Abstract
BackgroundSimilar to the debate around e-cigarettes, an increase in snus use among Norwegian adolescents has prompted debate on whether flavour options in snus should be limited. To this end, we compared use of flavoured snus among snus users with different smoking status.MethodsQuestions about flavoured snus use were included in an online omnibus study conducted from 2015 to 2019 (N = 65,445) that included 16,295 ever snus users (aged 15+). Current snus users (N = 9783) were asked “Do you usually use snus that has a flavouring (liquorice, mint, wintergreen, etc.)? Adjusted predicted probabilities and 95% confidence intervals (CI) were calculated from a logistic regression model.ResultsLess than 25% of the snus users reported never having smoked. The overall probability of using flavoured snus was .45 (95% CI .44–.46), highest among daily (.51, 95% CI .47–.54) and former daily smokers (.50, 95% CI .48–.52), and lowest among never (.41, 95% CI .39–.43) and occasional smokers without any prior history of daily smoking (.41, 95% CI .38–.44). Use of flavoured products was higher among female snus users (p = .67, 95% CI .65–.69) compared to males (p = .35, 95% CI .34–.36), highest among the youngest age group, 15–24 years (p = .58, 95% CI .56–.60) and decreased with increasing age.ConclusionRegulation that would ban or limit flavoured snus use may affect smokers—an at risk population—more than never smokers. The health authorities should be mindful of the real-world complexity governing potential harms and benefits of flavour restrictions on snus. A further assessment of flavour limitations should acknowledge that flavoured snus products also function as alternatives to cigarettes.
Highlights
Cigarette smoking is a leading cause of mortality and causes an estimated 6.3 million deaths globally each year [1]
California, Massachusetts, New Jersey, New York and Rhode Island, and dozens of United States (US) cities, have enacted policies ending the sale of flavoured e-cigarettes, and in Europe, the Dutch Government has recently proposed banning all non-tobacco flavours in e-cigarettes from 2021 [5, 6]
Results for the three categories of current snus users (1–3) that answered the question about flavoured snus are marked in grey
Summary
Cigarette smoking is a leading cause of mortality and causes an estimated 6.3 million deaths globally each year [1]. In Sweden (exempted from the ban), Norway (not an EU member) and the USA, multiple flavours of snus, including mint, whiskey, bergamot, liquorice and nuts, have been on the market for a long time [7]. While the proportion of snus users that consume flavoured products is currently unknown in Norway and Sweden, the majority of snus users in the USA consume mentholated products [8]. Similar to the debate around e-cigarettes, an increase in snus use among Norwegian adolescents has prompted debate on whether flavour options in snus should be limited. To this end, we compared use of flavoured snus among snus users with different smoking status
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