CoChat
Sign Up
Cited by 3

Use of oral moist tobacco (snus) in puberty and its association with asthma in the population-based RHINESSA study

López-Cervantes, Juan Pablo, Schlünssen, Vivi, Senaratna, Chamara, Accordini, Simone, Callejas, Francisco Javier, Franklin, Karl A, Holm, Mathias, Jogi, Nils Oskar +7 more·2024·BMJ Open Respiratory Research
DOI 10.1136/bmjresp-2024-002401PMC PMC11268032
Open this paper in CoChat — free account

Abstract

Objectives: To investigate the association of early snus use initiation (≤15 years of age) with asthma and asthma symptoms. Design: Cross-sectional analysis of a population-based cohort. Setting: Study centres in Norway, Sweden, Iceland, Denmark and Estonia, from 2016 to 2019. Participants: 9002 male and female participants above 15 years of age of the Respiratory Health in Northern Europe, Spain and Australia study. Main outcome measures: Current asthma and asthma symptoms. Results: The median age of study participants was 28 years (range 15–53) and 58% were women. 20% had used snus, 29% men and 14% women. Overall, 26% of males and 14% of females using snus started ≤15 years of age. Early snus use initiation was associated with having three or more asthma symptoms (OR 2.70; 95% CI 1.46 to 5.00) and a higher asthma symptom score (β-coefficient (β) 0.35; 95% CI 0.07 to 0.63) in women. These associations were weak in men (OR 1.23; 95% CI 0.78 to 1.94; β 0.16; 95% CI −0.06 to 0.38, respectively). There was evidence for an association of early snus initiation with current asthma (OR 1.72; 95% CI 0.88 to 3.37 in women; OR 1.31; 95% CI 0.84 to 2.06 in men). A sensitivity analysis among participants without smoking history showed stronger estimates for all three outcomes, in both men and women, statistically significant for three or more asthma symptoms in women (OR 3.28; 95% CI 1.18 to 9.10). Finally, no consistent associations with asthma outcomes were found for starting snus after age 15 years. Conclusions: Snus initiation in puberty was associated with higher likelihood of asthma and asthma symptoms, with the highest estimates in females and those without smoking history. These results raise concerns about the health adversities of early snus initiation and emphasise the need for public health initiatives to protect young people from this tobacco product.

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/bmjresp-2024-002401

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?

  • There is evidence for an association of early snus initiation with current asthma in women (OR = 1.72; 95% CI: 0.88-3.37) and men (OR = 1.31; 95% CI: 0.84-2.06).

    “There was evidence for an association of early snus initiation with current asthma (OR = 1.72; 95% CI: 0.88-3.37 for women; OR = 1.31; 95% CI: 0.84-2.06for men).”

    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. 2024b

  • Early initiation of snus use is positively associated with having three or more asthma symptoms in women (OR = 2.70; 95% CI: 1.46-5.00) and a higher asthma symptom score in women (β = 0.35; 95% CI: 0.07-0.63), but not significantly in men.

    “early initiation of snus use was positively associated with having three or more asthma symptoms (OR = 2.70; 95% CI: 1.46-5.00for women; OR = 1.23; 95% CI: 0.78-1.94for men) and a higher asthma symptom score (β-coefficient (β) = 0.35; 95% CI: 0.07-0.63 for women; β = 0.16; 95% CI: -0.06-0.38 for men).”

