Janne Scheffels

The use of snus for quitting smoking compared with medicinal products

Introduction: Given there are few experimental studies comparing the effects of snus and medicinal products for quitting smoking, self-reports from smokers who have used different methods for quitting smoking can be informative. Methods: Fourteen thousand seven hundred and forty-four Norwegian men aged between 20 and 50 years were selected at random from a national representative web panel and sent a questionnaire by E-mail. Of the 7,170 (48.6%) who responded, there were 1,775 former and 1,808 current smokers. They were asked about the method they used and the outcome of their last attempt to quit smoking. Results: In a regression model in which education, number of previous attempts to quit smoking, perception of risk, and age were controlled for, the odds ratio (OR) for reporting total abstinence at the time of the survey was significantly higher for those who had used varenicline (OR = 4.95, p < .006) and snus (OR = 2.68, p < .001) compared with those who had used nicotine chewing gum (reference OR = 1). For smokers who reported that they had tried to quit with the help of snus, 62.4% reported that they still used snus at the time of the survey either daily (43.8%) or occasionally (18.6%). The proportion who still used medicinal nicotine products at the time of the survey was 9.5%. Discussion: Compared with medicinal nicotine products, snus and varenicline increased the probability of quitting smoking completely, but snus seemed to maintain nicotine dependence.

The association between use of snus and quit rates for smoking: results from seven Norwegian cross-sectional studies

Aim Swedish studies have shown that experience of using snus is associated with an increased probability of being a former smoker. We examined whether this result is also found in Norway. Design Seven cross-sectional data sets collected during the period 2003–08. Setting Norway. Participants A total of 10 441 ever (current or former) smokers Measurements Quit ratios for smoking were compared for people with different histories of snus use. Motive for snus use was examined among combination users (snus and cigarettes). Smoking status was examined among snus users. Findings Compared to smokers with no experience of using snus, the quit ratio for smoking was significantly higher for daily snus users in six of seven data sets, significantly higher for former snus users in two of five data sets and significantly lower for occasional snus users in six of seven data sets. Of combination users who used snus daily, 55.3% [confidence interval (CI) 44.7–65.9] reported that their motive for using snus was to quit smoking totally. This motive was reported significantly less often by combination users who used snus occasionally (35.7%, CI 27.3–44.2). Former smokers made up the largest proportion of daily snus users in six of seven data sets. In the remaining data set, that included only the age group 16–20 years, people who had never smoked made up the largest segment of snus users. Conclusions Consistent with Swedish studies, Norwegian data shows that experience of using snus is associated with an increased probability of being a former smoker. In Scandinavia, snus may play a role in quitting smoking but other explanations, such as greater motivation to stop in snus users, cannot be ruled out.

Out of sight, out of mind? Removal of point-of-sale tobacco displays in Norway

Aim To evaluate retailers compliance and consumers perceptions of and experiences with the point-of-sale (POS) tobacco display ban in Norway, implemented 1 January 2010. Methods Retailer compliance was measured using audit surveys. Consumers perceptions of the ban were assessed in three web surveys: one conducted before and two after implementation of the ban. The sample for each of these consisted of about 900 people aged 15–54 years and an extra sample of smokers and snus users. 10 focus group interviews with male and female daily, occasional and former smokers aged 16–50 years (N=62) were also conducted, before and after implementation of the ban. Results Immediately following implementation of the POS display ban, compliance was 97% for cigarettes and rolling tobacco and 98% for snus. Preimplementation, young people were tempted by tobacco products when seeing them in the shop more often than older people. Postimplementation, young people also more often found it difficult to choose brand. The POS tobacco display ban was supported by a majority of the population, and by one out of three daily smokers. The removal of POS tobacco displays was perceived as a barrier for young peoples access to tobacco products, as affecting attachment to cigarette brands and as contributing to tobacco denormalisation. Conclusions Retailers compliance with the POS display ban in Norway was high, and the ban was well supported in the population. Consumers believed that the ban could contribute to preventing smoking initiation among young people and to some extent also support cessation efforts.

