Role of snus in initiation and cessation of tobacco smoking in Sweden.

OBJECTIVE: To examine patterns of smoking and snus use and identify individual pathways of Swedish tobacco users in order to clarify whether snus use is associated with increased or decreased smoking. METHODS: Retrospective analysis of data from a cross-sectional survey completed by 6752 adult Swedes in 2001-2 focusing on identifying tobacco use history by survey items on current and prior tobacco use and smoking initiation and cessation procedures. RESULTS: 15% of the men and 19% of the women completing the survey were daily smokers. 21% of the men and 2% of the women were daily snus users. Almost all (91%) male daily smoking began before the age of 23 years, whereas initiation of daily snus use continued throughout the age range (33% of initiation after age 22). 20% of male primary snus users started daily smoking compared to 47% of non-primary snus users. Thus, the odds of initiating daily smoking were significantly lower for men who had started using snus than for those who had not (odds ratio (OR) 0.28, 95% confidence interval (CI) 0.22 to 0.36). Among male primary smokers, 28% started secondary daily snus use and 73% did not. 88% of those secondary snus users had ceased daily smoking completely by the time of the survey as compared with 56% of those primary daily smokers who never became daily snus users (OR 5.7, 95% CI 4.9 to 8.1). Among men who made attempts to quit smoking, snus was the most commonly used cessation aid, being used by 24% on their latest quit attempt. Of those men who had used one single cessation aid 58% had used snus, as compared with 38% for all nicotine replacement therapy products together. Among men who used snus as a single aid, 66% succeeded in quitting completely, as compared with 47% of those using nicotine gum (OR 2.2, 95% CI 1.3 to 3.7) or 32% for those using the nicotine patch (OR 4.2, 95% CI 2.1 to 8.6). Women using snus as an aid were also significantly more likely to quit smoking successfully than those using nicotine patches or gum. CONCLUSION: Use of snus in Sweden is associated with a reduced risk of becoming a daily smoker and an increased likelihood of stopping smoking.

Implications of the tobacco dependence syndrome for smoking control programmes.

Motivational and psychosocial treatments for tobacco dependence, while valuable, are not sufficient to solve nicotine-related problems, which usually require a pharmacological approach. There is also a need for training programmes for health workers and major educational campaigns on the nature of tobacco dependence to be directed at opinion leaders, teachers and the public at large.

Worldwide changes and trends in cigarette brands and consumption.

When looking at the above review of changes and trends in cigarette consumption some summary conclusions can be drawn: a continued growth in cigarette consumption will mainly take place in developing countries; price increases may have complex and unexpected effects, such as changing the brand structure of the market rather than reducing its size on a long-term basis; future studies of cigarette consumption trends will have to give increased attention to generic and hand-rolled cigarettes; in the future it will be irrelevant to look at the distinction between filter cigarettes and nonfilter ones; the important distinction will be between different types of filter cigarettes; an increasing taste consciousness among large groups of smokers will most probably constitute an additional obstacle to low-tar cigarettes ever becoming a viable vehicle for the limitation of smoking-related health risks.

Passive smoking in aircraft--a current WHO project.

Only few measurements of levels of pollution by tobacco smoke in aircraft have been made. The results suggest that levels are quite moderate, but studies of actual reactions by passengers and cabin crew indicate rather strong, objective effects. These consist of irritation of the mucous membranes of eye, nose and throat as well as perception of bad odours. Evidently, environmental tobacco smoke causes distress in aircraft already at lower concentrations than under ground conditions, probably because of special climatic conditions such as ultra-low air humidity, elevated levels of ozone, subnormal air pressure and, eventually, disturbance of the concentration of light air ions. None of these abnormalities can easily be eliminated. Ventilation, however effective in terms of rate of air changes, can not effectively curb local peak concentrations, and, close to a smoker the concentration of smoke may be 100 times as high as the room average. Therefore, aircraft must provide separate smoking resp non-smoking areas. Area division along an aisle is unacceptable since the ventilation system makes the aisle and adjacent seats on both sides be located in one whirl of common air. WHO will try to stimulate improvements of airline practices and aircraft design.