Snus is an oral smokeless tobacco product which is usually placed behind the upper lip, either in a loose form or in portioned sachets, and is primarily used in Sweden and Norway. The purpose of this review is to examine the reported effects of snus use in relation to specified health effects, namely lung cancer, cardiovascular disease, pancreatic cancer, diabetes, oral cancer and non-neoplastic oral disease. The review also examines the harm reduction potential of snus as an alternative to cigarettes by comparing the prevalence of snus use and cigarette smoking, and the reported incidence of tobacco-related diseases across European Union countries. The scientific literature generally indicates that the use of snus is not a significant risk factor for developing lung cancer, cardiovascular disease, pancreatic cancer or oral cancer. Studies investigating snus use and diabetes have reported that high consumption of snus (estimated as being four or more cans per week) may be associated with a higher risk of developing diabetes or components of metabolic syndrome; however, overall results are not conclusive. Snus use is associated with the presence of non-neoplastic oral mucosal lesions which are reported to heal rapidly once use has stopped. The most recent Eurobarometer data from 2017 reported that Sweden had the lowest prevalence of daily cigarette use in the European Union at 5% whilst daily “oral tobacco” use was reported to be 20%. European data published by the World Health Organisation in 2018 indicated that Sweden had the lowest rate of tobacco-related mortality and the lowest incidence of male lung cancer. Overall, prevalence statistics and epidemiological data indicate that the use of snus confers a significant harm reduction benefit which is reflected in the comparatively low levels of tobacco-related disease in Sweden when compared with the rest of Europe. The available scientific data, including long-term population studies conducted by independent bodies, demonstrates that the health risks associated with snus are considerably lower than those associated with cigarette smoking.

Background Electronic cigarettes (e-cigarettes) have been characterised as significantly less harmful than cigarettes by many health agencies and regulators globally. In this study, we examined to what extent perceived relative harms of e-cigarettes compared to cigarettes have changed in the USA. Methods We analysed the data from the longitudinal and nationally representative, Population Assessment of Tobacco and Health Study to assess the relative perceived harm of e-cigarettes amongst US adults between 2013 and 2016. Results The proportion of US adults who correctly perceived e-cigarettes as less harmful than cigarettes decreased each year from 41.1% (CI 40.1–42.1%) in 2013–2014, 31.5% (CI 30.8–32.2%) in 2014–2015 and 25.3% (CI 24.6–26.0%) in 2015–2016. Concurrently, the proportion of US adults who perceived e-cigarettes as equally, or more, harmful than cigarettes increased from 53.7% (CI 52.3–55.1%), 64.9% (CI 63.6–66.2%) to 72.7% (CI 71.5–73.9%) respectively. The proportion of US adults who held negative relative harm perceptions of e-cigarettes increased regardless of current smoking or vaping status by 24.6% and 29.6% respectively within 3 years. In Wave 3, the proportion of current smokers who perceived the relative harm of e-cigarettes as less harmful was lower at 29.3% (CI 28.2–30.4%) compared to current e-cigarette users at 43.5% (CI 40.3–46.7%). Former smokers who used e-cigarettes and believed that they were equally, or more, harmful than cigarettes in 2014–2015 had significantly higher rates of smoking relapse in the following year, 29% and 37% (p < 2.2e−16), respectively, compared to those with positive relative harm perceptions who reported relapse rates of 19%. Conclusions In this study, the proportion of US adults who incorrectly perceived e-cigarettes as equal to, or more, harmful than cigarettes increased steadily regardless of smoking or vaping status. Current adult smokers appear to be poorly informed about the relative risks of e-cigarettes yet have potentially the most to gain from transitioning to these products. The findings of this study emphasise the urgent need to accurately communicate the reduced relative risk of e-cigarettes compared to continued cigarette smoking and clearly differentiate absolute and relative harms. Further research is required to elucidate why the relative harm of e-cigarettes is misunderstood and continues to deteriorate.

This study reports on an innovative version of adaptive primary literature (APL) that we call Science Behind the Scenes used during a summer professional development (PD) program. Classroom teachers read and discussed papers from the primary literature, and created translations of these papers relevant to their own classroom needs. We randomly selected 31 teacher‐created Science behind the Scenes products for evaluation with a rubric that was aligned with the K‐12 Science Education Frameworks (2012). In addition, we interviewed groups of teachers at follow‐up sessions and individual teachers who used the APL in their classrooms. We used frameworks for grounded theory to sort the interview text and descriptive statistical measures for quantitative data. Our analysis reveals two key findings: (i) the teachers created respectable adaptations of primary scientific literature into APL; and (ii) the teachers used the APL products in their classrooms to support the discourse of science and disciplinary literacy, and to create a bridge to the scientific enterprise. Our findings have implications for instructional design, curricular materials, professional development, and science education. © 2016 Wiley Periodicals, Inc. J Res Sci Teach 53: 847–894, 2016

No abstract