The Relationship Between Smokeless Tobacco (snus) and Anxiety and Depression Among Adults and Elderly People. A Comparison to Smoking in the Tromsø Study

Aims: To (i) define the characteristics of snus users compared with non-users and smokers and (ii) define the relationship between snus use and self-reported anxiety and depression and compare it with the relation between smoking and anxiety and depression.

Design, Setting And Participants: A cross-sectional study based on data from the Norwegian population-based survey, the Tromsø Study (2015-16). A total of 32 591 people aged 40 years and older in the municipality of Tromsø were invited to attend. There were 21 083 respondents, giving a 65% attendance rate.

Measurements: Tobacco use was assessed by current and previous use of snus or cigarettes. Symptoms of anxiety and depression were measured using the Hospital Anxiety and Depression Scale (HADS).

Findings: Snus users were more often male, were younger and had higher income and higher alcohol consumption than smokers and non-users of snus. In a linear regression analysis, we found no significant association between current snus use and anxiety and depression after adjusting for background variables. However, there was a positive association between previous snus use and anxiety among males [adjusted beta = 0.258; 99% confidence interval (CI) = 0.023-0.492]. Regarding anxiety, the adjusted beta-coefficients for current smoking were 0.425 (99% CI = 0.184-0.666) for females and 0.303 (99% CI = 0.084-0.522) for males. Concerning depression, the adjusted beta coefficients for current smoking were 0.569 (99% CI = 0.358-0.780) for females and 0.281 (99% CI = 0.060-0.503) for males.

Conclusions: In Norway, current snus users differ from current smokers by having a higher socio-economic status and no detectable association with anxiety and depression. This suggests that the relationship between tobacco use and anxiety and depression is associated with the administration method.