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Quitting cigarettes completely or switching to smokeless tobacco: do US data replicate the Swedish results?
  1. S-H Zhu1,
  2. J B Wang1,
  3. A Hartman2,
  4. Y Zhuang1,
  5. A Gamst1,
  6. J T Gibson3,
  7. H Gilljam4,
  8. M R Galanti4
  1. 1
    University of California, San Diego, California, USA
  2. 2
    National Cancer Institute
  3. 3
    Information Management Services, Rockville, Maryland, USA
  4. 4
    Karolinska Institutet, Stockholm, Sweden
  1. Dr Shu-Hong Zhu, Department of Family and Preventive Medicine, University of California, San Diego, 9500 Gilman Drive 0905, La Jolla, CA 92093-0905, USA; szhu{at}


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

Methods: US 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 US 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 tobacco, infrequent among current tobacco users (<4%), was more often from smokeless to smoking. Men quit smokeless tobacco at three times the rate of quitting cigarettes (38.8% vs 11.6%, p<0.001). Overall, US 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 United States. Both male and female US 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 programmes may not result in any positive population effect on smoking cessation.

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  • Competing interests: HG, on behalf of his institution, has conducted clinical trials on smoking cessation with funding from Pharmacia, Pfizer, Glaxo-Smith-Kline and Sanofi-Aventis and has also received compensation from the above-mentioned companies for lectures on prevention of tobacco use. Other authors declare no competing interests.

  • Funding: This work was supported in part by a supplemental grant to the University of California, San Diego Cancer Center from the National Cancer Institute (NCI): grant 5 P30 CA 23100-22S4 (to S-HZ). Findings and conclusions are those of the authors and do not reflect the views of the NCI.

  • Ethics approval: This study has been approved by the ethics committee of the institutional review board, University of California, San Diego, Human Research Protection Program.

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