title: Cigarettes and oral snuff use in Sweden: Prevalence and transitions.
abstract: OBJECTIVE
  To investigate the prevalence and patterns of transitions between cigarette and snus use.
  
  
  METHODS
  Cross-sectional study within the population-based Swedish Twin Registry.
  
  
  METHODS
  A total of 31 213 male and female twins 42-64 years old.
  
  
  METHODS
  Age-adjusted prevalence odds ratios (POR) and 95% confidence intervals (CIs) described the association between gender and tobacco use, while Kaplan-Meier survival methods produced cumulative incidence curves of age at onset of tobacco use. Life-time tobacco use histories were constructed using ages at onset of tobacco use and current tobacco use status.
  
  
  RESULTS
  Although more males reported ever smoking (64.4%) than females (61.7%), more males were former smokers (POR: 1.33, 95% CI: 1.27-1.39). Males were far more likely to use snus than females (POR: 18.0, 95% CI: 16.17-20.04). Age at onset of cigarette smoking occurred almost entirely before age 25, while the age at onset of snus use among males occurred over a longer time period. Most men began using cigarettes first, nearly one-third of whom switched to using cigarettes and snus in combination. While 30.6% of these combined users quit tobacco completely, only 7.4% quit snus and currently use cigarettes, while 47.7% quit cigarettes and currently use snus.
  
  
  CONCLUSIONS
  Current cigarette smoking is more prevalent among Swedish women than men, while snus use is more prevalent among men. Among men who reported using both cigarettes and snus during their life-time, it was more common to quit cigarettes and currently use snus than to quit snus and currently use cigarettes. Once snus use was initiated, more men continued using snus rather than quit tobacco completely.
authors.affiliation: Department of Genetics, University of North Carolina at Chapel Hill, NC 27599-7264, USA.
authors.forename: Helena
authors.initials: H
authors.lastname: Furberg
authors.forename: Paul
authors.initials: P
authors.lastname: Lichtenstein
authors.forename: Nancy L
authors.initials: NL
authors.lastname: Pedersen
authors.forename: Cynthia
authors.initials: C
authors.lastname: Bulik
authors.forename: Patrick F
authors.initials: PF
authors.lastname: Sullivan
mesh_terms: D000328:Adult; D017668:Age of Onset; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012907:Smoking / Q000453:epidemiology*; D013548:Sweden / Q000453:epidemiology; D014030:Tobacco, Smokeless