    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. 2024b

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: 29

  1. [1]IARC Working Group on the Evaluation of Carcinogenic Risks to Humans Personal habits and indoor Combustions. Smokeless tobacco IARC Monogr Eval Carcinog Risks Hum, Vol 100 2012 1 538 PMC4781577 23193840
  2. [3]Tjora T Skogen JC Sivertsen B Increasing similarities between young adults’ smoking and snus use in Norway: a study of the trends and stages of smoking and snus epidemic from 2010 to 2018 BMC Public Health 2020 20 1511 10.1186/s12889-020-09604-6 33023560 PMC7539463 · DOI
  3. [4]Ramström L Borland R Wikmans T Patterns of smoking and snus use in Sweden: implications for public health Int J Environ Res Public Health 2016 13 1110 10.3390/ijerph13111110 27834883 PMC5129320 · DOI
  4. [5]Byhamre ML Araghi M Alfredsson L et al Swedish snus use is associated with mortality: a pooled analysis of eight prospective studies Int J Epidemiol 2021 49 2041 50 10.1093/ije/dyaa197 33347584 PMC7825961 · DOI
  5. [6]Gudnadóttir AÝ Ólafsdóttir IS Middelveld R et al An investigation on the use of snus and its association with respiratory and sleep-related symptoms: a cross-sectional population study BMJ Open 2017 7 e015486 10.1136/bmjopen-2016-015486 PMC5730007 28554933 · DOI · Paper page
  6. [7]Titova OE Baron JA Michaëlsson K et al Swedish snuff (snus) and risk of cardiovascular disease and mortality: prospective cohort study of middle-aged and older individuals BMC Med 2021 19 111 10.1186/s12916-021-01979-6 33957912 PMC8103653 · DOI · Paper page
  7. [8]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
  8. [9]Rostron BL Chang CM van Bemmel DM et al Nicotine and toxicant exposure among U.S. Smokeless tobacco users: results from 1999 to 2012 National health and nutrition examination survey data Cancer Epidemiol Biomarkers Prev 2015 24 1829 37 10.1158/1055-9965.EPI-15-0376 26582044 PMC5134927 · DOI
  9. [10]Albuquerque EX Pereira EFR Alkondon M et al Mammalian nicotinic acetylcholine receptors: from structure to function Physiol Rev 2009 89 73 120 10.1152/physrev.00015.2008 19126755 PMC2713585 · DOI · Paper page
  10. [11]Herman M Tarran R E-cigarettes, nicotine, the lung and the brain: multi-level cascading pathophysiology J Physiol (Lond) 2020 598 5063 71 10.1113/JP278388 32515030 PMC7721976 · DOI
  11. [12]Wang Y Pereira EF Maus AD et al Human bronchial epithelial and endothelial cells express alpha7 nicotinic acetylcholine receptors Mol Pharmacol 2001 60 1201 9 10.1124/mol.60.6.1201 11723227 · DOI · Paper page
  12. [13]Decrue F Gorlanova O Usemann J et al Lung functional development and asthma trajectories Semin Immunopathol 2020 42 17 27 10.1007/s00281-020-00784-2 31989229 · DOI
  13. [14]Erbas B Knudsen TM Janson C et al Critical age windows in the impact of lifetime smoking exposure on respiratory symptoms and disease among ever smokers Environ Res 2018 164 241 7 10.1016/j.envres.2018.02.028 29522998 · DOI
  14. [15]Gold DR Wang X Wypij D et al Effects of cigarette smoking on lung function in adolescent boys and girls N Engl J Med 1996 335 931 7 10.1056/NEJM199609263351304 8782500 · DOI
  15. [16]Svanes C Koplin J Skulstad SM et al Father’s environment before conception and asthma risk in his children: a multi-generation analysis of the respiratory health in Northern Europe study Int J Epidemiol 2017 46 235 45 10.1093/ije/dyw151 27565179 · DOI
  16. [17]Svanes C Holloway JW Krauss-Etschmann S Preconception origins of asthma, allergies and lung function: the influence of previous generations on the respiratory health of our children J Intern Med 2023 293 531 49 10.1111/joim.13611 36861185 · DOI
  17. [18]Zacharasiewicz A Maternal smoking in pregnancy and its influence on childhood asthma ERJ Open Res 2016 2 00042-2016 10.1183/23120541.00042-2016 PMC5034599 27730206 · DOI
  18. [19]Becklake MR Kauffmann F Gender differences in airway behaviour over the human life span Thorax 1999 54 1119 38 10.1136/thx.54.12.1119 10567633 PMC1763756 · DOI
  19. [20]Prakash YS Pabelick CM Chiarella SE Sex differences in respiratory physiology Silveyra P Tigno XT Sex-based differences in lung physiology Cham Springer International Publishing 2021 1 11
  20. [21]Svanes C Johannessen A Bertelsen RJ et al Cohort profile: the multigeneration respiratory health in northern Europe, Spain and Australia (RHINESSA) cohort BMJ Open 2022 12 e059434 10.1136/bmjopen-2021-059434 PMC9163543 35654464 · DOI
  21. [22]Pekkanen J Sunyer J Anto JM et al Operational definitions of asthma in studies on its aetiology Eur Respir J 2005 26 28 35 10.1183/09031936.05.00120104 15994386 · DOI
  22. [23]Greenland S Principles of multilevel modelling Int J Epidemiol 2000 29 158 67 10.1093/ije/29.1.158 10750618 · DOI
  23. [24]Lee J-H Han G Fulp WJ et al Analysis of overdispersed count data: application to the human Papillomavirus infection in men (HIM) study Epidemiol Infect 2012 140 1087 94 10.1017/S095026881100166X 21875452 PMC3471780 · DOI
  24. [25]Patel BD Luben RN Welch AA et al Childhood smoking is an independent risk factor for obstructive airways disease in women Thorax 2004 59 682 6 10.1136/thx.2003.010215 15282389 PMC1747099 · DOI
  25. [26]Holmen TL Barrett-Connor E Clausen J et al Gender differences in the impact of adolescent smoking on lung function and respiratory symptoms. The Nord-Trøndelag health study, Norway, 1995-1997 Respir Med 2002 96 796 804 10.1053/rmed.2002.1350 12412979 · DOI
  26. [27]Reddy KD Oliver BGG Sexual dimorphism in chronic respiratory diseases Cell Biosci 2023 13 47 10.1186/s13578-023-00998-5 36882807 PMC9993607 · DOI
  27. [28]Ilmarinen P Tuomisto LE Kankaanranta H Phenotypes, risk factors, and mechanisms of adult-onset asthma Mediat Inflamm 2015 2015 514868 10.1155/2015/514868 PMC4619972 26538828 · DOI
  28. [29]Sunyer J Pekkanen J Garcia-Esteban R et al Asthma score: predictive ability and risk factors Allergy 2007 62 142 8 10.1111/j.1398-9995.2006.01184.x 17298422 · DOI
  29. [31]Rebagliato M Validation of self reported smoking J Epidemiol Community Health 2002 56 163 4 10.1136/jech.56.3.163 11854332 PMC1732087 · DOI

