use. The follow-up questionnaires took place in August and September and used subsets of the original respondents, who were reinterviewed using the same procedures including data consistency checks as the original survey.

The pouched user follow-up survey of August returned valid datasets for 1, users of pouched snus, and the loose user follow-up survey of September returned valid datasets for loose snus users, following consistency and quality checks in both cases Supplementary Table 1. For loose snus, portion weight was calculated from the total weight of tobacco in a package divided by the number of reported portions per package.

Statistical analysis of the datasets, including descriptive statistics, frequency counts, and nonparametric significance tests, was conducted using Minitab software Version The product use distributions of the respondents in the survey, their use of different snus styles, and detailed demographic data age and gender for the survey respondents are provided in Table 1. The age distribution of all snus users in the study defined in this survey as those who normally use at least one snus portion per day was similar to the national age distribution, with no significant differences in the mean and median age of the survey respondents and general population.

However, there was a slightly greater proportion of 30—55 year olds in the survey in comparison with the Swedish population in general. The distribution shows that the percentage of loose snus users between 18 and 29 years old was lower compared with the pouch users The data also show significant polarization in type of snus use, with few respondents 3.

Due to the small number of survey respondents who used both types of snus, the analyses reported in the rest of this report are for sole—loose or sole—pouched snus users only. The incidence of sole snus use was compared with the concurrent use of other tobacco products by daily snus users Supplementary Table 2. The data showed limited use of other tobacco products by survey respondents. Only A total of Cigarettes were the major co-used tobacco product, with 9. A slightly higher incidence of cigarette smoking was reported among pouched snus users Frequency of cigarette use among daily snus users was also investigated; all daily snus users who also smoked reported doing so at least once per week, and Few differences in tobacco product use behaviors were observed across genders or snus type, although no female respondents reported concurrent use of snus with cigars, pipe, or chewing tobacco.

Several styles of pouch are available on the Swedish market. Mini pouches tend to contain tobacco with lower moisture content than the larger pouches. The survey respondents had a general preference for the Large Normal pouches; this preference was different for female respondents, who showed greater use of Mini pouches There are also different pouch color types, the main styles being brown and white, which can result from different processing practices during the manufacture of the products.

The brown pouch products tend to have higher moisture content than the white ones due to the spraying of water during pouching. In: P. Clarke, M. Quik, F. Thurau Eds. Andersson, G. Oral mucosal changes and nicotine disposition in users of Swedish smokeless tobacco products: A comparative study. Oral Pathol. Reduction in nicotine intake and oral mucosal changes among users of Swedish oral moist snuff after switching to a low-nicotine product.

The influence of cigarette consumption and smoking machine yields of tar and nicotine on the nicotine uptake and oral mucosal lesions in smokers. Benowitz, N. III, and Yu, L.

Daily use of smokeless tobacco: systemic effects. Gilljam, H. Smokeless tobacco cessation with NRT: A feasibility study. Holm, H. Nicotine intake and dependence in Swedish snuff takers. Psychopharmacology Larsson, I. Disposition of nicotine and cotinine in plasma, saliva and urine of snuff-users. The Adolescent Health and Lifestyle Survey , adolescent smoking, alcohol and substance use in — Awareness and determinants of electronic cigarette use among Finnish adolescents in a population-based study.

Most smokeless tobacco use is not a causal gateway to cigarettes: using order of product use to evaluate causation in a national US sample. Is Swedish snus associated with smoking initiation or smoking cessation. Role of snus in initiation and cessation of tobacco smoking in Sweden. Tomar SL. Is use of smokeless tobacco a risk factor for cigarette smoking? The US experience. Nicotine Tob Res. Use of smokeless tobacco is a risk factor for cigarette smoking. Patterns of snus and cigarette use: a study of Norwegian men followed from age 16 to Is smokeless tobacco use an appropriate public health strategy for reducing societal harm from cigarette smoking?

