Effect of smokeless tobacco (snus) on smoking and public health in Sweden

• Published in: Tobacco Control 2003-12, Vol.12 (4), p.349-359
• Main Authors: Foulds, J, Ramstrom, L, Burke, M, Fagerström, K
• Format: Article
• Language: English
• Subjects: Adult; Analysis; cancer; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - etiology; Cigar smoking; Cigarette smoking; Cigarettes; confidence interval; Developed countries; Female; Health risks; Humans; IOM; Lung cancer; Male; Manufacturing; Men; Middle Aged; Myocardial infarction; Neoplasms - epidemiology; Neoplasms - etiology; Nicotine; Nicotine - administration & dosage; Nicotine - adverse effects; odds ratio; oesophageal squamous cell carcinoma; OSCC; Pregnancy; Pregnancy Complications - epidemiology; Pregnancy Complications - etiology; Product development; Product lines; Public health; relative risk; Respiratory diseases; REVIEW; Risk Factors; Smokeless tobacco; Smoking; Smoking - adverse effects; Smoking cessation; Snuff; Sweden; Sweden - epidemiology; Tobacco; Tobacco chewing; Tobacco industry; Tobacco smoking; tobacco specific nitrosamines; Tobacco use; Tobacco Use Disorder - epidemiology; Tobacco Use Disorder - etiology; Tobacco, Smokeless - adverse effects; TSNAs; US Institute of Medicine
• ISSN: 0964-4563; 1468-3318
• DOI: 10.1136/tc.12.4.349

Objective: To review the evidence on the effects of moist smokeless tobacco (snus) on smoking and ill health in Sweden. Method: Narrative review of published papers and other data sources (for example, conference abstracts and internet based information) on snus use, use of other tobacco products, and changes in health status in Sweden. Results: Snus is manufactured and stored in a manner that causes it to deliver lower concentrations of some harmful chemicals than other tobacco products, although it can deliver high doses of nicotine. It is dependence forming, but does not appear to cause cancer or respiratory diseases. It may cause a slight increase in cardiovascular risks and is likely to be harmful to the unborn fetus, although these risks are lower than those caused by smoking. There has been a larger drop in male daily smoking (from 40% in 1976 to 15% in 2002) than female daily smoking (34% in 1976 to 20% in 2002) in Sweden, with a substantial proportion (around 30%) of male ex-smokers using snus when quitting smoking. Over the same time period, rates of lung cancer and myocardial infarction have dropped significantly faster among Swedish men than women and remain at low levels as compared with other developed countries with a long history of tobacco use. Conclusions: Snus availability in Sweden appears to have contributed to the unusually low rates of smoking among Swedish men by helping them transfer to a notably less harmful form of nicotine dependence.