Article Text

Download PDFPDF
Snus undermines quit attempts but not abstinence: a randomised clinical trial among US smokers
  1. Matthew J Carpenter1,2,3,
  2. Amy E Wahlquist2,
  3. Jessica L Burris1,4,
  4. Kevin M Gray1,
  5. Elizabeth Garrett-Mayer2,3,
  6. K Michael Cummings1,2,3,
  7. Anthony J Alberg2,3
  1. 1Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina (MUSC), Charleston, South Carolina, USA
  2. 2Department of Public Health Sciences, MUSC, Charleston, South Carolina, USA
  3. 3Hollings Cancer Center, MUSC, Charleston, South Carolina, USA
  4. 4[Current address] Department of Psychology & Markey Cancer Center, University of Kentucky, Lexington, Kentucky, USA
  1. Correspondence to Dr Matthew J Carpenter, Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, 68 President St., MSC 955, Charleston, SC 29425, USA; carpente{at}


Background Observational studies and a few clinical trials suggest that use of low nitrosamine smokeless tobacco (snus) can facilitate smoking cessation. To better understand the real-world impact of snus on smoking behaviour, a large-scale, long-term clinical trial of naturalistic snus use among smokers is needed.

Study design A nationwide clinical trial compared abstinence outcomes among smokers who were randomised to receive free samples of snus versus not. Participants (N=1236) were recruited throughout the US and assessed for 1 year following a 6-week naturalistic sampling period, with high retention throughout. Primary outcomes included self-reported quit attempts, floating abstinence (any 7-day period of non-smoking) and 7-day point-prevalence abstinence at 6 months and 12 months. Secondary outcomes were changes in smoking, motivation and confidence to quit and adverse events. No tobacco industry support was provided.

Results Within snus group, 82% used at least once, and 16% were using regularly at end of sampling period. Compared to control participants, smokers in the snus group were less likely to make any quit attempt (RR=0.83; 95% CI 0.70 to 1.00), and any 24 h quit attempt (RR=0.77; 95% CI 0.63 to 0.95). There were no group differences on any measure of abstinence.

Conclusions Provision of snus in a naturalistic context resulted in minimal uptake, and as a whole, undermined quit attempts and did not increase smoking abstinence. Results do not support the unguided, free provision of snus among smokers not motivated to quit as a means to facilitate quit attempts.

Trial registration number NCT01509586, Results.

  • Cessation
  • Non-cigarette tobacco products
  • Harm Reduction

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.