CoChat
Sign Up
Cited by 17

An investigation on the use of snus and its association with respiratory and sleep-related symptoms: a cross-sectional population study

Gudnadóttir, Arna Ýr, Ólafsdóttir, Inga Sif, Middelveld, Roelinde, Ekerljung, Linda, Forsberg, Bertil, Franklin, Karl, Lindberg, Eva, Janson, Christer·2017·BMJ Open
DOI 10.1136/bmjopen-2016-015486PMC PMC5730007
Open this paper in CoChat — free account

Abstract

Introduction: Studies of the health effects of moist oral tobacco, snus, have produced inconsistent results. The main objective of this study is to examine the health effects of snus use on asthma, respiratory symptoms and sleep-related problems, a field that has not been investigated before. Methods and material: This cross-sectional study was based on a postal questionnaire completed by 26 697 (59.3%) participants aged 16 to 75 years and living in Sweden. The questionnaire included questions on tobacco use, asthma, respiratory symptoms and sleeping problems. The association of snus use with asthma, respiratory symptoms and sleep-related symptoms was mainly tested in never-smokers (n=16 082). Results: The current use of snus in never-smokers was associated with an increased risk of asthma (OR 1.51 (95% CI 1.28 to 1.77)), asthmatic symptoms, chronic bronchitis and chronic rhinosinusitis. This association was not present among ex-snus users. Snoring was independently related to both the former and current use of snus ((OR 1.37 (95% CI 1.12 to 1.68)) and (OR 1.59 (95% CI 1.34 to 1.89), respectively)). A higher risk of difficulty inducing sleep was seen among snus users. Conclusion: Snus use was associated with a higher prevalence of asthma, respiratory symptoms and snoring. Healthcare professionals should be aware of these possible adverse effects of snus use.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1136/bmjopen-2016-015486

Cites

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Using snus is positively associated with increased odds of asthma (aOR = 1.49; 95% CI: 1.20-1.85) and asthma symptoms, chronic bronchitis, and chronic rhinosinusitis.

    “positive association between using snus and increased odds of asthma (aOR = 1.49; 95% CI: 1.20-1.85)and asthma symptoms: wheezing (aOR = 1.56; 95% CI: 1.32-1.84),wheezing and breathlessness (aOR = 1.38; 95% CI: 1.12-1.69),wheezing without having a cold (aOR = 1.48; 95% CI: 1.21-1.80),night-time chest tightness (aOR = 1.41; 95% CI: 1.16-1.71),night-time attacks of breathlessness (aOR = 1.39; 95% CI”

    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 Gudnadóttir et al. 2017

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

No references could be resolved yet.

