From Norway: Snus Risk Perception Can Drive Smoking Cessation; The Right to Truth and Health

Norway has been documented recently as the second European country to embrace the substitution of snus for cigarettes, confirming the “Swedish experience” of tobacco harm reduction. Karl Erik Lund, a researcher at the Norwegian Institute for Alcohol and Drug Research, has published a series of studies illustrating the “Norwegian experience” (here and here). His newest study shows that a smoker’s willingness to try snus is closely correlated with one’s perception of the product’s health risks relative to cigarettes. The study appears in Nicotine & Tobacco Research (abstract here).

Dr. Lund used a survey of 14,700 men age 20-50 years with a 49% response rate. Participants included 1,155 former smokers and 1,417 current smokers (80% of whom had tried to quit).

Snus, used by 32% of former smokers, was the most common method used to quit smoking. Nicotine gum was a distant second, at 14%.

Dr. Lund measured perceptions among current and former smokers of the risks of snus compared with cigarettes. Here are the results for former smokers:

Perception of Snus Risk Among Former Smokers
	Percent
Far more or somewhat more risky	3
About the same	31
Somewhat less risky	35
Far less risky	32

Compared with former smokers who incorrectly believed that snus has the same or higher risks compared to cigarettes, the 32% of smokers who correctly believed that snus was “far less risky” were 11 times more likely to have used snus to quit smoking. In addition, the “somewhat less risky” group was 3.5 times as likely to have used snus.

Perceptions among current smokers also had important implications:

Perception of Snus Risk Among Current Smokers
	Percent
Far more or somewhat more risky	3
About the same	37
Somewhat less risky	37
Far less risky	23

Compared with smokers who incorrectly believed that snus has the same or higher risks than cigarettes, the 23% of smokers who correctly believed that snus was “far less risky” were five times more willing to try snus in a future quit attempt. In addition, the “somewhat less risky” group was over twice as likely to try snus.

Dr. Lund described the implications: “The main finding in our study was that correct perception of the relative risk between snus and cigarettes was positively correlated with having used snus when quitting smoking. Likewise, among current smokers, correct beliefs of differential risks between the two products were positively correlated with the willingness to use snus in future quit attempts. Thus, providing accurate risk estimates to smokers may not only have an ethical justification, dissemination of such information might also result in increased quit rates for smoking.

“Lacking any compelling evidence of net harm to society from correcting misperceptions of the relative risk between cigarettes and snus, the human right for the individual to receive accurate information about options to reduce risk should prevail. Going beyond the no-safe-tobacco message to provide better informa¬tion … is necessary to respect the individual right to health relevant information and smokers’ autonomy and may also—as our study indicates—result in increased quit rates for cigarette smoking. Some have argued that failure to disseminate infor¬mation about reduced risks for fear that population nicotine use may increase could be regarded as paternalism and create public mistrust of health messages about tobacco use. To prevent uptake of snus among youth, public health and tobacco control professionals could use other methods than withholding information about relative risks, including taxation, restrictions, and information campaigns aiming to change the cultural symbolism of snus use…Devising a way to inform smokers about the risk contin¬uum of tobacco products (without anyone decoding this infor¬mation as snus being risk free) should be an important research priority in countries where snus is allowed to compete with cigarettes for market share.”

In the U.S., where smokeless tobacco products compete with cigarettes, public health authorities must begin to communicate truthful information about the differential risks to smokers. Disinformation and obfuscation about the relative risks of varying tobacco products costs lives and disgraces those who pursue such actions. Truthful communication about tobacco harm reduction is a public health imperative.