Snus doesn’t help smokers quit, either

Snus — small pouches of tobacco inserted under the lip — has been promoted for a long time as a less harmful way to consume tobacco than smoking and as a smoking cessation aid. The argument that snus helps people quit smoking is based on the fact that the prevalence of smoking dropped at the same time the prevalence of snus increased in Scandinavian countries. (The same argument has been used in England to support the claim that e-cigarettes help smokers quit.) The problem is that many other changes are happening at the same time and, as e-cig enthusiasts love to stress, correlation is not causation.

A much better way to examine whether snus (or e-cigarettes) help smokers quit is to collect data at the level of individual smokers.

Now Inger Gram and her colleagues have provided a strong analysis of individual level data showing that Norwegian smokers who were enrolled in a large national smoking cessation trial who used snus were half as likely (adjusted OR=0.49; 95% CI: 0.35–0.69) to have quit smoking six months later than smokers who did not use snus. Importantly, their analysis controlled for level of addiction and other important demographic factors.

Far from being an alternative to cigarettes, snus promotes continued smoking and supports overall tobacco company profits.

This paper also provides strong evidence against the idea that declining smoking prevalence at the same time snus use is increasing shows that snus helps people quit smoking. In particular, the new study shows that different people are quitting smoking than are taking up snus. Specifically, the increasing numbers of snus users are adolescent women aged 16-24 years and the decreasing number of smokers are women 50 years and older that are quitting.

Here is the abstract:

Introduction: We examined if we could identify predictors for smoking cessation at six months post cessation, among smokers enrolled in a large Norwegian population-based intervention study.

Methods: We followed 4333 (72.1% women) smokers who enrolled in an internet-based smoking cessation intervention during 2010-2012. The baseline questionnaire collected information on sociodemographic and lifestyle factors, including current snus use. The cessation outcome was self-reported no smoking past seven days, at six months. We used logistic regression to estimate odds ratios (ORs) with 95% confidence intervals, to identify predictors of smoking cessation, adjusting for potential confounders.

Results: Women (OR=1.30; 95% CI: 1.01-1.69) compared with men, and those with medium (OR=1.31; 95% CI: 1.02-1.68) and longer (OR=1.42; 95% CI: 1.06-1.90) education compared with those with shorter education, were more likely to be successful quitters.Overall, being a student (OR=0.56; 95% CI: 0.37-0.85) compared with having full-time work, and a moderate to high Fagerström test for nicotine dependence (FTND) score (OR=0.69; 95% CI: 0.55-0.87) compared with a low score, were predictors for unsuccessful cessation. Current snus use was a predictor for unsuccessful cessation compared to no snus use for both men (OR=0.49; 95% CI: 0.28-0.88) and women (OR=0.49; 95% CI: 0.32-0.75).

Conclusions: Our study identifies female sex and longer education as predictors for successful smoking cessation, while a medium or high FTND score, being a student, and current snus use, were predictors for unsuccessful smoking cessation. Only current snus use was a predictor for unsuccessful cessation for both sexes. Our results indicate that smokers should be warned that snus use may prevent successful smoking cessation.

The full citation is: Gram IT, Antypas K, Wangberg SC, Løchen ML, Larbi D. Factors associated with predictors of smoking cessation from a Norwegian internet-based smoking cessation intervention study. Tob Prev Cessat. 2022 Oct 31;8:38. doi: 10.18332/tpc/155287. PMID: 36382026; PMCID: PMC9620393. It is available here.