The development of tobacco use in adolescence among ”snus starters” and ”cigarette starters”: An analysis of the Swedish ”BROMS” cohort
Abstract
Whether the use of smokeless tobacco can facilitate the transition to cigarette smoking and/or to prolonged tobacco use in adolescence is unclear. We analyzed data from a cohort of 2,938 Swedish adolescents, with six follow-up assessments of tobacco use between the ages of 11 and 18 years. The majority of tobacco users (70%) started by smoking cigarettes, 11% took up snus before smoking, and 19% used both tobacco types close in time. Ever users of tobacco at baseline had a higher risk of being current smokers and/or smokeless tobacco users at the end of follow-up compared with never users, with the highest excess relative risk for "mixed users." Adolescents who initiated tobacco use with cigarettes had a non-significantly increased probability to end up as current smokers compared with snus starters (adjusted OR=1.42; 95% CI 0.98-2.10) The OR of smoking for "mixed starters" was 2.54 (95% CI 1.68-3.91). The risk of becoming current user of any tobacco was also significantly enhanced for "mixed starters." Marked sex differences were observed in these associations, as initiation with cigarettes rather than with snus predicted current smoking or tobacco use only among females. Progression of tobacco use in adolescence is not predicted by onset with snus or cigarettes, but rather by initiation with both tobacco types close in time and/or at young age. The proportion of adolescent smoking prevalence attributable to a potential induction effect of snus is likely small.
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In Sweden, daily or almost daily smoking increases during adolescence from <1% at age 11-12 to 12% at age 18-20.
“In Sweden, daily or almost daily smoking increases during adolescence from < 1 % at age 11-12 to a 12 % at age 18-20 (56,57)”
From Influence of the COMT genotype on working memory and brain activity changes during development (2011) · cites this paper as [57]
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“In Sweden, daily or almost daily smoking increases during adolescence from , 1% at age 11 to 12 years to 12% at age 18 to 20 years (56,57), and the COMT Val allele has been shown to be a small risk factor (odds ratio 1.”
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Borgerding, M. F., Bodnar, J. A., Curtin, G. M., & Swauger, J. E. (2012) · Regulatory Toxicology and Pharmacology · doi:10.1016/j.yrtph.2012.09.003 · Cited by 84 · see citing works
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“The study Children’s Smoking and Environment in Stockholm County (BROMS) followed tobacco use by a group of school pupils from the 5th grade up to and including three years after leaving compulsory school [9].”
BackgroundGalanti, M. R., Coppo, A., Jönsson, E., Bremberg, S. G., & Faggiano, F. (2013) · Tobacco Control · doi:10.1136/tobaccocontrol-2012-050846 · Cited by 93 · see citing works
Self-citationPost, A., Gilljam, H., Rosendahl, I. K., Bremberg, S. G., & Galanti, M. R. (2010) · Addiction · doi:10.1111/j.1360-0443.2009.02852.x · Cited by 84 · see citing works
“The order of initiation of products in this longitudinal study indicated that the risk to proceed to current use was lowest among exclusive snus users and highest among experimenters of both product [18].”
BackgroundSelf-citationSoneji, S. S., Sargent, J. D., Tanski, S. E., & Primack, B. A. (2014) · Archives of Pediatrics and Adolescent Medicine · doi:10.1001/jamapediatrics.2014.2697 · Cited by 77 · see citing works
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“Indeed, a longitudinal study from Sweden [21] has shown that use of snus reduces the risk of starting to smoke among young people, when known predictors for starting to smoke are controlled for.”
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“A Swedish study following adolescents from 11 to 18 years of age demonstrated that initiation of snus and cigarettes close in time predicted future smoking [26].”
BackgroundThe scientific foundation for tobacco harm reduction, 2006-2011
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“[62].”
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“, 2000; Tercyak & Audrain, 2002) and in Sweden (Digard et al., 2009; Galanti et al., 2008; Post et al., 2005, 2010; Wickholm et al., 2003), direct comparisons of populations is compromised by the lack of a common definition.”
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“be associated with mixed use of cigarettes and snus [31].”
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“induction or the gateway theory only seemed to affected a minority [12].”
