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Is Swedish snus associated with smoking initiation or smoking cessation?
  1. H Furberg1,
  2. C M Bulik2,
  3. C Lerman3,
  4. P Lichtenstein4,
  5. N L Pedersen4,,
  6. P F Sullivan1,*
  1. 1Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
  2. 2Department of Psychiatry, University of North Carolina at Chapel Hill
  3. 3Department of Psychiatry, Transdisciplinary Tobacco Use Research Center, University of Pennsylvania, Pennsylvania, USA
  4. 4Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
  1. Correspondence to:
 Dr Patrick F Sullivan
 Department of Genetics, CB#7264, 4109D Neurosciences Research Building, University of North Carolina, Chapel Hill, NC, 27599-7264, USA; pfsulliv{at}


Nicotine replacement therapies (NRT) are an effective treatment for tobacco dependence, yet most smokers do not quit or remain abstinent. We investigated whether Swedish snus (snuff) use was associated with smoking cessation among males participating in a large population based twin study in Sweden. Snus use was associated with smoking cessation but not initiation. Given that snus delivers comparable nicotine concentrations but carries lesser cancer risk than cigarettes, snus may be a widely used, non-medical form of NRT. Evaluation of the efficacy of snus for smoking cessation should be evaluated in randomised clinical trials.

  • FTND, Fagerstrom test for nicotine dependence
  • NRT, nicotine replacement therapy
  • SALT, screening across lifespan twin study
  • nicotine replacement therapy
  • snus
  • smoking cessation

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  • * Also Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden;

  • Also Department of Psychology, University of Southern California, California, USA

  • Competing interest: None of the authors has a conflict of interest that could inappropriately bias the work. In the late 1970s the Council for Tobacco Research funded collection of data used by N Pedersen in her dissertation. P Sullivan had full access to all the data in the study and had final responsibility for the decision to submit for publication.