The relationship between smokeless tobacco (snus) and anxiety and depression among adults and elderly people. A comparison to smoking in the Tromsø Study
Abstract
Aims: To (i) define the characteristics of snus users compared with non‐users and smokers and (ii) define the relationship between snus use and self‐reported anxiety and depression and compare it with the relation between smoking and anxiety and depression. Design, setting and participants: A cross‐sectional study based on data from the Norwegian population‐based survey, the Tromsø Study (2015–16). A total of 32 591 people aged 40 years and older in the municipality of Tromsø were invited to attend. There were 21 083 respondents, giving a 65% attendance rate. Measurements: Tobacco use was assessed by current and previous use of snus or cigarettes. Symptoms of anxiety and depression were measured using the Hospital Anxiety and Depression Scale (HADS). Findings: Snus users were more often male, were younger and had higher income and higher alcohol consumption than smokers and non‐users of snus. In a linear regression analysis, we found no significant association between current snus use and anxiety and depression after adjusting for background variables. However, there was a positive association between previous snus use and anxiety among males [adjusted beta = 0.258; 99% confidence interval (CI) = 0.023–0.492]. Regarding anxiety, the adjusted beta‐coefficients for current smoking were 0.425 (99% CI = 0.184–0.666) for females and 0.303 (99% CI = 0.084–0.522) for males. Concerning depression, the adjusted beta coefficients for current smoking were 0.569 (99% CI = 0.358–0.780) for females and 0.281 (99% CI = 0.060–0.503) for males. Conclusions: In Norway, current snus users differ from current smokers by having a higher socio‐economic status and no detectable association with anxiety and depression. This suggests that the relationship between tobacco use and anxiety and depression is associated with the administration method.
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There is no association between current snus use and depression.
“No association between current snus use and depression (Bondø et al. 2022)”
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 Bondø et al. 2022
There is no association between current snus use and anxiety.
“No association between current snus use and anxiety (Bondø et al. 2022)”
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 Bondø et al. 2022
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Socioeconomic status and smoking: a review
Hiscock, R., Bauld, L., Amos, A., Fidler, J. A., & Munafò, M. (2012) · Annals of the New York Academy of Sciences · doi:10.1111/j.1749-6632.2011.06202.x · Cited by 1,572 · see citing works
Mykletun, A., Overland, S., Aarø, L. E., Liabø, H.-M., & Stewart, R. (2008) · European Psychiatry · doi:10.1016/j.eurpsy.2007.10.005 · Cited by 213 · see citing works
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Research works printed but not linked: 32
- [1]Fluharty M, Taylor AE, Grabski M, Munafò MR. The association of cigarette smoking with depression and anxiety: a systematic review. Nicotine Tob Res. 2017; 19: 3– 13. 27199385 PMC5157710
- [3]Pedersen W, von Soest T. Tobacco use among Norwegian adolescents: from cigarettes to snus. Addiction. 2014; 109: 1154– 62. 24521070 PMC4309515
- [5]European Union. Directive 2014/40/EU of the European Parliament and of the Council of 3 April 2014 on the approximation of the laws, regulations and administrative provisions of the Member States concerning the manufacture, presentation and sale of tobacco and related products and repealing Directive 2001/37/EC. Brussels: Official Journal of the European Union; 2014; L 127/6.
- [7]Øverland S, Hetland J, Aarø LE. Relative harm of snus and cigarettes: what do Norwegian adolescents say? Tob Control. 2008; 17: 422– 5. 18849315
- [8]Fu Q, Vaughn MG, Wu LT, Heath AC. Psychiatric correlates of snuff and chewing tobacco use. PLOS ONE. 2014; 9: e113196. 25535739 PMC4275177
- [9]King JL, Reboussin BA, Spangler J, Cornacchione R. J, Sutfin EL. Tobacco product use and mental health status among young adults. Addict Behav. 2018; 77: 67– 72. 28965069 PMC5701872
- [10]Sawchuk CN, Roy‐Byrne P, Noonan C, Bogart A, Goldberg J, Manson SM, et al. Smokeless tobacco use and its relation to panic disorder, major depression, and posttraumatic stress disorder in American Indians. Nicotine Tob Res. 2012; 14: 1048– 56. 22345318 PMC3432277
- [11]Sihvola E, Rose RJ, Dick DM, Pulkkinen L, Marttunen M, Kaprio J. Early‐onset depressive disorders predict the use of addictive substances in adolescence: a prospective study of adolescent Finnish twins. Addiction. 2008; 103: 2045– 53. 18855807 PMC2693250
- [13]Munafò MR, Larsson Lönn S, Sundquist J, Sundquist K, Kendler K. Snus use and risk of schizophrenia and non‐affective psychosis. Drug Alcohol Depend. 2016; 164: 179– 82. 27173660 PMC4907123
- [14]Jacobsen BK, Eggen AE, Mathiesen EB, Wilsgaard T, Njølstad I. Cohort profile: the Tromso Study. Int J Epidemiol. 2012; 41: 961– 7. 21422063 PMC3429870
- [16]Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983; 67: 361– 70. 6880820
- [17]Bush K, Kivlahan DR, McDonell MB, Fihn SD, Bradley KA. The AUDIT alcohol consumption questions (AUDIT‐C): an effective brief screening test for problem drinking. Ambulatory Care Quality Improvement Project (ACQUIP). Alcohol Use Disorders Identification Test. Arch Intern Med. 1998; 158: 1789– 95. 9738608
- [19]Bell ML, Fairclough DL, Fiero MH, Butow PN. Handling missing items in the Hospital Anxiety and Depression Scale (HADS): a simulation study. BMC Res Notes. 2016; 9: 479. 27770833 PMC5075158
- [20]Liskola J, Haravuori H, Lindberg N, Niemelä S, Karlsson L, Kiviruusu O, et al. AUDIT and AUDIT‐C as screening instruments for alcohol problem use in adolescents. Drug Alcohol Depend. 2018; 188: 266– 73. 29803033
- [21]Engström K, Magnusson C, Galanti MR. Socio‐demographic, lifestyle and health characteristics among snus users and dual tobacco users in Stockholm County. Sweden BMC Publ Health. 2010; 10: 619. PMC2976748 20955584
- [22]Norberg M, Lundqvist G, Nilsson M, Gilljam H, Weinehall L. Changing patterns of tobacco use in a middle‐aged population: the role of snus, gender, age, and education. Glob Health Action. 2011; 4: 5613. PMC3118776 21695071
- [23]Norberg M, Malmberg G, Ng N, Broström G. Who is using snus? Time trends, socioeconomic and geographic characteristics of snus users in the ageing Swedish population. BMC Public Health. 2011; 11: 929. 22169061 PMC3267833
- [24]Larsen E, Rise J, Lund KE. Risk and protective factors of adolescent exclusive snus users compared to non‐users of tobacco, exclusive smokers and dual users of snus and cigarettes. Addict Behav. 2013; 38: 2288– 94. 23583834
- [25]Sæbø G. Cigarettes, snus and status: differences in lifestyle of different tobacco user groups in Norway. Health Sociol Rev. 2017; 26: 175– 89.
