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. 2016 Nov 9;13(11):1110.
doi: 10.3390/ijerph13111110.

Patterns of Smoking and Snus Use in Sweden: Implications for Public Health

Free PMC article

Patterns of Smoking and Snus Use in Sweden: Implications for Public Health

Lars Ramström et al. Int J Environ Res Public Health. .
Free PMC article


There has been concern that the availability of alternative less harmful forms of nicotine might inhibit smoking cessation and/or encourage those who would not otherwise have smoked to do so. The plausibility of such effects can be best assessed by looking at population trends in use of smoking in relation to alternatives. This paper looks at the relationships between snus use and smoking in Sweden. Analyses are based on a data set for the period January 2003 to February 2011 from a long-term study covering nationally representative samples of the Swedish population aged 18-79, with a total study population of 60,675 individuals. Questionnaires made it possible to identify detailed tobacco use categories and use trajectories. The results showed that uptake of snus use is much more common in males than females. Those who began daily tobacco use using snus were much less likely to subsequently take up smoking than those who had not, both among males (17.6% vs. 45.9%), and females (8.2% vs. 40.2%). Further, among those who started using snus after starting as smokers, 76.3% of men and 71.6% of women had stopped smoking completely, including 31.5% of the men and 28.6% of the women who had quit all forms of tobacco. Indeed, those who were primary snus users were also more likely to have quit altogether than those who only ever smoked. Snus was also reported as the most common smoking cessation aid among men and yielded higher success rates than nicotine replacement therapy and other alternatives. As conclusions, snus has both contributed to decreasing initiation of smoking and, when used subsequent to smoking, appears to facilitate smoking cessation. All these effects suggest that the availability and use of snus has been a major factor behind Sweden's record-low prevalence of smoking and the lowest level of tobacco-related mortality among men in Europe.

Keywords: harm reduction; public health; smokeless tobacco; smoking cessation; snus; tobacco control.

Conflict of interest statement

The authors declare no conflicts of interest.


Figure 1
Figure 1
Changes over time concerning primary initiation. The bars represent cohorts from five consecutive birth decades. The segments show the proportions of different options for primary initiation in each cohort.
Figure 2
Figure 2
Self-treatment smoking cessation/quit attempts with use of different self-administered cessation aids and outcome of these quit attempts. The height of each bar illustrates the percentage of quit attempts that were made with the aid(s) in question, indicated numerically at the top of each bar by percentages adding up to 100% for each set. The segments of each bar represent outcome with the aid in question—failure (light-grey) or success (dark-grey). The numerical data in the dark-grey segments indicate the proportion of successful quit attempts for each cessation aid.

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