Article Text

Download PDFPDF
Role of snus in initiation and cessation of tobacco smoking in Sweden
  1. L M Ramström1,
  2. J Foulds2
  1. 1Institute for Tobacco Studies, Stockholm, Sweden
  2. 2Tobacco Dependence Program, University of Medicine and Dentistry of New Jersey-School of Public Health, New Brunswick, USA
  1. Correspondence to:
 Dr Lars Ramström
 Institute for Tobacco Studies, Ingemarsgatan 4B, SE-113 54 Stockholm, Sweden; tobstud{at}


Objective: To examine patterns of smoking and snus use and identify individual pathways of Swedish tobacco users in order to clarify whether snus use is associated with increased or decreased smoking.

Methods: Retrospective analysis of data from a cross-sectional survey completed by 6752 adult Swedes in 2001–2 focusing on identifying tobacco use history by survey items on current and prior tobacco use and smoking initiation and cessation procedures.

Results: 15% of the men and 19% of the women completing the survey were daily smokers. 21% of the men and 2% of the women were daily snus users. Almost all (91%) male daily smoking began before the age of 23 years, whereas initiation of daily snus use continued throughout the age range (33% of initiation after age 22). 20% of male primary snus users started daily smoking compared to 47% of non-primary snus users. Thus, the odds of initiating daily smoking were significantly lower for men who had started using snus than for those who had not (odds ratio (OR) 0.28, 95% confidence interval (CI) 0.22 to 0.36). Among male primary smokers, 28% started secondary daily snus use and 73% did not. 88% of those secondary snus users had ceased daily smoking completely by the time of the survey as compared with 56% of those primary daily smokers who never became daily snus users (OR 5.7, 95% CI 4.9 to 8.1). Among men who made attempts to quit smoking, snus was the most commonly used cessation aid, being used by 24% on their latest quit attempt. Of those men who had used one single cessation aid 58% had used snus, as compared with 38% for all nicotine replacement therapy products together. Among men who used snus as a single aid, 66% succeeded in quitting completely, as compared with 47% of those using nicotine gum (OR 2.2, 95% CI 1.3 to 3.7) or 32% for those using the nicotine patch (OR 4.2, 95% CI 2.1 to 8.6). Women using snus as an aid were also significantly more likely to quit smoking successfully than those using nicotine patches or gum.

Conclusion: Use of snus in Sweden is associated with a reduced risk of becoming a daily smoker and an increased likelihood of stopping smoking.

  • CI, confidence interval
  • FSI, Research Group for Societal and Information Studies
  • ITS, Institute for Tobacco Studies
  • NRT, nicotine replacement therapy
  • OR, odds ratio
  • TSNAs, tobacco-specific nitrosamines
  • smokeless tobacco
  • snuff
  • snus
  • smoking cessation
  • nicotine replacement therapy

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • * A copy of the tobacco items of the questionnaire is available by request from the corresponding author.

  • From table 1 the prevalence of daily snus use in all men is 20% + 2%. Since both these percentages are rounded upwards, the sum is rounded down to 21%.

  • Competing interests: LR owns shares in Pfizer Inc, and both he and JF have done paid consultancy work for Pfizer Inc and other agencies involved in public health. LR has periodically been employed as short term consultant with WHO and JF has provided testimony for plaintiffs in law suits against tobacco companies. None of the authors has received any financial support from the tobacco industry.