Comparison Between Different Pathways of Tobacco Use in Sweden – Implications for the Prevention of Tobacco Induced Diseases Lars M. Ramström Institute for Tobacco Studies Stockholm, Sweden 6th Annual Conference of ISPTID, Little Rock, Arkansas, 2- 4 November, 2007
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Lars M. Ramström Institute for Tobacco Studies Stockholm, Sweden
Comparison Between Different Pathways of Tobacco Use in Sweden – Implications for the Prevention of Tobacco Induced Diseases. Lars M. Ramström Institute for Tobacco Studies Stockholm, Sweden. 6th Annual Conference of ISPTID, Little Rock, Arkansas, 2-4 November, 2007. SNUS (moist oral snuff). - PowerPoint PPT Presentation
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Comparison Between Different Pathways of Tobacco Use in Sweden – Implications for the
Prevention of Tobacco Induced Diseases
Lars M. Ramström
Institute for Tobacco Studies
Stockholm, Sweden
6th Annual Conference of ISPTID, Little Rock, Arkansas, 2-4 November, 2007
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2005Ukraine2004Russian Federation2000Albania2005Armenia2005Belarus2001Georgia2003Turkey2002Bosnia and Herzegovina2004Latvia2000Greece2000Serbia2001Bulgaria2005Lithuania2004Estonia2005Poland2002Andorra2005Kyrgyzstan1998Slovakia2004Kazakhstan1999TFYR Macedonia2003Cyprus2005Republic of Moldova2003Germany2003Hungary2005Netherlands2003Spain2003Croatia2003Romania1999Portugal2005Israel2005Luxembourg2002Italy2004Czech Republic2003France2002Malta1997Austria2004Denmark1994San Marino2005Finland2005Norway2004United Kingdom2005Ireland2002Uzbekistan2004Switzerland2005Slovenia2005Belgium2004Iceland2005Sweden
% of regular daily smokers in the population, age 15+, male, Last available
WHO HFA DATABASE Percent of daily smokers in the population age 15+
Daily tobacco use in Sweden 1980-2005Point observations and least square regression lines
Sources: Smoking data from STATISTICS SWEDEN suveys of Living Conditions Snus use data from NTS-suveys (1980-1987) and ITS/FSI-surveys (2000-2005)
%
The changes of prevalence depend both on – changes of initiation patterns and on – changes of cessation patterns
For an in depth study of the development over time it would have been desirable that the two above parameters had been continuously monitored in the past. However, we can now emulate such a monitoring by retrospective analysis of consecutive birth cohorts from a 50 year period.
1930-19391940-1949
1950-19591960-1969
1970-19790
25
50
75
100
NonePrimary smokingPrimary snus use
Y e a r o f b i r t h
Initiation of primary daily tobacco use.Swedish men in different birth cohorts.
%
Source: FSI/ITS surveys 2003-2006
1930-19391940-1949
1950-19591960-1969
1970-19790
25
50
75
100
NonePrimary smokingPrimary snus use
Y e a r o f b i r t h
Initiation of primary daily tobacco use.Swedish women in different birth cohorts.
Quit rates (fraction of Ever-daily-smokers having quit smoking completely)without or with initiation of secondary snus use.Swedish men in different birth cohorts.
Quit rates (fraction of Ever-daily-smokers having quit smoking completely)without or with initiation of secondary snus use.Swedish women in different birth cohorts.
Ever-Daily-Smokers who have tried to quit smoking.Percentage having used different cessation aids at latest quit attempt.
Category of aidMEN
(n=4528)
WOMEN (n=538
8)
Nicotine gum only 7% 12%
Nicotine patch only 5% 8%
Snus only 21% 5%
Snus and gum 1% 1%
Other single aid 3% 4%
Bupropion only 1% 2%
Gum and patch 2% 4%
Other combination 2% 2%
No particular aid 57% 61%Source: FSI/ITS surveys 2003-2006
Quit attempts with use of different aidsSwedish women in different birth cohorts.
Source: FSI/ITS surveys 2003-2006
%
Gum onlyPatch only
Snus onlyGum only
Patch onlySnus only
0
25
50
75
100
Smoke dailySmoke just occasionallyDo not smoke at all
C e s s a t i o n a i d u s e dSource: FSI/ITS surveys 2003-2006
WomenMen
Outcome of latest quit attemptby cessation aid used
p.161“The epidemiology of tobacco use in Sweden suggests that if the public isoffered a substantially less harmful smokeless tobacco product along with accessto accurate information on relative risks, a substantial proportion can switch tothe less harmful product. This has clear implications for public health.”
Conclusions• Prevention of Tobacco Induced Diseases is first of all a
matter of reducing cigarette smoking• Comparisons between different pathways of
tobacco use in Sweden suggest that the use of snus has contributed to lower smoking rates by– reducing initiation of smoking– helping smokers to quit smoking (switching to snus or quitting all tobacco)
• This suggests that the use of snus has had implications for public health in a way that has contributed to the Prevention of Tobacco Induced Diseases in Sweden