Research works printed but not linked: 37

  1. [1]Digard H, Errington G, Richter A, et al Patterns and behaviors of snus consumption in Sweden. Nicotine Tob Res 2009; 11: 1175– 81. 10.1093/ntr/ntp118 19687306 PMC2746836 · DOI · Paper page
  2. [2]IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. Smokeless tobacco and some tobacco-specific N-nitrosamines. IARC Monogr Eval Carcinog Risks Hum 2007; 89: 1– 592. 18335640 PMC4781254
  3. [3]Digard H, Gale N, Errington G, et al Multi-analyte approach for determining the extraction of tobacco constituents from pouched snus by consumers during use. Chem Cent J 2013; 7: 55 10.1186/1752-153X-7-55 23548061 PMC3618139 · DOI
  4. [5]Norberg M, Lundqvist G, Nilsson M, et al Changing patterns of tobacco use in a middle-aged population – the role of snus, gender, age, and education. Glob Health Action 2011; 4: 5613 10.3402/gha.v4i0.5613 PMC3118776 21695071 · DOI
  5. [6]Lundqvist G, Sandström H, Ohman A, et al Patterns of tobacco use: a 10-year follow-up study of smoking and snus habits in a middle-aged swedish population. Scand J Public Health 2009; 37: 161– 7. 10.1177/1403494808096169 19039092 · DOI
  6. [7]Post A, Gilljam H, Rosendahl I, et al Symptoms of nicotine dependence in a cohort of swedish youths: a comparison between smokers, smokeless tobacco users and dual tobacco users. Addiction 2010; 105: 740– 6. 10.1111/j.1360-0443.2009.02852.x 20148785 · DOI
  7. [8]Fagerström K, Eissenberg T Dependence on tobacco and nicotine products: a case for product-specific assessment. Nicotine Tob Res 2012; 14: 1382– 90. 10.1093/ntr/nts007 22459798 PMC3611984 · DOI
  8. [9]Gartner CE, Hall WD, Vos T, et al Assessment of swedish snus for tobacco harm reduction: an epidemiological modelling study. Lancet 2007; 369: 2010– 4. 10.1016/S0140-6736(07)60677-1 17498798 · DOI
  9. [10]Luo J, Ye W, Zendehdel K, et al Oral use of swedish moist snuff (snus) and risk for cancer of the mouth, lung, and pancreas in male construction workers: a retrospective cohort study. Lancet 2007; 369: 2015– 20. 10.1016/S0140-6736(07)60678-3 17498797 · DOI · Paper page
  10. [11]Boffetta P, Aagnes B, Weiderpass E, et al Smokeless tobacco use and risk of cancer of the pancreas and other organs. Int J Cancer 2005; 114: 992– 5. 10.1002/ijc.20811 15645430 · DOI
  11. [12]Roosaar A, Johansson AL, Sandborgh-Englund G, et al Cancer and mortality among users and nonusers of snus. Int J Cancer 2008; 123: 168– 73. 10.1002/ijc.23469 18412245 · DOI
  12. [13]Hansson J, Galanti MR, Hergens MP, et al Use of snus and acute myocardial infarction: pooled analysis of eight prospective observational studies. Eur J Epidemiol 2012; 27: 771– 9. 10.1007/s10654-012-9704-8 22722951 · DOI · Paper page
  13. [14]Hansson J, Galanti MR, Hergens MP, et al Snus (Swedish smokeless tobacco) use and risk of stroke: pooled analyses of incidence and survival. J Intern Med 2014; 276: 87– 95. 10.1111/joim.12219 24548296 · DOI · Paper page
  14. [15]Arefalk G, Hergens MP, Ingelsson E, et al Smokeless tobacco (snus) and risk of heart failure: results from two swedish cohorts. Eur J Prev Cardiol 2012; 19: 1120– 7. 10.1177/1741826711420003 21828223 · DOI · Paper page
  15. [16]Jerning C, Martinander E, Bjerg A, et al Asthma and physical activity--a population based study results from the swedish GA(2)LEN survey. Respir Med 2013; 107: 1651– 8. 10.1016/j.rmed.2013.08.040 24055634 · DOI
  16. [17]Sabanayagam C, Shankar A The association between active smoking, smokeless tobacco, second-hand smoke exposure and insufficient sleep. Sleep Med 2011; 12: 7– 11. 10.1016/j.sleep.2010.09.002 21144798 PMC3056485 · DOI
  17. [18]Jarvis D, Newson R, Lotvall J, et al Asthma in adults and its association with chronic rhinosinusitis: the GA2LEN survey in Europe. Allergy 2012; 67: 91– 8. 10.1111/j.1398-9995.2011.02709.x 22050239 · DOI · Paper page
  18. [19]Tomassen P, Newson RB, Hoffmans R, et al Reliability of EP3OS symptom criteria and nasal endoscopy in the assessment of chronic rhinosinusitis--a GA² LEN study. Allergy 2011; 66: 556– 61. 10.1111/j.1398-9995.2010.02503.x 21083566 · DOI
  19. [20]Sundbom F, Lindberg E, Bjerg A, et al Asthma symptoms and nasal congestion as independent risk factors for insomnia in a general population: results from the GA(2)LEN survey. Allergy 2013; 68: 213– 9. 10.1111/all.12079 23176562 · DOI
