How Do Smokers in a Snus-Prevalent Society Consider E-cigarettes, Snus, and Nicotine Replacement Therapy Products As Relevant Replacements for Cigarettes in the Event They Should Stop Smoking?

Overview

Journal Nicotine Tob Res

Publisher Oxford University Press

Specialty Public Health

Date 2023 Jul 6

PMID 37410922

Authors

Tord Finne Vedoy

Karl Erik Lund

Affiliations

Soon will be listed here.

Abstract

Introduction: Around 50 percent of the tobacco in Norway is consumed in the form of snus, a smokeless oral tobacco. We examined Norwegian smokers' openness, and thereby the potential reach, to use e-cigarettes, nicotine replacement therapy products (NRT), and snus in the event of quitting smoking, in a society where snus use is common.

Methods: Using data from an online survey of 4073 smokers from 2019 to 2021, we calculated predicted probabilities of smokers' being open, undecided, and not open to use e-cigarettes, snus, and NRT in the event they should quit smoking.

Results: Among daily smokers, the probability of being open to use e-cigarettes in the event of quitting smoking was .32. The corresponding probabilities for using snus and NRT were .22 and .19. Snus was the product with the highest probability of not being open (.60). NRT had the highest probability of being undecided (.39). Among smokers who had never used e-cigarettes or snus, the probabilities of being open were .13 for e-cigarettes, .02 for snus and .11 for NRT.

Conclusions: In a snus-friendly norm climate where smokers have traditionally used snus as an alternative to cigarettes, the probability of using e-cigarettes in the event of smoking cessation was higher compared to both snus and NRT. However, among smokers who had never used e-cigarettes or snus, the likelihood of being open to use of NRT was similar to e-cigarettes, and higher than snus, which suggests that NRT may still play a role in smoking cessation.

Implications: In a snus-prevalent country in the endgame phase of the cigarette epidemic, where robust infrastructure for tobacco control in combination with the availability of snus has reduced smoking to a minimum, the remaining smokers seem to prefer e-cigarettes to snus if they should quit smoking. This indicates that availability of several nicotine alternatives might increase the likelihood of a future product replacement within the small group of remaining smokers.

References

West R, Coyle K, Owen L, Coyle D, Pokhrel S . Estimates of effectiveness and reach for 'return on investment' modelling of smoking cessation interventions using data from England. Addiction. 2017; 113 Suppl 1:19-31. PMC: 6032933. DOI: 10.1111/add.14006. View

Vedoy T, Lund K . The impact of the COVID-19 epidemic on where tobacco users purchased cigarettes and snus in different Norwegian regions. Nordisk Alkohol Nark. 2022; 39(5):521-534. PMC: 9549216. DOI: 10.1177/14550725221096911. View

Asthana S, Labani S, Kailash U, Sinha D, Mehrotra R . Association of Smokeless Tobacco Use and Oral Cancer: A Systematic Global Review and Meta-Analysis. Nicotine Tob Res. 2018; 21(9):1162-1171. DOI: 10.1093/ntr/nty074. View

. WHO Study Group on Tobacco Product Regulation. Report on the scientific basis of tobacco product regulation: third report of a WHO Study Group. World Health Organ Tech Rep Ser. 2010; (955):1-41, back cover. View

Lund K, Vedoy T . Relative Risk Perceptions between Snus and Cigarettes in a Snus-Prevalent Society-An Observational Study over a 16 Year Period. Int J Environ Res Public Health. 2019; 16(5). PMC: 6427464. DOI: 10.3390/ijerph16050879. View

Vedoy T, Lund K . Nicotine Content in Swedish-Type Snus Sold in Norway From 2005 to 2020. Nicotine Tob Res. 2022; 24(7):1130-1133. PMC: 9199937. DOI: 10.1093/ntr/ntac006. View

Pierce J, Benmarhnia T, Chen R, White M, Abrams D, Ambrose B . Role of e-cigarettes and pharmacotherapy during attempts to quit cigarette smoking: The PATH Study 2013-16. PLoS One. 2020; 15(9):e0237938. PMC: 7467279. DOI: 10.1371/journal.pone.0237938. View

