Snus is moist smokeless tobacco developed in Sweden.
It's contained in a small pouch, and unlike regular chewing tobacco,
it doesn't make the user spit.
Research suggests snus has lower levels of chemicals called
nitrosamines than cigarettes and may be less harmful.
In Norway, snus has become a smoking cessation aid, and most older snus users are former smokers.
But snus is also becoming increasingly popular among young Norwegian
adults, many of whom have not smoked cigarettes. And although
research is divided, the current thinking is that snus use reduces
the likelihood of taking up smoking.
The authors of the new study wanted to know more about when people
start using snus, to see if that ties into whether they also begin
"I already knew about the research investigating associations
between snus use and later smoking, but discovered that snus debut
age had not been mentioned in that research," Ingeborg Lund told
Reuters Health in an email.
Lund is a researcher with the Norwegian Institute for Alcohol and
Drug Research — SIRUS, in Oslo. She and her colleague Janne
Scheffels published their study in Nicotine and Tobacco Research.
The researchers analyzed surveys of Norwegian teenagers and adults
conducted from 2005 to 2011.
Out of 8,313 people, 409 were long-term snus users who had started
using snus before cigarettes or never used cigarettes. Of the snus
users, 30 percent were long-term smokers.
Just over one-third of the snus users started using snus before age
16. The researchers discovered those participants had two to three
times the odds of becoming lifetime smokers, compared with people who
began using snus after age 16.
They also found that early snus users had about the same rate of
cigarette smoking as non-snus users. About 23 percent of early snus
users were current smokers at the time of the survey, compared to
only 6 percent of people who started using snus when they were
"Snus use seems to protect against smoking if the snus debut does
not happen too early during adolescence," Lund said.
She said it's particularly important to keep teenagers tobacco-free
until they are at least 16 years old.
"At younger ages, even if they start with a low-risk product such as snus, there is a high risk that they will switch to — or add — other
high-risk products, such as cigarettes," she said. "This risk is
reduced when they grow older."
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Since snus use is much less common in other countries, Lund said
she doesn't know if these results can be generalized outside of
Norway and Sweden.
Lucy Popova, from the Center for Tobacco Control Research and
Education at the University of California, San Francisco, told
Reuters Health the new study was "interesting." She was not involved
in the research.
"Earlier initiation of snus basically makes it a gateway to tobacco
use, to cigarette use in the future," she said.
Popova explained that traditional Swedish snus is less dangerous
"But it's not harm-free, and (what) is really bad is when people
start using both products because of increased rates of
cardiovascular disease, pancreatic cancers and other problems," she
Snus is fairly new to the U.S., and Popova said the version made in
the U.S. isn't like the traditional Swedish product.
"A research study found that it's different from the traditional
low-nitrosamine snus in Sweden — it's not necessarily going to be as
low-harm," she said.
Popova is concerned with heavy promotion for smokeless tobacco
products like snus.
"There's been a lot of studies showing that more advertisement for
tobacco products makes it more likely that children will use tobacco
products," she said, "and it's important to keep youth tobacco-free
as long as possible."
Nicotine and Tobacco Research, online Feb. 5, 2014.
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