Cited by

Sorted by citations

Authors
López-Cervantes, J. P., Schlünssen, V., Senaratna, C., Accordini, S., Callejas, F. J., Franklin, K. A., Holm, M., Jogi, N. O., Malinovschi, A., Oudin, A., Sigsgaard, T., Thorarinsdottir, E. H., Janson, C., Bertelsen, R. J., & Svanes, C.
Venue
BMJ Open Respiratory Research
Publisher
BMJ
Published
2024-07
Volume
11
Issue
1
Pages
e002401
ISSN
2052-4439
DOI
10.1136/bmjresp-2024-002401
PMC
PMC11268032
Cited by
3
References
0
Language
en
Licence
creativecommons.org/licenses/by/4.0/ (unspecified, 21 d)
Funders
  • The Danish Wood Foundation (444508795)
  • Bergen Medical Research Foundation (911631, 911892, 912011)
  • Eesti Teadusagentuur (PUT562)
  • Sociedad Española de Neumología y Cirugía Torácica
  • Hjärt-Lungfonden
  • National Health and Medical Research Council (ID1128450)
  • Arbejdstilsynet (20150067134)
  • Háskóli Íslands
  • University of Bergen
  • Astma- och Allergiförbundet
  • Norwegian Asthma and Allergy Association
  • HORIZON EUROPE European Innovation Council (633212)
  • Research Council of Norway (214123, 228174, 230827, 273838, 274767)
  • University of Melbourne
  • NAV
  • Worldwide Universities Network
  • Aarhus University
  • European Research Council (804199)

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