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Relative harm of snus and cigarettes: what do Norwegian adolescents say?
  1. S Øverland1,2,
  2. J Hetland3,
  3. L E Aarø2,4
  1. 1
    Unifob Health, University of Bergen, Norway
  2. 2
    Research Centre for Health Promotion, Faculty of Psychology, University of Bergen, Norway
  3. 3
    Faculty of Psychology, University of Bergen, Norway
  4. 4
    Norwegian Institute of Public Health, Division of Mental Health, Norway
  1. Simon Øverland, Research Centre for Health Promotion, University of Bergen, Christiesgt. 13, 5015 Bergen, Norway; Simon.overland{at}


Background: The public receives mixed messages about the harmfulness of alternative tobacco products to cigarettes, and little is known about what present and potential users of these products actually think about their relative harmfulness.

Methods: In a nationally representative survey of 2415 Norwegian adolescents aged 16–20 years, participants were asked to rate the harmfulness of various available tobacco products and their own use of snus and cigarettes. A study was undertaken to examine how adolescents rate the relative harm of tobacco products in general, and snus and cigarettes in particular, and how this varies with age, gender and their own use of snus and smoking.

Results: Cigarettes were generally rated as more harmful than snus, but 41% still rated snus as equally or more harmful than cigarettes. Male participants reported lower harm from all products than females. Being a snus user was associated with lower ratings of harm for snus, but being a smoker was not associated with reporting of harm for cigarettes.

Conclusions: Compared with the current scientific consensus, the participants overrated the harmfulness of snus and, as such, our results suggest a potential for changing peoples’ perceptions of the relative health risks of various tobacco products. To the extent that health information affects consumption, accurate information on relative risks may lead more people to choose snus over cigarettes.

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  • Competing interests: None.

  • Funding: The data used in this study are from a survey on tobacco use and related topics in Norwegian adolescents and young adults funded by the Norwegian Directorate for Health and Social Affairs.

  • Ethics approval: The study protocol was presented to the Regional Committee for Medical Research Ethics (REK-Vest) and could be carried out within the general permits of Synovate MMI Inc. The sample of participants was drawn from the Norwegian population registry with approval from the Norwegian Tax Administration.