Early use of oral moist tobacco as related to respiratory symptoms: a cross-sectional analysis from the RHINESSA study

Abstract

Background: Evidence suggests an association of oral moist tobacco (snus) with higher risk of asthma, asthma-symptoms, and chronic bronchitis among never smokers. However, there is no knowledge of whether time at snus initiation plays a role for respiratory outcomes. Objective: To investigate associations of snus use starting in puberty (≤15 years of age) and after, with asthma and asthma-like symptoms. Methods: Questionnaire data on tobacco habits and respiratory outcomes were obtained in Norway, Sweden, Denmark, Iceland, and Estonia from 9002 responders [median age 29 years (15-72); 58% females] from the Respiratory Health In Northern Europe, Spain and Australia (RHINESSA) study in 2013-16. Time at snus initiation was classified as never (reference), ≤15, or >15 years of age. Multilevel logistic regression models adjusted for age and smoking, and stratified by sex were used to analyze associations of time at snus initiation and 1) asthma-like symptoms (≥3 vs. <3), and 2) asthma medication use and/or asthma attacks in the last 12 months (yes vs. no). Results: Snus use was reported by 20.4% of the participants of whom 21.7% had started in puberty. Women using snus in puberty had a higher OR for asthma-like symptoms (OR 2.54; 95%CI 1.37-4.70) and for asthma medication/attacks (OR 1.70; 95%CI 0.87-3.31) compared to never users. No significant effect could be identified for early onset snus use in males (OR 1.15; 95%CI 0.74-1.79) or late initiation in either of the sexes. Conclu…