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Patterns of snus and cigarette use: a study of Norwegian men followed from age 16 to 19
  1. Liv Grøtvedt1,
  2. Lisa Forsén2,3,
  3. Knut Stavem4,5,6,
  4. Sidsel Graff-Iversen2,7
  1. 1Department of Health Statistics, Norwegian Institute of Public Health, Oslo, Norway
  2. 2Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway
  3. 3National Competence Centre of Women Health, Oslo University Hospital, Oslo, Norway
  4. 4Department of Pulmonary Medicine, Medical Division, Akershus University Hospital, Lørenskog, Norway
  5. 5Helse Sør-Øst Health Services Research Centre, Akershus University Hospital, Lørenskog, Norway
  6. 6Institute of Clinical Medicine, University of Oslo, Oslo, Norway
  7. 7Department of Community Medicine, University of Tromsø, Tromsø, Norway
  1. Correspondence to Liv Grøtvedt, Department of Health Statistics, Norwegian Institute of Public Health, P.O. Box 4404 Nydalen, NO-0403 Oslo, Norway; liv.grotvedt{at}


Background The use of moist snuff (snus) in young Norwegians is increasing, while smoking rates are declining. It is not clear whether snus facilitates smoking.

Objective To assess whether 16-year-old men who were never-smokers, but snus users in 2001, had an increased risk of smoking 3 years later.

Methods In a prospective school-based cohort study, 1440 men, who responded to questionnaires in 2001 and 2004, were included in the analyses. The participation rate was 89% in 2001 and 50% in 2004. Multinomial logistic regression models were used to assess the OR of snus users, smokers and dual users of cigarettes and snus, compared with non-tobacco users at baseline, to be smokers at follow-up.

Results Snus use at baseline was associated with increased odds of dual use at follow-up when the outcome was (1) current dual use versus no tobacco (OR 3.49, 95% CI 1.8 to 6.8) and when the outcome was (2) current dual use versus no smoking but including snus-only use (OR 1.88, 95% CI 1.1 to 3.3). Baseline snus users who were dual users at follow-up seemed to prefer using snus daily and cigarettes occasionally. Use of snus only at baseline was not associated with increased odds of smoking only at follow-up, after adjusting for known risk factors.

Conclusions Young men who only used snus at baseline had an increased risk of being dual users at follow-up. Snus use may therefore facilitate smoking.

  • Smokeless tobacco
  • smoking
  • adolescence
  • Norway
  • non-cigarette tobacco products
  • harm reduction
  • nicotine
  • addiction

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  • Funding The City of Oslo (baseline) and the Centre for Child and Adolescent Mental Health (follow-up) in Oslo contributed to the funding of the study. The Norwegian Association for Public Health and the Norwegian Heart and Lung Patient Organisation (LHL) funded this research project.

  • Competing interests None.

  • Ethics approval The protocols from both baseline and follow-up were evaluated by the Regional Committee for Medical Research Ethics and approved by the Norwegian Data Inspectorate. Approval from the school authorities was obtained from the school part of the study.

  • Provenance and peer review Not commissioned; externally peer reviewed.