- [26]Kvaavik E, Lund I, Nygård M, Hansen BT. Lifestyle correlates of female snus use and smoking: a large population‐based survey of women in Norway. Nicotine Tob Res. 2016; 18: 431– 6. 26069033
- [28]Øverland S, Tjora T, Hetland J, Aarø LE. Associations between adolescent socioeducational status and use of snus and smoking. Tob Control. 2010; 19: 291– 6. 20547578
- [29]Tseveenjav B, Pesonen P, Virtanen JI. Use of snus, its association with smoking and alcohol consumption, and related attitudes among adolescents: the Finnish National School Health Promotion Study. Tob Induc Dis. 2015; 13: 34. 26500472 PMC4619440
- [30]Løchen M‐L, Gram IT, Mannsverk J, Mathiesen EB, Njølstad I, Schirmer H, et al. Association of occasional smoking with total mortality in the population‐based Tromsø study, 2001–2015. BMJ Open. 2017; 7: e019107. PMC5770901 29288187
- [31]Senol Y, Donmez L, Turkay M, Aktekin M. The incidence of smoking and risk factors for smoking initiation in medical faculty students: cohort study. BMC Public Health. 2006; 6: 128. 16686941 PMC1482690
- [32]Marmorstein NR, White HR, Loeber R, Stouthamer‐Loeber M. Anxiety as a predictor of age at first use of substances and progression to substance use problems among boys. J Abnorm Child Psychol. 2010; 38: 211– 24. 19821024 PMC2857386
- [33]Cuijpers P, Smit F, ten Have M, de Graaf R. Smoking is associated with first‐ever incidence of mental disorders: a prospective population‐based study. Addiction. 2007; 102: 1303– 9. 17624980
- [34]Moylan S, Gustavson K, Karevold E, Øverland S, Jacka FN, Pasco JA, et al. The impact of smoking in adolescence on early adult anxiety symptoms and the relationship between infant vulnerability factors for anxiety and early adult anxiety symptoms: the TOPP Study. PLOS ONE. 2013; 8: e63252. 23696803 PMC3655993
- [36]Taylor AE, Fluharty ME, Bjørngaard JH, Gabrielsen ME, Skorpen F, Marioni RE, et al. Investigating the possible causal association of smoking with depression and anxiety using Mendelian randomisation meta‐analysis: the CARTA consortium. BMJ Open. 2014; 4: e006141. PMC4187451 25293386
- [37]Boden JM, Fergusson DM, Horwood LJ. Cigarette smoking and depression: tests of causal linkages using a longitudinal birth cohort. Br J Psychiatry. 2010; 196: 440– 6. 20513853
- [38]Pasco JA, Williams LJ, Jacka FN, Ng F, Henry MJ, Nicholson GC, et al. Tobacco smoking as a risk factor for major depressive disorder: population‐based study. Br J Psychiatry. 2008; 193: 322– 6. 18827296
- [39]Goodwin RD, Zvolensky MJ, Keyes KM. Nicotine dependence and mental disorders among adults in the USA: evaluating the role of the mode of administration. Psychol Med. 2008; 38: 1277– 86. 18366824 PMC7872214
- [40]VanderWeele TJ, Ding P. Sensitivity analysis in observational research: introducing the e‐value. Ann Intern Med. 2017; 167: 268– 74. 28693043
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Sorted by citations
Kopa-Stojak, P. N., & Pawliczak, R. (2026) · Exposure and Health · doi:10.1007/s12403-026-00812-w
- Authors
- Bondø, P., Høye, A., Løchen, M., & Bramness, J. G.
- Venue
- Addiction
- Publisher
- Wiley
- Published
- 2022-06-11
- Volume
- 117
- Issue
- 10
- Pages
- 2695-2706
- ISSN
- 0965-2140
- 1360-0443
- PMC
- PMC9544089
- Cited by
- 10
- References
- 2
- Language
- en
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