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Quitting Cigarettes Completely or Switching to Smokeless: Do U.S. Data Replicate the Swedish Results?
  1. Shu-Hong Zhu1,
  2. Julie B Wang1,
  3. Anne Hartman2,
  4. Yuerong Zhuang1,
  5. Anthony Gamst1,
  6. James T Gibson3,
  7. Hans Gilljam4,
  8. Maria Rosaria Galanti4
  1. 1 University of California, San Diego, United States;
  2. 2 National Cancer Institute, United States;
  3. 3 Information Management Services, United States;
  4. 4 Karolinska Institutet, United States
  1. E-mail: szhu{at}


Background: Swedish male smokers are likelier than female smokers to switch to smokeless tobacco (snus) and males’ smoking cessation rate is higher than females’. These results have fueled international debate over promoting smokeless tobacco for harm reduction. This study examines whether similar results emerge in the U.S., one of few other western countries where smokeless tobacco has long been widely available.

Methods: U.S data source: national sample in Tobacco Use Supplement to Current Population Survey, 2002, with 1-year follow-up in 2003. Analyses included adult self-respondents in this longitudinal sample (N=15,056). Population-weighted rates of quitting smoking and switching to smokeless tobacco were computed for the 1-year period.

Results: Among U.S. men, few current smokers switched to smokeless tobacco (0.3% in 12 months). Few former smokers turned to smokeless tobacco (1.7%). Switching between cigarettes and smokeless, infrequent among current tobacco users (<4%), was more often from smokeless to smoking. Men’s quit rate for smokeless tobacco was three times higher than for cigarettes (38.8% vs. 11.6%, p<0.001). Overall, U.S. men have no advantage over women in quitting smoking (11.7% vs. 12.4%, p=0.65), even though men are far likelier to use smokeless tobacco.

Conclusion: The Swedish results are not replicated in the U.S. Both male and female U.S. smokers appear to have higher quit rates for smoking than have their Swedish counterparts, despite greater use of smokeless tobacco in Sweden. Promoting smokeless tobacco for harm reduction in countries with ongoing tobacco control programs may not result in any positive population effect on smoking cessation.

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