Dual Use and Smoking Suppression

Norway has proven that the Swedish tobacco experience can be duplicated in other countries where smokeless tobacco is used (discussed earlier here and here).  Karl Erik Lund, from the Norwegian Institute for Alcohol and Drug Research, and Ann McNeill from the University of Nottingham in the UK, have profiled male dual users (of snus and cigarettes) in Norway in a new report published in Nicotine & Tobacco Research (abstract here).

Drs. Lund and McNeill use Norwegian survey data to show that dual use has been relatively stable at 4-7% over the 25-year period from 1985 to 2010, during which exclusive snus use increased from 3% to 12% and exclusive smoking dropped from about 50% to 20%.  While U.S. tobacco prohibitionists argue that dual use will be problematic if smokers are educated about safer smokeless products, dual use has not been a public health issue in Sweden or Norway.

Another finding in the Scandinavian research is that dual users smoked fewer cigarettes than exclusive smokers (57 vs. 80 per week).  I also reported this fact in my landmark Swedish study published ten years ago (abstract here), and I documented this finding among American dual users (abstract here). 

One finding not discussed by Lund and McNeill was that among all Norwegian men surveyed from 2005-2010, 5.3% were former smokers and current snus users, while only 3.3% were former snus users and current smokers.  This shows that snus was more of a gateway FROM smoking than the reverse.  This contrasts with U.S. experience, where more male smokeless users transition to smoking (documented by me here).  It appears that Norwegian men are better informed about the relative risks of  snus use and smoking, resulting in healthier decisions.

Lund and McNeill conclude: “The increase in snus use among men in Norway has not been paralleled by an increase in dual use of snus and cigarettes.  The prevalence of smoking—the far most dangerous form of nicotine uptake—is quite low among men who use snus everyday but generally quite high among men who use snus on a less-than-daily basis. Use of snus also seemed to lower cigarette consumption.  Dual use did not lessen plans to quit smoking within 6 months but increased expectancies of being smoke-free 5 years into the future.”