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Paternal snus use in puberty and increased risk for asthma and allergies in offspring: a RHINE/RHINESSA two-generation study

López-Cervantes, Juan Pablo, Bertelsen, Randi J, Schlünssen, Vivi, Holm, Mathias, Malinovschi, Andrei, Modig, Lars, Oudin, Anna, Callejas-González, Francisco Javier +8 more·2026·International Journal of Epidemiology
DOI 10.1093/ije/dyag035PMC PMC13032824
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Abstract

Background: Evidence suggests that a father’s smoking in puberty may adversely impact respiratory health in offspring, possibly through epigenetic changes in germ cells. This study investigates whether snus use starting in or after puberty influences respiratory health in future offspring. Methods: We analysed Swedish data from RHINE (Respiratory Health in Northern Europe) parents and RHINESSA (Respiratory Health in Northern Europe, Spain and Australia) offspring by using mixed-effect logistic regression to assess the links between paternal snus initiation around puberty and offspring asthma, chronic bronchitis, rhinitis, and eczema, adjusting for paternal and offspring smoking. Results: We identified 1090 offspring–father pairs. The offspring’s median age was 29 years (17–51) and 55% were women. The maternal line (n = 1421) was not analysed, as <1% of mothers used snus in puberty. The offspring of fathers starting snus use in puberty (n = 89) had a higher risk of current allergic asthma [odds ratio (OR) 1.42; 95% confidence interval (CI) 1.02–1.97], at least three asthma symptoms with allergy (OR 1.13; 95% CI 1.10–1.21), chronic bronchitis (OR 2.17; 95% CI 1.04–4.54), and eczema (OR 1.45; 95% CI 1.27–1.65). Fathers’ snus use starting after puberty (n = 252) showed no consistent associations with offspring outcomes. The effect estimates were consistent after excluding offspring using snus in puberty. Conclusion: Paternal snus use starting in puberty was associated with a higher risk of asthma and other respiratory and allergic symptoms in offspring. These findings support the hypothesis that exposures in puberty may impact future generations’ respiratory health, possibly through epigenetic changes. This highlights the need for research on exposures during this period and actions to prevent habits that could negatively impact future offspring’s health.

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  • Offspring of fathers who started using snus in puberty have higher odds of current allergic asthma (OR = 1.42; 95% CI: 1.02-1.97), at least three asthma symptoms with allergy (OR = 1.13; 95% CI: 1.10-1.21), chronic bronchitis (OR = 2.17; 95% CI: 1.04-4.54), and eczema (OR = 1.45; 95% CI: 1.27-1.65), but not in offspring of fathers who started using snus after puberty.

    “higher odds of current allergic asthma (OR = 1.42; 95% CI: 1.02-1.97),at least three asthma symptoms with allergy (OR = 1.13; 95% CI: 1.10-1.21),chronic bronchitis (OR = 2.17; 95% CI: 1.04-4.54),and eczema (OR = 1.45; 95% CI: 1.27-1.65) in offsprings of fathers who started using snus in puberty, but not in offsprings of fathers who started using snus use after puberty (López-Cervantes et al. 2026”

    From Comparison of the Health Effects Associated with the Use of Snus and Tobacco-Free Oral Nicotine Pouches: A Systematic Review (2026) · cites this paper as López-Cervantes et al. 2026

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Authors
López-Cervantes, J. P., Bertelsen, R. J., Schlünssen, V., Holm, M., Malinovschi, A., Modig, L., Oudin, A., Callejas-González, F. J., Dharmage, S. C., Jogi, N. O., Johannessen, A., Lando, V., Thorarinsdottir, E. H., Janson, C., Accordini, S., & Svanes, C.
Venue
International Journal of Epidemiology
Publisher
Oxford University Press (OUP)
Published
2026-02-18
Volume
55
Issue
2
ISSN
  • 0300-5771
  • 1464-3685
DOI
10.1093/ije/dyag035
PMC
PMC13032824
Cited by
2
References
2
Language
en
Licence
creativecommons.org/licenses/by/4.0/ (vor, 38 d)
Funders
  • University of Bergen
  • RHINE
  • Swedish Heart and Lung Association, Vårdal Foundation for Healthcare Science and Allergy Research
  • Asthma and Allergy Association
  • RHINESSA
  • Research Council of Norway (274767, 214123, 228174, 230827, 273838)
  • ERC StG project BRuSH (804199)
  • European Union’s Horizon 2020 Research and Innovation Program (633212)
  • Bergen Medical Research Foundation
  • Western Norwegian Regional Health Authorities (912011, 911892, 911631)
  • Uppsala RHINESSA
  • Swedish Heart and Lung Foundation
  • Swedish Asthma and Allergy Association

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