title: Cigarette smoking, snuff use and alcohol drinking: coexisting risk behaviours for oral health in young males.
abstract: OBJECTIVE
  The use of oral moist snuff (snus) is widespread among Swedish men, but little is known about the use in adolescents. The aim of this study was to describe patterns of snuff dipping, smoking and alcohol drinking in a sample (n = 6287) of 9th grade male students participating in a census survey in the Stockholm region.
  
  
  RESULTS
  About 20% of the sample reported use of snus, and more than two-thirds of snus users were also cigarette smokers. Among current nonusers of tobacco (66% of the sample), 14% reported frequent binge drinking, in contrast to 49% among current exclusive cigarette smokers, 60% among exclusive snus users and 69% among users of both cigarettes and snus. The estimated mean annual consumption of alcohol was 5-10 times higher among tobacco users than among nonusers, with users of snus consuming more alcohol than smokers. Compared to non- or minimal drinkers, heavy alcohol drinkers had a disproportionately higher risk to report snus use, after adjustment for smoking behaviour (OR = 16.7, 95% CI 12.9-21.7). When the analysis was restricted to users of only one type of tobacco, heavy drinkers were twice as likely to report snus, rather than cigarette, use.
  
  
  CONCLUSIONS
  Both tobacco use and alcohol drinking have been independently associated with a variety of pathological oral conditions in adults. These behaviours coexist in early adolescence. Their effect on oral health need to be investigated in prospective studies and should be of concern to the dental professionals.
authors.affiliation: Centre for Tobacco Prevention, Stockholm Centre of Public Health, Stockholm County Council, Sweden. seppo.wickholm@smd.sll.se
authors.forename: Seppo
authors.initials: S
authors.lastname: Wickholm
authors.forename: M Rosaria
authors.initials: MR
authors.lastname: Galanti
authors.forename: Birgitta
authors.initials: B
authors.lastname: Söder
authors.forename: Hans
authors.initials: H
authors.lastname: Gilljam
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D000428:Alcohol Drinking / Q000453:epidemiology*; D000704:Analysis of Variance; D017004:Codependency, Psychological; D006801:Humans; D008297:Male; D016017:Odds Ratio; D012044:Regression Analysis; D012907:Smoking / Q000453:epidemiology*; D013548:Sweden / Q000453:epidemiology; D014029:Tobacco Use Disorder / Q000453:epidemiology; D014030:Tobacco, Smokeless