Karl Erik Lund

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.

To what extent do parents strive to protect their children from environmental tobacco smoke in the Nordic countries? A population-based study

OBJECTIVE To assess to what extent Nordic parents strive to protect their children from environmental tobacco smoke (ETS) at home. DESIGN A cross-sectional study using an anonymous questionnaire. SUBJECTS AND SETTING A stratified, random sample of 5500 households containing a child born during 1992, including 1500 households in Denmark and 1000 households in each of the countries of Finland, Iceland, Norway, and Sweden. MAIN OUTCOME MEASURES Smoking status of parents, prevalence and magnitude of weekly ETS exposure, rules regarding smoking in the home. RESULTS 82% of current smokers reported having tried to change their smoking behaviour for the sake of their children. Of all parents who answered the questionnaire, 75% reported having introduced some rules to limit ETS in their home. In households where at least one parent smoked, 57% reported that children were exposed to ETS at home. Child exposure to ETS was most prevalent in single-parent households and in households in which parents had lower levels of education. However, these parents were not less likely than other smoking parents to report having tried to change their smoking behaviour for the sake of their children. CONCLUSION Environmental tobacco smoke at home is still a problem for many children in the Nordic countries. However, most smoking parents reported having made efforts to change their smoking behaviour for the sake of their children; and in approximately half of all households containing at least one daily smoker, parents reported protecting their children from ETS exposure in the home. Although actual exposure may be higher owing to possible under-reporting of ETS, our results indicate a general awareness in the Nordic countries of the potential negative effects of ETS on children.

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.

Environmental tobacco smoke exposure of young children — attitudes and health-risk awareness in the Nordic countries

AIMS To assess attitudes towards environmental tobacco smoke (ETS) and health-risk awareness regarding the potential hazards of ETS for children among parents of young children in the Nordic countries. Also to investigate to what extent these factors are related to ETS exposure of the children. DESIGN A cross-sectional community-based survey using an anonymous mailed questionnaire. PARTICIPANTS Parents of children aged 3 years at the time of selection from a random sample of 5500 households in the Nordic countries (Sweden, Norway, Denmark, Iceland and Finland). MAIN OUTCOME MEASURES Smoking status of parents, weekly ETS exposure of children within and outside the home, health-risk awareness and attitudes regarding the potential hazards of passive smoking. FINDINGS Two in three parents who smoked did not recognize the increased risk for an inner ear infection and approximately 50% were not aware of the role of parental smoking in recruiting smokers. One in two smokers tended to agree or agreed that an act should be passed which forbids all indoor smoking in the vicinity of children. After adjustment for covariates, the level of health-risk awareness about ETS was significantly related to no ETS exposure within and outside the home. CONCLUSION The main findings indicate that educating parents about the established health risks of ETS for their children may significantly reduce childrens exposure to ETS. An increased effort is needed to educate parents who smoke on the potential health risks of ETS for their children.

Hardcore Smokers in Norway 1996-2009

Introduction: The aim of this study was to investigate changes in the relative proportion of hardcore smokers (HCS) in Norway for the years 1996–2009. Methods: Data were derived from Statistics Norway’s annually cross-sectional representative samples of the adult population. The total sample size of smokers each year was between 250 and 500. The outcome measure was HCS, defined by their intention not to quit smoking and absence of attempts to quit during the last 12 months. Logistic regression analysis was conducted to estimate the association between time (survey year) and the number of HCS. Results: We identified three groups of smokers: occasional smokers, daily non-HCS, and HCS. The relative proportion of HCS declined in the period 1996–2009, from 30% to 23%. A model adjusted for gender, age, educational level, and the use of snus (smokeless tobacco) showed the same downward trend. Conclusions: Within this sample of Norwegian smokers, the relative share of HCS is not increasing. This knowledge is important for tobacco prevention policy. The result does not support a hardening hypothesis regarding changes in the size of the group of HCS. Further analysis is needed to investigate individual resistance to smoking cessation.

Children's residential exposure to environmental tobacco smoke varies greatly between the Nordic countries.

Objective: To assess similarities and differences in the Nordic countries regarding ETS (environmental tobacco smoke) exposure in young children. Design: A population-based cross-sectional study comprising a randomly selected sample of 5,500 households which included a child born in 1992. Data were collected using a mailed anonymous questionnaire. Results: While the prevalence of household smoking was similar in all countries, there was a great difference between the countries with regard to child ETS exposure. Finnish parents were more likely than all other Nordic parents to protect their children from ETS and the situation was worst in Denmark and Iceland, where almost half of all households, and nine out of ten households containing daily smokers, exposed their children. Approximately eight out of ten current and former smokers in all countries stated that they had made efforts to change their smoking habits because of their children.

