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How Swede It Is!

Evolving patterns of tobacco use in northern Sweden. Published in the Journal of Internal Medicine (Volume 243: pages 660-665, 2003) by Brad Rodu, Birgitta Stegmayr, Salmir Nasic, Philip Cole and Kjell Asplund. (UAB TRF)

In our first study from Sweden, we used cross-sectional data to show that the increased use of Swedish moist snuff (snus) contributed to a decline in smoking rates, especially among men. This study described the more additional patterns of tobacco use in northern Sweden over the period 1986-1999.

Our study group consisted of 1,651 men and 1,756 women age 25-64 who enrolled in the northern Sweden MONICA project in 1986, 1990 and 1994 and who were followed up in 1999. We used information on their tobacco use at enrollment and at follow-up to describe the stability of various forms of tobacco use (eg smoking, snus use) over a period of 5 to 13 years ending in 1999.

Our analysis showed that snus was the most stable form of tobacco use among men (75% stability); only 2% of users switched to cigarettes and 20% quit tobacco altogether. Smoking was less stable (54%); 27% of smokers were tobacco-free and 12% used snus at follow-up. Combined use (smoking and snus) was the least stable (39%), as 43% switched to snus and 6% switched to cigarettes. Former users of both products were much less stable than former users of either cigarettes or snus. The stability of smoking among women was 69%, which was higher than that among men (p < 0.05).

Our study shows that snus use played a major role in the decline of smoking rates among men in northern Sweden during the 1980s and 1990s. The evolution from smoking to snus use occurred in the absence of a specific public health policy encouraging such a transition and probably resulted from historical and societal influences.

This study was supported in part by the Tobacco Research Fund (UAB). This study was also supported by grants from the Swedish Medical Research Council, the Swedish Research Council, the Research Council for Social Sciences, the Heart and Chest Fund, King Gustaf V’s and Queen Victoria’s Foundation, Vasterbotten and Norrbotten County Councils and the Swedish Public Health Institute.

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