Smokeless tobacco and cancer. Lancet Oncol. Dual use of cigarettes and Swedish snuff snus among young adults in Northern Finland. Eur J Public Health. Critchley JA, Unal B. Health effects associated with smokeless tobacco: a systematic review. Oral use of Swedish moist snuff snus and risk for cancer of the mouth, lung, and pancreas in male construction workers: a retrospective cohort study. Scand J Public Health. Socio-demographic, lifestyle and health characteristics among snus users and tobacco users in Stockholm County, Sweden.

BMC Public Health. Between harm and dangers. Both daily and occasional use were included in ever and current tobacco use in the main analyses. Quantity of tobacco use was only given for the daily users, and is therefore not included in the analyses. Other tobacco products apart from cigarettes and snus were rarely used in Norway and not asked for in the survey [ 17 ].

The questions were worded as below and the categories are given in Table 1. Variables with a theoretical causal association to both the predictor and the outcome confounders , and with a notable impact on the effect measure, were included in the main multivariable analyses.

Family smoking may also act as a proxy for parental socioeconomic status [ 18 , 19 , 20 , 21 , 22 ]. Information on personality traits and school functioning were considered as potential confounders sensitivity analyses. An item version of the Eysenck Personality Questionnaire, scored according to the established guide, was used to measure three dimensions of personality introversion-extraversion, neuroticism and psychoticism, and included as covariates in the multivariable regression model [ 23 ].

Tobacco use is known to be associated with all three dimensions of personality traits [ 24 , 25 ]. Psychosocial and behavioral factors were considered as confounding regarding tobacco transistions from adolecence to adulthoood.

The adolescents were also asked to consider 13 statements concerning school functioning, evaluated on a 4-point scale ranging from «never» to «very often». The predictor tobacco variables in adolescence baseline were ever snus use, ever smoking and ever dual use, all versus never tobacco use, as mutually exclusive groups. In multivariable regressions, we used a log-risk model with binreg binomial family in STATA and chose log as link-function, giving the outcome RR.

Convergence problems occurred when more covariates than age were included. Binreg was then replaced with a log-risk model, poisson family GLM , with the option robust.

This was treated as binomial regressions with RRs, with somewhat increased standard errors SE. STATA version 15 was used. Among the possible confounders mentioned in subsection above, only family smoking dichotomized into no vs any family smoking altered the RRs, and were thus included in the main analyses. Personality traits and school functioning were included as confounders in sensitivity analyses.

Factor analyses were performed to achieve the dimensions for the Eysenck Personality and school functioning scales.

Mean age for the study participants as adolescent boys was Among the boys participating at baseline, one in three participated in our study population. Also, no difference was found in the pupils educational plans between participants and non-participants to the study population. The difference in attendance between younger and older age adolescent tobacco users is shown in Additional file 3. Within our cohort 51 participants gave inconsistent answers about their smoking behavior at baseline and follow-up.

Regarding snus use, 53 participants stated at follow-up that they had never used snus, but reported occasional snus use at baseline. In additional analyses where participants with inconsistent answers were removed, the main results were confirmed, but with larger effect size of the transitions of tobacco use. The effect size of the transitions from tobacco use to no tobacco use decreased when removing inconsistent answers data not shown.

The prevalence of tobacco use in the study population doubled from adolescents aged 13—15 to those aged 16— All adolescent tobacco use categories had higher prevalence of parental divorce, family smoking and parental alcohol use than adolescent no tobacco users.

Level of educational plans did not differ significantly between adolescent tobacco users and no tobacco users Table 1. Adolescent smokers and dual users, but not snus users, had higher mean levels of neurotic personality traits than non-tobacco users. All categories of adolescent tobacco users had higher mean levels of extrovert personality traits, while only dual users had higher levels of psychotic personality traits than the non-users of tobacco.

The crude prevalence of ever tobacco use in adolescence and current tobacco use in young adulthood are shown in Fig. Hence, the probability for young ever tobacco users to quit was about one in three for snus users and smokers, and about one in six for dual users.

