Wednesday, September 25, 2013

Population-Level Proof: Snus Saving Swedish Smokers’ Lives as Tobacco Consumption Declines

New research confirms earlier findings demonstrating that widespread snus use is tied to reduced rates of smoking.

A decade ago I worked with scientists from Sweden’s Umeå University to publish the first scientific evidence that smokeless tobacco (“snus” in Swedish) played an impressive role in low smoking rates among Northern Swedish men from 1986 to 1999 (here and here).  We published another study showing that in 2004 smoking among women also declined as a result of increased snus use (here).

I am the lead author on a new study documenting that snus continues to play a role in low Swedish smoking rates.  That work, based on 2009 data, was just published in the Scandinavian Journal of Public Health (here), with coauthors Drs. Jan-Håkan Jansson and Mats Eliasson from Umeå University.

The chart on the left illustrates the most interesting finding from this study: Snus continues to play a role in low smoking rates among both men and women, but all tobacco use, including that of snus, is declining.  Critics of tobacco harm reduction charge that snus and other safer smoke-free substitutes are a gateway TO smoking, and thus will lead to a negative population effect.  The data from Sweden is conclusive.  As we wrote, “…tobacco harm reduction is not contrary to overall reductions in tobacco use at the population level.”

We also documented the direct role snus plays in smoking cessation.  From our study: “The prevalence of former smoking was 27% for men and 31% for women in 2009. Among men, only 27% of former smokers were never snus users, 39% were current snus users and 34% were former snus users. Among women former smokers, 70% never used snus, 19% were current users and the remainder were former snus users.”

Snus’s impact was seen in the smoking quit rate, which is the percentage of former smokers among ever smokers (current + former smokers).  “The smoking quit rate among men was 71%; 52% were ever users of snus and 19% were never users.  This was consistent with earlier surveys (reference here). The quit rate among women was 72%, which was considerably higher than previous years, reflecting increases in both ever users of snus (21%) and never users (51%).”

I have noted in this blog that American policymakers insist on population-level proof that vastly safer smoke-free products do not increase tobacco use (here and here).  This study provides that proof: snus promotes low rates of smoking in Sweden and is also compatible with reductions in all tobacco use.


Chris Price said...

Which is the latest year, please, for which there are generally agreed figures for: smoking prevalence in Sweden male/female, male prevalence, female prevalence; and what are those three numbers? Are they developed using the usual 'past month' method?


Brad Rodu said...

This article began with this statement: "Snus, a form of oral tobacco, has been used for over
200 years in Sweden, a country which has high quality health surveillance. It is therefore ironic that there is very little detailed information on population prevalence of snus use available from government sources." Information on smoking is also very difficult to obtain. Peter Lee has collected some useful data, available at