TMA Annual Conference, Williamsburg, May 20-22, Public Health. The Swedish Experience

Transcription

1 TMA Annual Conference, Williamsburg, May 20-22, 2012 Effects of Snus Use on Public Health The Swedish Experience Lars M. Ramström PhD Director, Institute for Tobacco Studies Stockholm, Sweden

2 Background Concerns have been raised that the use of snus - despite its benefits to the health of individuals - could have negative effects on public health. Issues to be discussed Snus use and initiation of smoking Subsequent tobacco use after uptake of snus use among daily smokers Snus use and cessation of smoking Transferability of the Swedish experience

3 Annual sales of snus in Sweden (metric tons) Source: Official trade statistics

4 Boys in Sweden: Initiation of daily tobacco use 100 Snus use Smoking None Around Around Around Around Around Source: FSI / ITS surveys

5 Boys in Sweden: Initiation of daily tobacco use Regression lines 75 None 50 Smoking 25 Snus use 0 Around Around Source: FSI / ITS surveys

6 Girls in Sweden: Initiation of daily tobacco use 100 Snus use Smoking None Around Around Around Around Around Source: FSI / ITS surveys

7 Boys who have NOT initiated daily snus use: - 46% start daily smoking Boys who have first initiated daily snus use: - 17% start daily smoking Source: FSI / ITS surveys

8 Girls who have NOT initiated daily snus use: - 40% start t daily smoking Girls who have first initiated daily snus use: - 8% start daily smoking Source: FSI / ITS surveys

9 Among boys who have started daily smoking - 92% come from the group of never dil daily snus users - 8% come from the group of daily snus-usersusers Source: FSI / ITS surveys

10 In Sweden the use of snus has served as a diversion from smoking, not as a gateway to smoking. This has contributed to the increasing proportion of young people who do NOT start any daily tobacco use. These findings suggest that the use of snus in Sweden has yielded benefits for public health.

11 Subsequent tobacco use after uptake of snus use among daily smokers Men Women No daily smoking No daily smoking Source: FSI / ITS surveys

12 In the vast majority of cases, smokers uptake of snus use... has NOT resulted in dual use has either been replacing smoking or, serving as a stepping-stone towards quitting all tobacco use and has then NOT perpetuated nicotine dependence These findings suggest that the use of snus in Sweden has yielded benefits for public health.

13 Cessation of smoking in Sweden Quit ratios* in different categories Men Women Former/current / daily snus users Never daily snus users All *Proportion of Ever daily smokers that has quit completely Source: FSI / ITS surveys

14 Both in men and women quit ratios are substantially ti higher h among former and current snus users than among never snus users. The difference between All men and All women is a consequence of the lower prevalence of snus use in women. Gender itself does not influence smoking cessation, but snus use does favour smoking cessation.

15 Snus use and cessation of smoking The numbers in green sectors indicate aid-specific ifi quit ratios (successfulness) Source: FSI /ITS surveys

16 Al large study in Norway has yielded dsimilar il results as this Swedish one. These studies jointly suggest, that in Sweden the combination of -wide usage in real life settings, and - superior success rate among users has made snus an effective aid for smoking cessation on the population level and thereby yyielded public health benefits.

17 Transferability of the Swedish experience Some populations with no tradition of snus use: Prevalence of daily snus use Swedish women, age % 5% Norwegian men, age % 11% Norwegian women, age % 6%

18 Annual sales of snus in Sweden (metric tons) The upturn of snus use at this particular time appears to reflect an awareness of the harmfulness of cigarettes raised by the 1962 and reports and a subsequent demand for less harmful alternatives Smoking and Heath, RCP 1962 Smoking and Heath, US Surgeon General

19 A previously unknown product cannot be a realistic alternative to cigarettes unless it is clearly perceived as less harmful. However, in many countries there is a widespread misunderstanding that all tobacco is equally harmful. A thoughtful comment is given in the 2007 Report of The Royal College of Physicians of London: The epidemiology of tobacco use in Sweden suggests that if the public is offered a substantially less harmful smokeless tobacco product along with access to accurate information on relative risks, a substantial proportion can switch to the less harmful product. This has clear implications for public health. It seems that the transferability of the Swedish experience will not depend so much on existing traditions but rather on the availability of comprehensive and accurate public information to eradicate prevailing misunderstandings.

20 Effects of Snus Use on Public Health - The Swedish Experience Conclusions Snus use and initiation of smoking: Positive effects by contributing to less initiation of smoking Subsequent tobacco use after uptake of snus use among daily smokers: Positve effects by serving as stepping-stone to tobacco-free endpoints No negative effects in terms of widespread dual use No negative effect in terms of unavoidable perpetuation of nicotine dependence d Snus use and cessation of smoking: Positive effects by contributing to more cessation of smoking through the combination of widespread usage in real life settings and high level of successfulness Transferability of the Swedish experience: Appears not to be blocked by absence of tradition but hampered by misunderstandings about relative risks