Snus user identity and addiction: a Swedish focus group study on adolescents.

BACKGROUND: The teenage years are the years when adolescents seek their identity, and part of this involves experimenting with tobacco. The use of tobacco as such, and norms among their friends, is more important to the adolescents than the norms of parents when it comes to using tobacco or not. The aim was to explore the significance of using snus for adolescents, and attitudes to snus, as well as the reasons why they began using snus and what maintained and facilitated the use of snus. METHODS: Adolescents who use snus were interviewed in focus groups. The material was analysed using content analysis. RESULTS: Four groups of boys and one group of girls were interviewed, a total of 27 students from the upper secondary vocational program. Three themes related to the students' opinions on and experiences of using snus were found: Circumstances pertaining to snus debut indicate what makes them start using snus. Upholding, which focuses on the problem of becoming addicted and development of identity, and approach, where the adolescents reflect on their snus habits in relation to those around them. A number of factors were described as relevant to behaviour and norm building for the development into becoming a snus user. Attitudes and actions from adults and friends as well as - for the boys - development of an identity as a man and a craftsman influenced behaviour. CONCLUSIONS: The results showed that development of identity was of major importance when adolescents start using snus. The adolescents were initially unable to interpret the early symptoms of abstinence problems, but subsequently became well aware of being addicted. Once they were stuck in addiction and in the creation of an image and identity, it was difficult to stop using snus. These factors are important when considering interventions of normative changes and tobacco prevention in schools as well as among parents.

When do adolescents become smokers? Annual seven-year population-based follow-up of tobacco habits among 2000 Swedish pupils--an open cohort study.

OBJECTIVE: To follow the development of a class of pupils' tobacco habits for seven years, and to study differences in tobacco use between girls and boys. SETTING: Kronoberg County in southern Sweden. SUBJECTS: All the approximately 2000 pupils were followed from approximately age 12 to approximately age 18. DESIGN: Yearly cross-sectional surveys from 1994 to 2000. Each year, the pupils filled in an established tobacco questionnaire. They did it anonymously in the classroom. MAIN OUTCOME MEASURES: Percentage of smokers, number of cigarettes smoked per day, and percentage of pupils using "snus", the Swedish variety of oral moist snuff. RESULTS: From grade 6 of compulsory school to grade 12 of upper secondary school, the proportion of daily smokers rose, from 0.2% to 22% for girls and from 0.5% to 14% for boys. Among both genders, the increase occurred mainly between grades 7 and 10, and from grade 10 onwards the daily smokers were the largest group of smokers. Starting from grade 9, boys had higher total tobacco consumption than girls, as a result of their increased use of "snus", and at the end of the study 39% of the boys used tobacco compared with 34% of the girls. CONCLUSION: Studying young people's tobacco habits over time gives an understanding of when preventive measures should be implemented. In order for these to influence attitudes, they should be put in place well before tobacco is introduced.