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“Other studies have not found any statistical association (Galanti et al., 2008; Larsen et al., 2012), and some have found that snus reduces the likelihood of smoking onset (Furberg et al., 2005; Lund & Scheffels, 2014 – if snus debut took place after the age of 15 years; Ramström et al., 2016;…”
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BackgroundWiium, N., & Aarø, L. E. (2010) · Scandinavian Journal of Psychology · doi:10.1111/j.1467-9450.2010.00823.x · Cited by 8 · see citing works
Koller, K. R., Flanagan, C. A., Day, G. E., et al. (2017) · International Journal of Circumpolar Health · doi:10.1080/22423982.2017.1398009 · Cited by 8 · see citing works
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“…them to substance use and controlling for such common traits may weaken the association between snus use and smoking (Engström et al., 2010; Galanti et al., 2008; Grøtvedt et al., 2008; Kendler et al., 2019; Kvaavik et al., 2015; E. Larsen et al., 2013; Lund et al., 2008; Pedersen & von…”
BackgroundUnderner, M., Perriot, J., & Peiffer, G. (2011) · La Presse Médicale · doi:10.1016/j.lpm.2011.06.005 · Cited by 7 · see citing works
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Amrock, S. M., & Weitzman, M. L. (2015) · JAMA · doi:10.1001/jama.2015.11394 · Cited by 6 · see citing works
Underner, M., & Perriot, J. (2011) · Revue des Maladies Respiratoires · doi:10.1016/j.rmr.2011.08.003 · Cited by 5 · see citing works
The relationship between snus use and smoking cognitions
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“Dual use in adolescence is also found to be associated with a higher risk for dependence [10,11].”
BackgroundSnus et risque cardiovasculaire
Underner, M., Perriot, J., Sosner, P., & Herpin, D. (2011) · Annales de Cardiologie et d Angéiologie · doi:10.1016/j.ancard.2011.07.007 · Cited by 3 · see citing works
Rosendahl, I. K., & Galanti, M. R. (2010) · The Open Addiction Journal · doi:10.2174/1874941001003010050 · Cited by 2 · see citing works
Self-citationGARTNER, C. E. (2014) · Addiction · doi:10.1111/add.12586 · Cited by 2 · see citing works
Towards a tobacco-free generation. A study on the tobacco habits of adolescents: when, why and who?
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Commentary on Post et al. (2010): Snus, a cautionary reminder
Hatsukami, D. K., & Tomar, S. L. (2010) · Addiction · doi:10.1111/j.1360-0443.2010.02922.x · Cited by 1 · see citing works
Smoking, Snuffing and Oral Health with Special Reference to Dental Caries
Hellqvist, L. (2012) · Gothenburg University Publications Electronic Archive (Gothenburg University) · Cited by 1 · see citing works
Batanova, M., Loukas, A., Velazquez, C. E., et al. (2015) · Journal of Child & Adolescent Substance Abuse · doi:10.1080/1067828x.2013.829012
“Second, research in Sweden with adolescent dual users of cigarettes and snus indicates that dual users may be vulnerable to prolonged tobacco use and nicotine addiction (Galanti et al., 2008; Rosendahl et al., 2008).”
BackgroundMethodInfluentialSnus Habits of Norwegian Senior High School Students
Gullhav, H. K. (2015) · International Journal of Dentistry and Oral Health · doi:10.16966/2378-7090.121
Tobacco use : studies of onset and cessation
Grøtvedt, L. (2012) · NORA - Norwegian Open Research Archives
Additional file 1 of Determinants of smokeless tobacco use and prevalence among Sudanese adolescents
Othman, M., Farid, N. D. N., Aghamohammadi, N., et al. (2021) · Figshare · doi:10.6084/m9.figshare.16800421
- Authors
- Galanti, M. R., Rosendahl, I., & Wickholm, S.
- Affiliations
- Karolinska Institutet (SE)
- Corresponding author
- Galanti, Maria Rosaria
- Venue
- Nicotine & Tobacco Research
- Publisher
- Oxford University Press (OUP)
- Published
- 2008-02
- Volume
- 10
- Issue
- 2
- Pages
- 315-323
- ISSN
- 1462-2203 (ISSN-L)
- OpenAlex
- W2080286049
- Cited by
- 55
- References
- 0
- Citations by year
- 2023: 1 · 2021: 4 · 2019: 4 · 2017: 4 · 2016: 3 · 2015: 5 · 2014: 6 · 2013: 1 · 2012: 11
- FWCI
- 3.61
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Nicotine & Tobacco Research (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Prenatal Substance Exposure Effects
- Keywords
- tobacco initiation, snus, smokeless tobacco, cigarette smoking, adolescent smoking, induction effects, sex differences
- MeSH terms
- Adolescent, Cross-Sectional Studies, Female, Humans, Health Knowledge, Attitudes, Practice, Life Style, Male, Peer Group, Surveys and Questionnaires, Risk Factors, Risk-Taking, School Health Services, Smoking, Social Environment, Students, Sweden, Tobacco Use Disorder, Tobacco, Smokeless, Prevalence, Confidence Intervals, Odds Ratio, Smoking Cessation
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