Updated 27 May 2008 Printable version: www.endsmoking.org.nz/snusaidsquitting.pdf

Snus – an effective short- and long-term stop-smoking aid

Snus is a gateway drug away from smoking for young people, and helps adults quit smoking.

 

Smokeless tobacco (moist snuff and chewing tobacco) in the United States is highly effective as an aid to quitting smoking.

In 2008 in the USA, researchers found that 73% of the most recent quit attempts using smokeless had resulted in smokers quitting smoking, Of these, 54% (39% overall) had quit all tobacco, and 46% were still using smokeless. Extrapolated, this meant that in 2000, 250,000 Americans had quit using smokeless tobacco.

Figure 1. US men, success in stopping smoking by type of aid used in most recent attempt.1

Figure 1. US men, success in stopping smoking by type of aid used in most recent attempt.

Figure 1 cannot predict success in a given future attempt, because only the most recent attempt is recorded.

Patches and gum were more popular, and prescribed by the health system, but smokeless enabled twice as many smokers to quit, - it well as any short term medicinal nicotine, and in addition can provide nicotine long term, thus suppressing cravings for smoked nicotine.

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In 2004, in the USA, Kozlowski found that the 42% of young males surveyed who used cigarettes before using snuff, were 2.1 times more likely to have quit smoking than cigarette-only users.2 This was a cohort study of a natural experiment.

Sweden: Among men, snus is the most popular aid for stopping smoking, and the most likely to be successful (2-4 times more than patch or gum). Over the long term the cumulative effect is equivalent to an extra third of smokers quitting. The boost to quitting from snus over and above quitting smoking and tobacco together, suggests that if the nicotine receptors are continually ‘placated’ with snuff nicotine, the urge to resume smoking for nicotine will tend not be felt or heeded.

For quitting, randomised controlled trials are needed to prove whether snus is a superior short-term aid and long-term aid to stop smoking. No such trial has yet been conducted. Snus though not a medicine, is apparently at least as effective as medicinal nicotine in weaning smokers off smoked-cigarette nicotine.

In Sweden and the US, the only two OECD countries where cigarettes and snuff are used widely, many smokers use snus/smokeless as an aid to quit smoking, and those that do so are more likely to succeed in quitting smoking. The lifetime differences are greater than with the latest quit attempt.

1.        Rodu B, Phillips CV. Switching to smokeless tobacco as a smoking cessation method: evidence from the 2000 National Health Interview Study. Harm Reduction Journal, 2008-05-23

2.       Kozlowski LT, O’Connor RJ, Edwards BQ, Flaherty BP. Most smokeless tobacco use is not a causal gateway to cigarettes: using order of product use to evaluate causation in a national US sample. Addiction 2004; 99: 260-2.

Does snuff increase a smoker’s life time chances of becoming a nonsmoker?

Figure 2. In Swedish men, 92% of primary smokers who later used snus quit smoking2

Figure 2. In Swedish men, 92% of primary smokers who later used snus quit smoking

Among 6752 Swedes surveyed in 2001-2, 502 men first used tobacco by smoking it (primary smokers).

Of those smokers who did not use snus, 44% still smoked when surveyed, compared with only 8% still smoking among those who used snus.

Over time (assuming smokers knew the risks of continued smoking) snus apparently makes it possible for many more smokers to quit.

Regardless of snus use, just over half of smokers had managed to quit smoking and tobacco. Use of snuff resulted in an extra 38% switching from smoking to snuff, so that in total 92% of male primary smokers who used snuff had quit smoking.2

Is snuff more effective than nicotine patches or gum as an aid to stopping smoking?

Fig. 3. Likelihood of quitting smoking completely by using snus in the last quit attempt, compared with NRT gum and patch, where likelihood from using NRT is 1.0. Single aid used.

Fig. 3. Likelihood of quitting smoking completely by using snus in the last quit attempt, compared with NRT gum and patch, where likelihood from using NRT is 1.0. Single aid used.

 

Likelihood of completely quitting daily smoking in their most recent attempt to do so, was 2 to 4 times greater for Swedish smokers using snuff as a stop smoking aid, compared with those using patch or gum.2 (Figure 3).

 

Ramstrom LM, Foulds J. Role of snus in initiation and cessation of tobacco smoking. Tobacco Control 2006; 15: 210-4.

 

Snus is a popular aid to quitting in Sweden. At their last quit attempt, 24% of men used snus, and 11% used NRT.2 Among women, snus was third in popularity after nicotine gum and patch. Not only is snus popular, it is effective. (Figure 2).

 

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2. Ramstrom LM, Foulds J. Role of snus in initiation and cessation of tobacco smoking. Tobacco Control 2006; 15: 210-4.

 Dr Murray Laugesen QSO chair; Prof Ross McCormick, Sir John Scott KBE, Trish Fraser MPH, Dr Marewa Glover, Trustees

Making it easier to quit smoking for good 2009 End Smoking NZ