A difference that makes a difference : young adult smokers' accounts of cigarette brands and package design

Objective: To explore young adult smokers’ construction of meaning and identity in accounts of cigarette brands and cigarette package design, and the processes by which positive associations with a brand may be reinforced and sustained. Methods: Qualitative in-depth interviews with 21 smokers aged 18–23 in Norway, where advertising for tobacco has been banned since 1975. Results: Cigarette brand and cigarette package design appear as an integrated part of young smokers’ constructions of smoker identities, enabling the communication of personal characteristics, social identity and positions in hierarchies of status. Conclusion: Through branding and package design tobacco companies appear to be able to promote their products in a country where advertising is banned, by means of similar principles that make advertising effective: by creating preferences, differentiation and identification.

To be one who continues to smoke: Construction of legitimacy and meaning in young adults’ accounts of smoking

This study analyses young smokers’ accounts of continuing to smoke in a context of increasing structural and symbolic pressure to quit. It explores the accounts in relation to issues of legitimacy, meaning and identity. A qualitative study was conducted with interviews with 21 male and female smokers aged 18–23 years. The interviewees described themselves in various ways as ‘in control’ of their smoking, discursively rejecting addiction. They also spoke about control in accounts of calculation of risk of ill health, and of compensating for smoking by other health promoting lifestyles. At the same time the interviewees talked about smoking in a way that opposed this rational discourse, highlighting pleasure and an emotional and metaphysical side of smoking. The material was interpreted using a discourse analytic framework, inspired by a Foucauldian understanding of discourse as impacting on the construction of subjectivity, selfhood and identity.

The impact of cigarette branding and plain packaging on perceptions of product appeal and risk among young adults in Norway: A between-subjects experimental survey

Objectives This study examined the perceptions of cigarette packaging and the potential impact of plain packaging regulations. The hypothesis was that the branded cigarette packages would be rated more positively than the corresponding plain packs with and without descriptors. Design Between-subjects experimental online survey. Male and female participants were separately randomised to one of the three experimental conditions: fully branded cigarette packs, plain packs with descriptors and plain packs without descriptors; participants were asked to evaluate 12 individual cigarette packages. The participants were also asked to compare five pairs of packs from the same brand family. Setting Norway. Participants 1010 youths and adults aged 15–22. Primary outcome measures Ratings of appeal, taste and harmfulness for individual packages. Ratings of taste, harm, quality, ‘would rather try’ and ‘easier to quit’ for pairs of packages. Results Plain with and without descriptors packs were rated less positively than the branded packs on appeal (index score 1.63/1.61 vs 2.42, p<0.001), taste (index score 1.21/1.12 vs 1.70, p<0.001) and as less harmful (index score 1.0.34/0.36 vs 0.82, p<0.001) among females. Among males, the difference between the plain with and without descriptors versus branded condition was significant for appeal (index score 2.08/1.92 vs 2.58, p<0.005) and between the plain without descriptors versus branded condition for taste (index score 1.18 vs 1.70, p<0.00). The pack comparison task showed that the packs with descriptors suggesting a lower content of harmful substances, together with lighter colours, were more positively rated in the branded compared with the plain condition on dimensions less harmful (β −0.77, 95% CI −0.97 to −0.56), would rather try (β −0.32, 95% CI −0.50 to −0.14) and easier to quit (β −0.58, 95% CI −0.76 to −0.39). Conclusions The results indicate that a shift from branded to plain cigarette packaging could lead to a reduction in positive perceptions of cigarettes among young people.

