Effect of smokeless tobacco (snus) on smoking and public health in Sweden.
OBJECTIVE
To review the evidence on the effects of moist smokeless tobacco (snus) on smoking and ill health in Sweden.


METHODS
Narrative review of published papers and other data sources (for example, conference abstracts and internet based information) on snus use, use of other tobacco products, and changes in health status in Sweden.


RESULTS
Snus is manufactured and stored in a manner that causes it to deliver lower concentrations of some harmful chemicals than other tobacco products, although it can deliver high doses of nicotine. It is dependence forming, but does not appear to cause cancer or respiratory diseases. It may cause a slight increase in cardiovascular risks and is likely to be harmful to the unborn fetus, although these risks are lower than those caused by smoking. There has been a larger drop in male daily smoking (from 40% in 1976 to 15% in 2002) than female daily smoking (34% in 1976 to 20% in 2002) in Sweden, with a substantial proportion (around 30%) of male ex-smokers using snus when quitting smoking. Over the same time period, rates of lung cancer and myocardial infarction have dropped significantly faster among Swedish men than women and remain at low levels as compared with other developed countries with a long history of tobacco use.


CONCLUSIONS
Snus availability in Sweden appears to have contributed to the unusually low rates of smoking among Swedish men by helping them transfer to a notably less harmful form of nicotine dependence.
Foulds
J
J
University of Medicine and Dentistry of New Jersey- School of Public Health, Tobacco Dependence Program, New Brunswick, New Jersey 08852, USA. jonathan.foulds@umdnj.edu
Ramstrom
L
L
Burke
M
M
Fagerström
K
K
D000328:Adult; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology / Q000209:etiology; D009538:Nicotine / Q000008:administration & dosage* / Q000009:adverse effects; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology / Q000209:etiology; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D013548:Sweden / Q000453:epidemiology; D014029:Tobacco Use Disorder / Q000453:epidemiology / Q000209:etiology*; D014030:Tobacco, Smokeless / Q000009:adverse effects*
D009538:Nicotine