Snuff and smoking in Sweden
This topic is most authoritatively reviewed by
J.Foulds, L Ramstrom,
M Burke, and K Fagerström Effect of smokeless tobacco (snus) on smoking
and public health in Sweden Tob. Control, Dec 2003; 12:
349 - 359. www.tobaccocontrol.com
Oral tobacco snuff
has been popular in Sweden
since 1920 at least. In 1996-7, 20% of males consumed it.1
Even in 2000, only 2% of females used it. By 2005 20% of snuff takers were women.
Snuff taking in young Swedish male population is associated with lower
smoking prevalence in this group, and appears to continue to protect them
from smoking into early adulthood.
Has snuff consumption in Sweden been sufficient to have decreased
male Swedish lung cancer rates?
Yes. Figure 2 shows that from 1950 to 2000, Swedish snus
consumption was never less than one quarter of smoking tobacco
consumption. Moreover, if the snus was almost entirely consumed by men,
and if half the smoking tobacco was consumed by men, male snus
consumption in this period was equal to at least half that of total tobacco
consumption among males.
|
Figure
1. Smoking prevalence Sweden v. NZ, 1980-2004, age 16-24 years |
|
Males: the NZ rate is three times higher than in Sweden |
Females
the NZ rate is 76% higher than in Sweden |
|
|
|
Figure 2. Consumption of smoking tobacco in Sweden and New Zealand, and of snuff in Sweden 1990-2004
|
|
The steep fall in NZ in 1990-2 was due to taxation, advertising
bans and workplace smoking restrictions, and a recession, but smokers
may be smoking their cigarettes more intensively.
In Sweden,
the 1998 low in Sweden
was due to taxation. 0.65 g tobacco is allowed per manufactured
cigarette. www.statveca.com
For New Zealand
tobacco is as reported used in all smoking tobaccos. http://www.ndp.govt.nz/tobacco/tobaccoreturns/2004/analysis/analysis-2004-tablesa-e.pdf
Snus
consumption by Swedish men in the past half century has been of
sufficient scale to have provided a popular alternative to smoking
cigarettes, and thus is likely to have been a factor in lowering male
Swedish lung cancer rates. See Foulds www.tobaccocontrol.com |
Smoking
in adults
Figure 3. New Zealand and Sweden,
cigarette smoking prevalence, adults, 1990-2004
|
Males Swedish prevalence is 45% below NZ’s |
Females: Swedish prevalence is ¼ below
NZ’s |
|
|
|
Source:
www.statveca.com and Health New Zealand
international smoking prevalence database
Lung
cancer mortality
Table 1.
Consumption of smoking tobacco,
and lung cancer mortality rates
|
|
New Zealand |
Sweden |
NZ / Sweden ratio |
|
Averaged, g/adult/year
1950-1980
1981- 2000 |
3194
1967 |
1532
1580 |
2 to 1
1.2 to 1 |
|
Lung cancer rate 2000*
Males, all ages |
49.9 |
31.4 |
1.6 |
|
Females, all ages |
26.4 |
19.2 |
1.4 |
|
Males, 35-49 years* |
9.8 |
5.2 |
1.9 |
|
Females, 35-49 years* |
4.7 |
6.1 |
0.8 |
* average of rates for component five-year
age-groups.
Consumption: from Health New Zealand
database. Lung cancer: Peto
R. et al. Mortality from smoking in developed countries, 2nd edit.
2004. www.ctsu.ox.ac.uk
All ages. Tobacco
smoking levels over the last 20-50 years can explain current lung cancer
differences between New Zealand
and Sweden.
On average the New Zealand
adult population smoked twice as much tobacco as Swedes before
about 1980 and the lung cancer ratio NZ to Sweden
was 1.6 for males. (Table 1).
Age under
50. For males, the lung cancer ratio NZ to Sweden
for 2000 has increased to 1.9. (Table 1)
The lung cancer rate in Swedish males
under age 40 was zero in 2000, indicating that average annual rates are
now very low. At age 35-39 in 2000, the reported lung cancer rate for
Swedish males was zero, and 3.0 at age 40-44, as against 2.0 at age
35-39, and 8.5 at 40-44 years for New Zealand
males. In 2000, Swedish women age 35-49 had a higher lung cancer rate
than New Zealand
women of this age (Table 1).
Conclusion
Tobacco
consumption since 1950 and the all-ages rate of lung cancer.
Lower tobacco consumption in Sweden
since at least 1950 can explain lower male all-age lung cancer rates in Sweden
versus New Zealand.
For Swedish males, snus has been a popular alternative to smoking since
at least 1950. Smoking did not become as popular in Sweden
as in New Zealand,
and this explains why Swedish male all-age male lung cancer rates in Sweden
did not reach levels as high as seen in New Zealand.(Figure
1, Table 1).
Tobacco consumption
since 1980 and the lung cancer rate under 50
years of age.
- Increased snus
use since 1980 confined largely to males, may explain decreased
cigarette smoking in Swedish males – in male youth since 1980,
and in adult males since 1992.
- Decreased
smoking prevalence in males is now beginning to lower Swedish male
lung cancer rates. Sweden
reported a nil lung cancer mortality rate in men under age 40 in
2000.
The
Swedish decreases in male lung cancer mortality are greater than for New Zealand, where oral tobacco is banned, and
greater than for Swedish females, who have only recently begun to use
snus more.
1 Statistics Sweden, and ULF surveys. www.statveca.com
Suggested
warning for oral snuff products if and when sold in New Zealand: |
