Evolving patterns of tobacco use in northern Sweden

Abstract

Rodu B, Stegmayr B, Nasic S, Cole P, Asplund K (University of Alabama at Birmingham, Birmingham, AL, USA; Umeå Hospital, Umeå, Sweden). Evolving patterns of tobacco use in northern Sweden. J Intern Med 2003; 253: 660–665. Background and objectives. Cross‐sectional data from northern Sweden suggest that the increased use of Swedish moist snuff (snus) may have contributed to a decline in the prevalence of smoking, especially amongst men. This study describes the evolving patterns of tobacco use in this population over the period 1986–1999. Design. This is a prospective follow‐up study of 1651 men and 1756 women, aged 25–64 years, who were enrolled in the northern Sweden MONICA project (entry in 1986, 1990, 1994) and who were followed‐up in 1999. Information on tobacco use at entry and at follow‐up was used to describe the stability of tobacco use over a period of 5–13 years ending in 1999. Results. Snus was the most stable form of tobacco use amongst men (75%); 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 amongst women was 69%, which was higher than that amongst men (P < 0.05). Conclusions. The use of snus played a major role in the decline of smoking rates amongst men in northern Sweden. 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.