title: Assessment of Swedish snus for tobacco harm reduction: an epidemiological modelling study.
abstract: BACKGROUND
  Swedish snus is a smokeless tobacco product that has been suggested as a tobacco harm reduction product. Our aim was to assess the potential population health effects of snus.
  
  
  METHODS
  We assessed the potential population health effects of snus in Australia with multistate life tables to estimate the difference in health-adjusted life expectancy between people who have never been smokers and various trajectories of tobacco use, including switching from smoking to snus use; and the potential for net population-level harm given different rates of snus uptake by current smokers, ex-smokers, and people who have never smoked.
  
  
  RESULTS
  There was little difference in health-adjusted life expectancy between smokers who quit all tobacco and smokers who switch to snus (difference of 0.1-0.3 years for men and 0.1-0.4 years for women). For net harm to occur, 14-25 ex-smokers would have to start using snus to offset the health gain from every smoker who switched to snus rather than continuing to smoke. Likewise, 14-25 people who have never smoked would need to start using snus to offset the health gain from every new tobacco user who used snus rather than smoking.
  
  
  CONCLUSIONS
  Current smokers who switch to using snus rather than continuing to smoke can realise substantial health gains. Snus could produce a net benefit to health at the population level if it is adopted in sufficient numbers by inveterate smokers. Relaxing current restrictions on the sale of snus is more likely to produce a net benefit than harm, with the size of the benefit dependent on how many inveterate smokers switch to snus.
authors.affiliation: School of Population Health, The University of Queensland, Herston, Queensland, Australia.
authors.forename: Coral E
authors.initials: CE
authors.lastname: Gartner
authors.affiliation: School of Population Health, The University of Queensland, Herston, Queensland, Australia. Electronic address: w.hall@sph.uq.edu.au.
authors.forename: Wayne D
authors.initials: WD
authors.lastname: Hall
authors.affiliation: School of Population Health, The University of Queensland, Herston, Queensland, Australia.
authors.forename: Theo
authors.initials: T
authors.lastname: Vos
authors.affiliation: School of Population Health, The University of Queensland, Herston, Queensland, Australia.
authors.forename: Melanie Y
authors.initials: MY
authors.lastname: Bertram
authors.affiliation: School of Population Health, The University of Queensland, Herston, Queensland, Australia.
authors.forename: Angela L
authors.initials: AL
authors.lastname: Wallace
authors.affiliation: School of Population Health, The University of Queensland, Herston, Queensland, Australia.
authors.forename: Stephen S
authors.initials: SS
authors.lastname: Lim
mesh_terms: D000328:Adult; D000368:Aged; D001315:Australia / Q000453:epidemiology; D005260:Female; D006801:Humans; D008017:Life Expectancy; D015993:Life Tables; D008175:Lung Neoplasms / Q000209:etiology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D029424:Pulmonary Disease, Chronic Obstructive / Q000209:etiology / Q000401:mortality; D012907:Smoking / Q000009:adverse effects*; D014030:Tobacco, Smokeless / Q000009:adverse effects*