title: Quitting cigarettes completely or switching to smokeless tobacco: do US data replicate the Swedish results?
abstract: BACKGROUND
  Swedish male smokers are more likely than female smokers to switch to smokeless tobacco (snus) and males' smoking cessation rate is higher than that of females. These results have fuelled international debate over promoting smokeless tobacco for harm reduction. This study examines whether similar results emerge in the United States, one of few other western countries where smokeless tobacco has long been widely available.
  
  
  METHODS
  US DATA SOURCE: national sample in Tobacco Use Supplement to Current Population Survey, 2002, with 1-year follow-up in 2003. Analyses included adult self-respondents in this longitudinal sample (n = 15,056). Population-weighted rates of quitting smoking and switching to smokeless tobacco were computed for the 1-year period.
  
  
  RESULTS
  Among US men, few current smokers switched to smokeless tobacco (0.3% in 12 months). Few former smokers turned to smokeless tobacco (1.7%). Switching between cigarettes and smokeless tobacco, infrequent among current tobacco users (<4%), was more often from smokeless to smoking. Men quit smokeless tobacco at three times the rate of quitting cigarettes (38.8% vs 11.6%, p<0.001). Overall, US men have no advantage over women in quitting smoking (11.7% vs 12.4%, p = 0.65), even though men are far likelier to use smokeless tobacco.
  
  
  CONCLUSIONS
  The Swedish results are not replicated in the United States. Both male and female US smokers appear to have higher quit rates for smoking than have their Swedish counterparts, despite greater use of smokeless tobacco in Sweden. Promoting smokeless tobacco for harm reduction in countries with ongoing tobacco control programmes may not result in any positive population effect on smoking cessation.
authors.affiliation: Department of Family and Preventive Medicine, University of California, San Diego, 9500 Gilman Drive 0905, La Jolla, CA 92093-0905, USA. szhu@ucsd.edu
authors.forename: S-H
authors.initials: SH
authors.lastname: Zhu
authors.forename: J B
authors.initials: JB
authors.lastname: Wang
authors.forename: A
authors.initials: A
authors.lastname: Hartman
authors.forename: Y
authors.initials: Y
authors.lastname: Zhuang
authors.forename: A
authors.initials: A
authors.lastname: Gamst
authors.forename: J T
authors.initials: JT
authors.lastname: Gibson
authors.forename: H
authors.initials: H
authors.lastname: Gilljam
authors.forename: M R
authors.initials: MR
authors.lastname: Galanti
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D015203:Reproducibility of Results; D012737:Sex Factors; D016540:Smoking Cessation / Q000379:methods* / Q000706:statistics & numerical data; D000074606:Smoking Prevention; D013548:Sweden; D014030:Tobacco, Smokeless; D014481:United States