Holm L, Fisker J, Larsen B, Puska P, Halldorsson M . Snus does not save lives: quitting smoking does!. Tob Control. 2009; 18(4):250-1. DOI: 10.1136/tc.2009.030221. View

Barbeau A, Burda J, Siegel M . Perceived efficacy of e-cigarettes versus nicotine replacement therapy among successful e-cigarette users: a qualitative approach. Addict Sci Clin Pract. 2013; 8:5. PMC: 3599549. DOI: 10.1186/1940-0640-8-5. View

10.

Sai K, Zuo Y, Rose J, Garg P, Garg S, Nazih R . Rapid Brain Nicotine Uptake from Electronic Cigarettes. J Nucl Med. 2019; 61(6):928-930. PMC: 8008769. DOI: 10.2967/jnumed.119.230748. View

11.

Wadgave U, Nagesh L . Nicotine Replacement Therapy: An Overview. Int J Health Sci (Qassim). 2016; 10(3):425-35. PMC: 5003586. View

12.

Foulds J, Cobb C, Yen M, Veldheer S, Brosnan P, Yingst J . Effect of Electronic Nicotine Delivery Systems on Cigarette Abstinence in Smokers With No Plans to Quit: Exploratory Analysis of a Randomized Placebo-Controlled Trial. Nicotine Tob Res. 2021; 24(7):955-961. PMC: 9391685. DOI: 10.1093/ntr/ntab247. View

13.

Kasza K, Edwards K, Kimmel H, Anesetti-Rothermel A, Cummings K, Niaura R . Association of e-Cigarette Use With Discontinuation of Cigarette Smoking Among Adult Smokers Who Were Initially Never Planning to Quit. JAMA Netw Open. 2021; 4(12):e2140880. PMC: 8715340. DOI: 10.1001/jamanetworkopen.2021.40880. View

14.

Nutt D, Phillips L, Balfour D, Curran H, Dockrell M, Foulds J . Estimating the harms of nicotine-containing products using the MCDA approach. Eur Addict Res. 2014; 20(5):218-25. DOI: 10.1159/000360220. View

15.

Morphett K, Weier M, Borland R, Yong H, Gartner C . Barriers and facilitators to switching from smoking to vaping: Advice from vapers. Drug Alcohol Rev. 2019; 38(3):234-243. PMC: 8063207. DOI: 10.1111/dar.12907. View

16.

Benmarhnia T, Pierce J, Leas E, White M, Strong D, Noble M . Can E-Cigarettes and Pharmaceutical Aids Increase Smoking Cessation and Reduce Cigarette Consumption? Findings From a Nationally Representative Cohort of American Smokers. Am J Epidemiol. 2018; 187(11):2397-2404. PMC: 6211241. DOI: 10.1093/aje/kwy129. View

17.

Siahpush M, McNeill A, Borland R, Fong G . Socioeconomic variations in nicotine dependence, self-efficacy, and intention to quit across four countries: findings from the International Tobacco Control (ITC) Four Country Survey. Tob Control. 2006; 15 Suppl 3:iii71-5. PMC: 2593052. DOI: 10.1136/tc.2004.008763. View

18.

Saebo G, Lund I . Public support for further regulating smoking, snus and e-cigarettes in Norway, and its associations with risk perceptions and tobacco use. Int J Drug Policy. 2021; 101:103559. DOI: 10.1016/j.drugpo.2021.103559. View

19.

Lund K, Vedoy T . A conceptual framework for assessing the public health effects from snus and novel non-combustible nicotine products. Nordisk Alkohol Nark. 2022; 38(6):586-604. PMC: 8900171. DOI: 10.1177/14550725211021248. View

20.

Levy D, Mumford E, Cummings K, Gilpin E, Giovino G, Hyland A . The relative risks of a low-nitrosamine smokeless tobacco product compared with smoking cigarettes: estimates of a panel of experts. Cancer Epidemiol Biomarkers Prev. 2004; 13(12):2035-42. View