  20. [21]Pietinalho A, Pelkonen A, Rytilä P Linkage between smoking and asthma. Allergy 2009; 64: 1722– 7. 10.1111/j.1398-9995.2009.02208.x 19832738 · DOI
  21. [22]Lundbäck B, Backman H, Lötvall J, et al Is asthma prevalence still increasing? Expert Rev Respir Med 2016; 10: 39– 51. 10.1586/17476348.2016.1114417 26610152 · DOI
  22. [23]Liistro G, Stănescu DC, Veriter C, et al Pattern of snoring in obstructive sleep apnea patients and in heavy snorers. Sleep 1991; 14: 517– 25. 10.1093/sleep/14.6.517 1798885 · DOI
  23. [24]Saha S, Taheri M, Mossuavi Z, et al Effects of changing in the neck circumference during sleep on snoring sound characteristics. Conf Proc IEEE Eng Med Biol Soc 2015; 2015: 2235– 8. 10.1109/EMBC.2015.7318836 26736736 · DOI
  24. [25]Bury SB, Singh A The role of nasal treatments in snoring and obstructive sleep apnoea. Curr Opin Otolaryngol Head Neck Surg 2015; 23: 1– 46. 10.1097/MOO.0000000000000129 25565285 · DOI
  25. [26]Friberg D, Ansved T, Borg K, et al Histological indications of a progressive snorers disease in an upper airway muscle. Am J Respir Crit Care Med 1998; 157: 586– 93. 10.1164/ajrccm.157.2.96-06049 9476877 · DOI
  26. [27]Bloom JW, Kaltenborn WT, Quan SF Risk factors in a general population for snoring. importance of cigarette smoking and obesity. Chest 1988; 93: 678– 83. 3258226
  27. [28]Riemann R, Volk R, Müller A, et al The influence of nocturnal alcohol ingestion on snoring. Eur Arch Otorhinolaryngol 2010; 267: 1147– 56. 10.1007/s00405-009-1163-9 19949955 · DOI
  28. [29]Ekici A, Ekici M, Kurtipek E, et al Association of asthma-related symptoms with snoring and apnea and effect on health-related quality of life. Chest 2005; 128: 3358– 63. 10.1378/chest.128.5.3358 16304284 · DOI
  29. [30]Kohata Y, Fujiwara Y, Watanabe T, et al Long-Term benefits of smoking cessation on gastroesophageal reflux disease and Health-Related quality of life. PLoS One 2016; 11: e0147860 10.1371/journal.pone.0147860 26845761 PMC4742243 · DOI
  30. [31]Emilsson ÖI, Bengtsson A, Franklin KA, et al Nocturnal gastro-oesophageal reflux, asthma and symptoms of OSA: a longitudinal, general population study. Eur Respir J 2013; 41: 1347– 54. 10.1183/09031936.00052512 23018910 · DOI
  31. [32]Lie TM, Bomme M, Hveem K, et al Snus and risk of gastroesophageal reflux. A population-based case-control study: the HUNT study. Scand J Gastroenterol 2017; 52: 193– 8. 10.1080/00365521.2016.1245775 27797289 · DOI · Paper page
  32. [33]Malinovschi A, Janson C, Holmkvist T, et al Effect of smoking on exhaled nitric oxide and flow-independent nitric oxide exchange parameters. Eur Respir J 2006; 28: 339– 45. 10.1183/09031936.06.00113705 16641119 · DOI
  33. [34]Janson C, De Backer W, Gislason T, et al Increased prevalence of sleep disturbances and daytime sleepiness in subjects with bronchial asthma: a population study of young adults in three european countries. Eur Respir J 1996; 9: 2132– 8. 10.1183/09031936.96.09102132 8902479 · DOI
  34. [35]Sundberg R, Torén K, Franklin KA, et al Asthma in men and women: treatment adherence, anxiety, and quality of sleep. Respir Med 2010; 104: 337– 44. 10.1016/j.rmed.2009.10.017 19910178 · DOI
  35. [36]Norberg M, Malmberg G, Ng N, et al Use of moist smokeless tobacco (snus) and the risk of development of alcohol dependence: a cohort study in a middle-aged population in Sweden. Drug Alcohol Depend 2015; 149: 151– 7. 10.1016/j.drugalcdep.2015.01.042 25707707 · DOI
  36. [37]Huang R, Ho SY, Lo WS, Sy H, Ws L, et al Alcohol consumption and sleep problems in Hong Kong adolescents. Sleep Med 2013; 14: 877– 82. 10.1016/j.sleep.2013.03.022 23777753 · DOI
  37. [38]Janson C, Künzli N, de Marco R, et al Changes in active and passive smoking in the european community respiratory health survey. Eur Respir J 2006; 27: 517– 24. 10.1183/09031936.06.00106605 16507851 · DOI

Cited by

Sorted by citations

Authors
Gudnadóttir, A. Ý., Ólafsdóttir, I. S., Middelveld, R., Ekerljung, L., Forsberg, B., Franklin, K., Lindberg, E., & Janson, C.
Venue
BMJ Open
Publisher
BMJ
Published
2017-05
Volume
7
Issue
5
Pages
e015486
ISSN
2044-6055
DOI
10.1136/bmjopen-2016-015486
PMC
PMC5730007
Cited by
17
References
0
Language
en
Funders
  • Swedish Asthma and Allergy Foundation
  • EU Sixth Framework Programme for Research,
  • Hjrt-Lungfonden

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review