Quitting cigarettes completely or switching to smokeless tobacco: do US data replicate the Swedish results?

Abstract

Background Swedish male smokers are more likely than female smokers to switch to smokeless tobacco (snus) and males’ smoking cessation rate is higher than that of females. These results have fuelled international debate over promoting smokeless tobacco for harm reduction. This study examines whether similar results emerge in the United States, one of few other western countries where smokeless tobacco has long been widely available. Methods US data source: national sample in Tobacco Use Supplement to Current Population Survey, 2002, with 1-year follow-up in 2003. Analyses included adult self-respondents in this longitudinal sample (n = 15 056). Population-weighted rates of quitting smoking and switching to smokeless tobacco were computed for the 1-year period. Results Among US men, few current smokers switched to smokeless tobacco (0.3% in 12 months). Few former smokers turned to smokeless tobacco (1.7%). Switching between cigarettes and smokeless tobacco, infrequent among current tobacco users (<4%), was more often from smokeless to smoking. Men quit smokeless tobacco at three times the rate of quitting cigarettes (38.8% vs 11.6%, p<0.001). Overall, US men have no advantage over women in quitting smoking (11.7% vs 12.4%, p = 0.65), even though men are far likelier to use smokeless tobacco. Conclusion The Swedish results are not replicated in the United States. Both male and female US smokers appear to have higher quit rates for smoking than have their Swedish counterparts, despite greater use of smokeless tobacco in Sweden. Promoting smokeless tobacco for harm reduction in countries with ongoing tobacco control programmes may not result in any positive population effect on smoking cessation.

Commentary on Lund et al. (2011): Consolidating the evidence on effectiveness of snus for smoking cessation - implications for public health

“…It confirms earlier Swedish research data as such and, together with another recent paper by the same lead author, it also widens the perspective by demonstrating that the same patterns can actually develop in a country where snus has not such an old tradition as in Sweden [7]. This is particularly important, as some authors have tended to devalue the importance of the Swedish experience by claiming that it could not be replicable anywhere outside Sweden [8]. There are even authors who make explicit claims that evidence on the effectiveness of snus for smoking cessation does not exist [9].…”

Impact of Smokeless Tobacco Products on Cardiovascular Disease: Implications for Policy, Prevention, and Treatment

“…134 Further, US states with the lowest rates of smoking prevalence have the lowest rates of ST use. 132,134,135 The findings of Zhu et al 132 and Tomar et al 133 weaken the argument that promoting ST use for harm reduction in countries such as the United States that have established tobacco control programs would be an effective way to increase smoking cessation rates.…”

“…130 The decrease in smoking among men in Sweden from 40% to 15% between 1976 and 2002 has been attributable to the increase in ST snus use from 10% to 23% in the same period. 131 However, in a recent longitudinal study of a national US sample, Zhu et al 132 found no association between ST use and population smoking cessation rates. In fact, ST users were more likely to switch to cigarettes.…”

Cigarette Smokers’ Use of Unconventional Tobacco Products and Associations With Quitting Activity: Findings From the ITC-4 U.S. Cohort

“…Tomar, Alpert, and Connolly (2010) found that unsuccessful attempts to quit smoking were more prevalent among males who used snuff than among those who did not. Zhu et al (2009) found no advantage in cessation for men who switched to smokeless tobacco. However, several studies conducted in Sweden, where use of snus is relatively common among men, have concluded that males who use snus have greater odds of quitting cigarette smoking than those who do not use snus (Furberg et al, 2005;Gilljam & Galanti, 2003;Ramström & Foulds, 2006).…”