AVA Synopsis:
Similar to the increase use of e-cigarettes among youth in the United States, an increase in use of snus by youth in Norway has ignited a debate on banning flavors in snus products. The study sought to analyze “snus use according to smoking status” to compare the “probability” of flavored snus among different smoking patterns.
An online survey was administered weekly by the research firm Ipsos with the Norwegian Institute of Public Health, between February 2015 and December 2019, and comprised of a total of 65,445 persons aged 15 years or over, with 20 percent of respondents being above the age of 60.
The authors found that among all categories of snus use “never smokers comprised 25.3% or less.” Indeed, over 45 percent of daily snus reported being former daily smokers, and had quit smoking, or smoked occasionally. Regarding flavor use, “the overall probability” of using flavored snus “among all current snus users was 0.45.” The authors noted that flavor use “was highest among the youngest age group and decreased with increasing age.” The authors also found that when examining the combination of all current snus users, “results show that use of flavored snus was high among daily smokers and former daily smokers and lowest among never smokers.”
The authors conclude that “the health authorities should be mindful of the real-world complexity governing potential harms and benefits of flavor restrictions on snus.”
Implications:
Snus is another tobacco harm reduction tool that has been useful for adult smokers in quitting combustible cigarettes. Similar to e-cigarettes, the use of flavors is important in helping smokers transition and remain smoke-free.
Abstract:
Background: Similar to the debate around e-cigarettes, an increase in snus use among Norwegian adolescents has prompted debate on whether flavour options in snus should be limited. To this end, we compared use of flavoured snus among snus users with different smoking status.
Methods: Questions about flavoured snus use were included in an online omnibus study conducted from 2015 to 2019 (N = 65,445) that included 16,295 ever snus users (aged 15+). Current snus users (N = 9783) were asked “Do you usually use snus that has a flavouring (liquorice, mint, wintergreen, etc.)? Adjusted predicted probabilities and 95% confidence intervals (CI) were calculated from a logistic regression model.
Results: Less than 25% of the snus users reported never having smoked. The overall probability of using flavoured snus was .45 (95% CI .44–.46), highest among daily (.51, 95% CI .47–.54) and former daily smokers (.50, 95% CI .48–.52), and lowest among never (.41, 95% CI .39–.43) and occasional smokers without any prior history of daily smoking (.41, 95% CI .38–.44). Use of flavoured products was higher among female snus users (p = .67, 95% CI .65–.69) compared to males (p = .35, 95% CI .34–.36), highest among the youngest age group, 15–24 years (p = .58, 95% CI .56–.60) and decreased with increasing age.
Conclusion: Regulation that would ban or limit flavoured snus use may affect smokers—an at risk population—more than never smokers. The health authorities should be mindful of the real-world complexity governing potential harms and benefits of flavour restrictions on snus. A further assessment of flavour limitations should acknowledge that flavoured snus products also function as alternatives to cigarettes.
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