Among the dual users, however, nearly one third had quit smoking and switched to snus only. Tobacco use as young adults within adolescent tobacco user groups. Study population, unadjusted. For the transition from adolescent smoking to adult snus only use, as well as from dual use to snus only use, small differences were found between age groups.

The dual users were mostly a mix of daily users of one tobacco product and occasional users of the other product, besides a few using either both products occasionally or both products daily.

The composition of the dual user group changed from adolescence to adulthood. In our study population, one third of the initial occasional smokers and snus users had quit all tobacco, while half of them were daily users as adults, regarding current use of tobacco at both time points. Table 3 shows the results from the multivariable regression analyses of associations between ever tobacco use in adolescence, and risk of current or no tobacco use in adulthood.

The RRs with confidence intervals CI of adolescent snus users to be smokers in young adulthood, adjusted for age and family smoking, was 2. The RRs of adolescent smokers and dual users of still being smokers in adulthood, adjusted for age and family smoking, were 2. Adolescent snus users and smokers had a doubled, or more than doubled, likelihood to be smokers as adults. Adolescent dual users carried more than a threefold risk to be smokers as young adults, but at the same time also a comparable risk to be snus only users.

Adolescent snus users had nearly a threefold risk of still being snus users as young adults, with adjusted RR 2. Adolescent smokers had no significant likelihood of being snus only users as young adults. The likelihood of adolescent boys to become tobacco free in young adulthood, given tobacco use in adolescence, was comparable for previous snus users and smokers with RR 0.

The adolescent dual users had clearly the lowest likelihood to become tobacco free in young adulthood Table 3. Due to the relatively high rates of missing values attached to these variables Additional file 4 , we chose to present the results as sensitivity analyses. These sensitivity analyses gave weaker associations, but no substantial change from the main results in Table 3 : With all confounders included, the risk for adolescent snus users to be current smokers as adults were RR 1.

The corresponding RRs for smokers and dual users to be current smokers at follow-up were 2. The fully adjusted risks of adolescent snus users, smokers and dual users to be current snus users as adults were RR 2. A few comparative results for women belonging to the same cohort are given in Additional file 1. In this study, adolescent snus only users conferred a doubled risk of smoking, and almost a threefold risk to continue with snus as young adults.

Adolescent dual users conferred a threefold risk to still be smokers in adulthood. The transition from smoking to snus only use was less common. The associations between adolescent snus use and smoking in young adulthood in this study were similar to previous studies [ 27 , 28 , 29 ].

One recent study among young men enrolled in the army in Switzerland did not find any beneficial effect of snus use on smoking, but increased likelihood of smoking initiation and continuation [ 30 ]. In our study, a considerable proportion of the adult dual users used snus daily and smoked occasionally, instead of the opposite constellation, in line with another Norwegian study [ 14 ].

A US review including six studies among both adolescents and adults published since demonstrated the heterogeneity in design across studies, but indicated, similar to our results, limited transition from exclusive smoking to exclusive smokeless tobacco use [ 32 ].

In Sweden, both cigarette starters and snus starters were found, in contrast to our study, to have a low risk to end up as current smokers [ 31 ]. In USA, one study did not find any association between snus debut and later smoking [ 33 ] and another found little evidence of transition from one tobacco product in adolescence to another in adulthood [ 34 ]. Scandinavian studies among adults have supported a possible harm reduction effect of snus; A Swedish study found that men using both cigarettes and snus during their lifetime were likely to quit cigarettes and continue with snus only.

The same research group found the availability of snus to contribute to the low Swedish rates of smoking among men [ 12 , 13 ].

Lund et al. The results were not replicated in USA, where transitions between cigarettes and smokeless tobacco was infrequent [ 35 ]. Also, smoking cessation for dual users was not different from that of exclusive smokers, and even when the dual users were more likely to have tried to quit, they were found to relapse more quickly than the smokers [ 36 , 37 ].