title: Evolving patterns of tobacco use in northern Sweden.
abstract: OBJECTIVE
  Cross-sectional data from northern Sweden suggest that the increased use of Swedish moist snuff (snus) may have contributed to a decline in the prevalence of smoking, especially amongst men. This study describes the evolving patterns of tobacco use in this population over the period 1986-1999.
  
  
  METHODS
  This is a prospective follow-up study of 1651 men and 1756 women, aged 25-64 years, who were enrolled in the northern Sweden MONICA project (entry in 1986, 1990, 1994) and who were followed-up in 1999. Information on tobacco use at entry and at follow-up was used to describe the stability of tobacco use over a period of 5-13 years ending in 1999.
  
  
  RESULTS
  Snus was the most stable form of tobacco use amongst men (75%); only 2% of users switched to cigarettes and 20% quit tobacco altogether. Smoking was less stable (54%); 27% of smokers were tobacco-free and 12% used snus at follow-up. Combined use (smoking and snus) was the least stable (39%), as 43% switched to snus and 6% switched to cigarettes. Former users of both products were much less stable than former users of either cigarettes or snus. The stability of smoking amongst women was 69%, which was higher than that amongst men (P < 0.05).
  
  
  CONCLUSIONS
  The use of snus played a major role in the decline of smoking rates amongst men in northern Sweden. The evolution from smoking to snus use occurred in the absence of a specific public health policy encouraging such a transition and probably resulted from historical and societal influences.
authors.affiliation: Department of Pathology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294-0007, USA. rodu@uab.edu
authors.forename: B
authors.initials: B
authors.lastname: Rodu
authors.forename: B
authors.initials: B
authors.lastname: Stegmayr
authors.forename: S
authors.initials: S
authors.lastname: Nasic
authors.forename: P
authors.initials: P
authors.lastname: Cole
authors.forename: K
authors.initials: K
authors.lastname: Asplund
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006184:Habits; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012907:Smoking / Q000453:epidemiology* / Q000639:trends; D013548:Sweden / Q000453:epidemiology; D020340:Tobacco Use Cessation / Q000706:statistics & numerical data; D014030:Tobacco, Smokeless