Perceptions of Plain and Branded Cigarette Packaging Among Norwegian Youth and Adults: A Focus Group Study

INTRODUCTION In Norway, packaging is one of the few remaining ways for tobacco companies to promote their products. Plain packaging of tobacco products could be a means to limit this promotion. METHODS Eleven focus group interviews with daily, occasional, and former smokers and nonsmokers (N = 69) aged 16-50 were undertaken to explore perceptions of different cigarette brands, the role of package design in communicating brand images, and how participants perceived cigarette packages when important design elements such as colors, symbols, logos, and branded fonts were removed. RESULTS Distinct images of brands and user identities associated with these were narrated. Elements of the package design such as colors, images, and fonts were described as configuring brand images. Compared with current, completely branded cigarette packages, packages that displayed progressively fewer branding design elements were perceived increasingly unfavorably and as detracting from the images that packages otherwise communicate. CONCLUSIONS The findings indicate that packaging is vital to consumer identification with and differentiation between cigarette brands and that a policy of plain packaging could be useful in reducing the impact of packaging in promotion of tobacco products.

Occasional Smoking in Adolescence: Constructing an Identity of Control

This study discusses whether adolescent occasional smokers form a distinct subgroup in comparison with daily smokers, in terms of smoking motivation, confidence in ability to quit and social and cultural characteristics. In a sample of 2484 adolescents aged 16–19, 22 per cent (n=552) were daily smokers and 20 per cent (n=495) were occasional smokers. Findings show that occasional smokers differ from daily smokers in educational choices, subgroup identification and cultural preferences. In each area, daily smokers tend to make choices that correlate with lower cultural capital levels. Occasional smokers also show greater confidence in ability to quit smoking, and in the belief that they will not be smokers by age 25. Occasional smoking is interpreted as a means to construct an identity of control and of difference from daily smoking. Finally, we discuss where occasional smoking among youth is likely to head in the foreseeable future, using diffusion theory as the frame of analysis.

Contrasting snus and NRT as methods to quit smoking. an observational study

BackgroundSnus is considerably less hazardous to health than cigarettes. Recent data from Scandinavia have indicated that many smokers use snus as a method for quitting smoking.MethodsData from five repeated cross-sectional surveys of Norwegian men and women aged 16-74 were pooled (N = 6 262). Respondents were asked about current and former smoking and snus use. Former daily smokers (N = 1219) and current daily smokers who had tried to quit at least once (N = 1118) were asked about the method they had used at their latest quit attempt and how many quit attempts they had made. Former smokers were also requested to report what year they had made their final quit attempt.ResultsSnus was the most common method used for quitting smoking among men, while NRT was most often used among women. Stratifying the data according to year of quitting smoking (1945-2007) indicated a significant increase in use of the methods for quitting asked about over time. Among men, this was largely due to an increase in the use of snus. Among male quitters under the age of 45 years, 45.8% of those who had used snus on their last attempt to quit were current non-smokers (OR = 1.61, CI 1.04-2.29), while 26,3% of those who had used NRT were current non-smokers. 59.6% of successful quitters and 19.5% of unsuccessful quitters who had used snus as a method for quitting smoking had continued to use snus on a daily basis after quitting.ConclusionNorwegian men frequently use snus as a method for quitting smoking whereas women are more likely to use NRT. The findings indicate that switching to snus can be an effective method for quitting smoking.

Smoking and Snus Use Onset: Exploring the Influence of Snus Debut Age on the Risk for Smoking Uptake With Cross-Sectional Survey Data

INTRODUCTION Snus use has become increasingly prevalent among young people in Norway, while smoking has declined. Little is known about the transitions between snus and other tobacco products, particularly among younger users. A major concern involves the association between snus initiation and future smoking uptake. METHODS A total of 409 lifetime snus users who had started with snus before cigarettes or were never-smokers were selected from a national sample of participants in annually repeated cross-sectional surveys (2005-2011) of Norwegian men and women aged 15-74 years. About 30% of them were lifetime smokers, 84% were men, and the mean age was 29.4 years. Logistic regression was applied to investigate the association between age of snus uptake and the risk for becoming a smoker later on. RESULTS Respondents who started using snus before the age of 16 years had an odds ratio of 3.1 (confidence interval = 1.98-4.76) of being lifetime smokers compared with those who initiated snus later. The prevalence of current smoking among early snus initiators (22.9%) was comparable to that found among never-snus-users (29.6%). Among late snus initiators, current smoking prevalence was 5.9%. CONCLUSION In this study, snus debut age was an important factor for the association between snus use and smoking.