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Smoking Rate Among Swedish Boys is Lowest in All of Europe; 15-Year Smoking Decline Linked to Increasing Smokeless Tobacco Use

Tobacco Use Among Swedish Schoolchildren . Published in Tobacco Control, Volume 14, pages 405-408, December 2005. By Brad Rodu, Salmir Nasic and Philip Cole (UAB TRF).

Does the use of snus, a popular form of smokeless tobacco in Sweden, lead to higher smoking rates?  No, just the opposite, according to research published in the December 2005 issue of the journal Tobacco Control.  The high prevalence of snus use in Sweden, already strongly associated with low smoking rates among men, is associated with low smoking prevalence among boys as well. 

“This study squarely refutes the widely-held assumption that smokeless tobacco is a gateway to cigarette smoking,” says the study’s lead author, Dr. Brad Rodu, now Professor, Department of Medicine, and Endowed Chair, Tobacco Harm Reduction Research at the University of Louisville.  “Based on our data, some would say that snus use effectively vaccinates Swedish boys against smoking.”

For 50 years Swedish men have had the lowest smoking rates and the lowest incidence of smoking-related diseases in the developed world. Swedish men smoke -- and consequently die from smoking-related diseases-- at about half the rate of men in all other European Union (EU) countries.  According to a report in the Scandinavian Journal of Public Health earlier this year, only 9% of men in northern Sweden smoke, while 27% use snus.

The new research shows that about 20% of Swedish boys use tobacco regularly, which is the norm for boys in other European countries.  But fewer than 4% of Swedish boys smoke, while about 13% use snus (the rest used both products).  In contrast, data from the World Health Organization reveals an average smoking rate of 18% among boys in 24 other European countries.

Smoking prevalence among Swedish boys is far lower than among girls, which in 2003 was 14%, fifth lowest in Europe.  In most European countries, smoking among boys is about 80% the rate of girls; in Sweden, boys smoke at only one-third the rate of girls.
The new evidence of the favorable effect of snus use on smoking rates among children comes at an important time in the global tobacco debate.  European regulators are currently re-examining the EU’s ban on smokeless tobacco products in all countries other than Sweden.   Supporters of the ban have argued that widespread availability of smokeless tobacco may lead to tobacco initiation among adolescents, and eventually, higher smoking rates.  The new research should dispel those concerns.  The study concludes: “Snus use does not appear to be a gateway to smoking among Swedish youth, but instead is associated with low smoking prevalence among boys.”

Another recent Swedish study showed that parental tobacco use strongly influences tobacco use by children. For example, boys whose fathers used snus were three times more likely to use snus, compared with boys whose fathers were tobacco-free.  Similarly, mothers’ smoking was associated with smoking in their children.  Women in Sweden use snus at far lower rates than men, and smoke at roughly the same rate as European women in general, with similar mortality rates for smoking related diseases.

The article was authored by Dr. Rodu, Salmir Nasic, Department of Medicine, University Hospital, Umeå, Sweden; and Philip Cole, Department of Epidemiology, School of Public Health, University of Alabama at Birmingham.  The primary sources of data were surveys conducted by the Swedish Council for Information on Alcohol and Other Drugs.  A total of 84,472 boys and girls, age 15-16 years, were surveyed over the 15-year study period.

Drs. Rodu and Cole are supported in part by unrestricted gifts from smokeless tobacco manufacturers to their institutions. The sponsors had no scientific input or other influence in regard to this project, including design, analysis, interpretation or preparation of the manuscript. The sponsors had no knowledge of this project and did not seen the manuscript prior to its publication. (UAB)

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