The greater use of flavoured snus among ever-smokers versus never-smokers in Norway
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RESEARCH
The greater use of flavoured snus among ever‑smokers versus never‑smokers in Norway Tord Finne Vedoy and Karl Erik Lund*
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. Keywords: Smokeless tobacco, Snus, Tobacco, Flavour, Regulation Introduction Cigarette smoking is a leading cause of mortality and causes an estimated 6.3 million deaths globally each year [1]. Use of snus—a low-nitrosamine Swedish type of oral tobacco—has no or very weak association with the diseases that combined cause the majority of smoking attributable mortality—lung cancer, respiratory diseases
*Correspondence: [email protected] Department Alcohol, Tobacco and Drugs, Norwegian Institute of Public Health, PO Box 222, 0213 Skøyen, Oslo, Norway
and cardiovascular diseases [2]. In 2012, the WHO Framework Convention on Tobacco Control (FCTC) advised Parties to regulate, by prohibiting or restricting, ingredients that may be used to increase tobacco product attractiveness [3]. Accordingly, the 2014 European Tobacco Product Directive (TPD) prohibits cigarettes and roll-your-own tobacco with a characterizing flavour other than tobacco [4]. In the USA, the Family Smoking Prevention and Control Act banned flavoured cigarettes (with the exemption of menthol) in 2009. Non-cigarette tobacco products, such as e-cigarettes and smokeless tobacco, have so far not been subject to equivalent
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