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Epidemiology of tobacco use in Sweden, the country with Europe’s lowest level of tobacco-related disease
- 3. Tobacco consumption per year in Sweden per person 15 years and older Cigarettes Snus (kg) (kg) Around 1920 0.2 1.4 Around 1970 1.1 0.4 Around 2000 0.6 0.9
- 5. Swedish snus Fine ground tobacco leaves predominantly from air-cured dark tobacco Manufactured by a pasteurizing-like heating process (without any fermentation so as used in most manufacturing procedures for American snuff) ∎ TSNA content: < 5 mg/kg ∎ BaP content: < 10 g/kg (TSNA content of American snuff: 16-130 mg/kg)
- 8. Has the use of snus had an influence on the smoking habits in Sweden?
- 9. Initiation of tobacco use: Snus, is it a gate leading to smoking, or a vaccination against smoking? Which is the onset rate of smoking in those who have, respectively have not, taken snus as a primary tobacco use?
- 16. 24 hour systemic intake of nicotine Measured in: users of loose snus (≈ 2g pinches): around 25 mg (same as in smokers of 18-20 cigarettes per day) Source: Andersson et al 1994, Andersson et al 1997
- 20. Reproduced from: Lunell E. : SRNT Europe 2003
Editor's Notes
- This is the current picture of tobacco use in Sweden. Among men cigarette smoking is less common than use of the Swedish kind of oral tobacco, ”snus”. When using snus, a portion is kept (not chewed) between the gum and the upper lip.
- An overview of the long term development shows that total tobacco consumption has been quite stable, while the cigarette/snus proportions have gone up and down.
- Male smoking prevalence (blue regression line), has had a higher rate of decline, than female smoking (red regression line), the difference being of the same order as the male rise in snus use (green regression line). Although not being a proof of causality, this observation is well compatible with the idea that the increase of snus use has favoured the decrease of smoking in males.
- Low TSNA content due to choice of raw tobacco, curing method and the special manufacturing process.
- Swedish men have the lowest level of tobacco-related mortality in Europe .
- The record high snus consumption among Swedish males has NOT prevented them from occupying a bottom position with regard to oral cancer.
- This is a key question!
- The ”gateway hypothesis” postulates that the onset rate of smoking is higher in those with, than in those without snus as a primary tobacco use.
- This means that primary use of snus is associated with lower rate of onset of smoking, that is - the direct opposite of the gateway hypotheseis. Consequently, primary use of snus seems to prevent smoking rather than serve as a gateway to smoking.
- Both males and females with a history of snus use (left column), have less maintenance of daily smoking (top line in the table) and more cessation of smoking (partial and/or complete) than those without snus use. That is, there is an overall connection between snus use and smoking cessation.
- Among men, snus is the most commonly used cessation aid. This observation strengthens the connection between snus use and smoking cessation .
- Among males snus is not only the most commonly used but also the most efficient ones of the cessation aids. This finding further supports the idea that snus use has contributed to the increase of smoking cessation among men. Of those men who have quit smoking completely after having used snus as a cessation aid, 75% are currently daily snus users and 35% have quit snus use as well.
- Those who continue daily smoking do not often use snus also. The prevalence of combining daily smoking and daily snus use is very low, just 2 %. Most daily smokers do not use snus at all.
- You sometimes hear statements that snus use would entail an up to 5-fold burden of nicotine. This is entirely false. The average 24 hour systemic intacke is rather equal for smokers and snus users, and the ”nicotine burden” of snus users is rather less because of the absence of the ”arterial boli” hitting the smoker at each puff. One important implication of the above is that, while snus use does produce nicotine dependence, the dependence in snus users is not stronger, rather weaker than in smokers, since there is a lower ”delivery speed” of the nicotine from snus than from smoking, both in general terms and with respect to the absence of ”arterial boli” for snus users.