Some smokers say they just can’t quit cigarettes. But previous studies of
smokers in Sweden have suggested that many have done just that, by switching
to smokeless tobacco. While not without health risks, smokeless tobacco is
less harmful than cigarettes. With that in mind, an international team of
researchers asked the question, “Should public health officials start
promoting smokeless tobacco as a way to reduce the overall harm caused by
tobacco?” The answer: “Not so fast.”
According to a study from the University of California, San Diego and
Sweden’s Karolinska Institutet, there are important differences between the
United States and Sweden with respect to how people use—and quit—tobacco.
The study, in the online issue of Tobacco Control, examined data from more
than 15,000 individuals in the U.S. who were surveyed twice, a year apart,
to get a picture of tobacco use and cessation in the U.S.
“In Sweden, many smokers have quit smoking by switching to snus,” said Shu-Hong
Zhu, Ph.D., Professor of Family and Preventive Medicine in the UCSD School
of Medicine. (Snus—pronounced snoos—is a form of moist, powdered tobacco
that comes in a small sachet and is placed under the lip.) “This has piqued
a lot of interest, because anything that helps people quit cigarettes could
have huge benefits due to the great harm caused by smoking.”
“Historically, there has been no campaign to promote snus to Swedes as a
safer alternative to cigarettes,” said Hans Gilljam, M.D. a Professor at the
Karolinska Institutet and a study author. “But snus has been popular among
male smokers, and has helped them quit cigarettes. In fact, Swedish men have
a higher smoking cessation rate than Swedish women, few of whom use snus.”
The researchers looked for a similar effect among U.S. smokers, but didn’t
find one. Like their counterparts in Sweden, U.S. men are much more likely
than women to use smokeless tobacco. But it does not boost their rate of
quitting smoking.
Zhu explained, “With an ongoing tobacco control effort, men in the U.S. seem
to be quitting smoking at higher rates than men in Sweden. And U.S. women
are quitting at the same rate, unlike their counterparts in Sweden.”
These findings are important because there has been a vigorous debate in the
international public health community about whether tobacco control programs
should stop advocating complete tobacco cessation and start promoting
smokeless tobacco as a less-harmful alternative to smoking. If Sweden’s
results were to be replicated in a longitudinal study from another country,
it would support promoting smokeless as a harm-reduction strategy.
The current study examined data from the Tobacco Use Supplement to the
Current Population Survey, 2002, with one-year follow-up in 2003. Results
showed both male and female smokers in the U.S. appear to have higher quit
rates for smoking than their Swedish counterparts, despite greater use of
smokeless tobacco in Sweden.
Over a one-year period, the study tracked the quit rates, and the rates of
switching from one form of tobacco to another, of more than 15,000 adult
participants. It showed that:
*Among U.S. men, less than one percent of current smokers switched to
smokeless tobacco during the 12 month study.
*Only 1.7 percent of former smokers turned to smokeless tobacco.
*Men’s quit rate for smokeless tobacco was three times higher than for
cigarettes.
*Even though men were far more likely to use smokeless tobacco products than
women, overall, they had no advantage over women in quitting smoking (11.7
percent vs. 12.4 percent).
The Swedish data showed just the opposite: Swedes who use smokeless tobacco
are likely to keep using it, rather than switching to other tobacco
products. Their habit is relatively stable. By comparison, Swedes who smoke
cigarettes are more likely to switch to other tobacco products, such as
smokeless tobacco. Their habit is less stable.
“Many public health officials and scientists have cautioned that the Swedish
results may be unique to Sweden,” explained Zhu. “This research confirms
that idea.”
Background:
Some have proposed that a campaign to promote smokeless tobacco as a safer
alternative to cigarettes would lead to improved smoking cessation and
reduced tobacco-related death and disease. Those who oppose this approach
are concerned that it could dilute the overall anti-tobacco message and have
a negative net impact on public health compared to current, proven tobacco
control strategies.
It is difficult to gauge the likelihood of either a benefit or detriment to
public health from promoting smokeless tobacco, because the arguments for
each involve assumptions about population behavior, and empirical data to
verify these assumptions are hard to obtain.
This work was supported in part by a supplemental grant to the Moores UCSD
Cancer Center from the National Cancer Institute.
Authors on the current study include: Zhu, Julie B. Wang, Anne Hartman,
Yuerong Zhuang, Anthony Gamst, James T. Gibson, Hans Gilljam, and Maria
Rosaria Galanti. Authors’ research affiliations include: University of
California, San Diego, National Cancer Institute, Information Management
Services, Rockville, Maryland, and Karolinska Institutet, Stockholm, Sweden.