Patterns of Dual Use of Snus and Cigarettes in a Mature Snus Market

Introduction: We examine the prevalence of dual use of snus and cigarettes among Norwegian men by categorizing dual use into four categories according to the frequency of use of each product, considering the order of uptake of both products, and examining reasons for additional snus use. We compare dual users and exclusive cigarette smokers with respect to their smoking intensity, plans for quitting smoking, and future smoking identity. Methods: We used a data pool of six cross-sectional, national representative surveys conducted annually in the period 2005–2010 containing a total of 3,524 males aged 16–74. Results: 6.8% of men had some kind of current concomitant use of snus and cigarettes—but only 1% reported a daily consumption of both products. The most typical pattern of dual use was a combination where daily use of one product was paired with occasional use of the other. Dual users consumed significantly fewer cigarettes per week (56.6; n = 226; SD, 53.82) than smokers who had either quit snus (79.6; n = 108; SD, 61.47) or single smokers with no history of snus use (80.2; n = 621; SD, 55.86). Only 24% with a history of dual use reported snus to be their first tobacco product, but the proportion who had initiated tobacco use with snus increased significantly with younger age. Among dual users with daily intake of snus, a majority of 53.6% reported that the purpose of their snus use was to quit smoking. A higher proportion of dual users (74.4%; 95% CI, 68.8–80.0; n = 235) than exclusive smokers (61.3%; 95% CI, 57.6–65.0; n = 658) reported that they most definitely or probably would be totally smoke-free 5 years into the future. Conclusions: In the mature snus market of Norway, the magnitude of dual use of cigarettes and snus is relatively small. Dual users consume fewer cigarettes, and a higher proportion portray themselves as smoke-free in the future than do exclusive cigarette smokers.

Association Between Willingness to Use Snus to Quit Smoking and Perception of Relative Risk Between Snus and Cigarettes

Introduction: Smokers are often incorrect in their assessment of the relative risk of snus and cigarettes. We have studied how perception of risks of snus compared with cigarettes was associated with the willingness of trying snus as a quit-smoking method. Methods: Fourteen thousand seven hundred and forty-four Norwegian men aged 20–50 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 1,155 former daily smokers who reported method for quitting smoking and 1,213 current daily smokers who stated their willingness to try different methods for quitting smoking. They were also asked to assess the relative risk between daily use of snus and cigarettes. Results: Adjusted odds ratio (AOR) for reporting willingness to try snus in future quit attempts was significantly higher (AOR = 4.82, p < .001) for the 22.9% of the current smokers who, consistent with scientific evidence, believed that the health risks were “far lower” for snus than for cigarettes compared with the 39.8% who incorrectly perceived the health risks to be “equal or higher” for snus (reference AOR = 1). About 37.2% of the daily smokers believed that the risk was “somewhat lower” for snus than for cigarettes and had a significantly higher AOR of reporting willingness to try snus (AOR = 2.31, p < .001) compared with the reference group. Conclusion: Devising a way to inform smokers about the risk continuum of tobacco products could be an important research priority in countries where snus is allowed to compete with cigarettes for market share.

[Tobacco consumption among men and women 1927-2007].

BACKGROUND After 100 years of mass consumption of cigarettes, the smoking epidemic is on the verge of a historic decline in Norway. The article shows the number of smokers and tobacco consumption among men and women from 1927 to 2007. MATERIAL AND METHODS The total consumption of tobacco was estimated by adding up registered and unregistered sales. Data were collected from the Directorate of Customs and Excise and the tobacco industry. Sex-specific consumption was calculated from information on proportion of smokers and daily consumption (self-reported), excerpted from time series of representative cross-sectional surveys. RESULTS About 800,000 men - more men than women - smoked in the early 1960s, but the annual consumption of cigarettes per adult male reached its peak (2.8 kg) in the mid-1970s. The number of smokers among men has been halved since then and consumption reduced to 1.5 kg per adult male in 2007. Consumption peaked among women in about 1990, but stopped at 1.8 kg. The number of female smokers has only been reduced by about 150 000 individuals since it culminated at around 600,000 in the early 1970s. Men smoked more than 70 % of the cigarettes consumed from 1927 to 2007. INTERPRETATION The tobacco epidemic has affected men more than women. After 1995 a sex convergence has been observed.

Do smoke-free laws affect revenues in pubs and restaurants?

In the debate about laws regulating smoking in restaurants and pubs, there has been some controversy as to whether smoke-free laws would reduce revenues in the hospitality industry. Norway presents an interesting case for three reasons. First, it was among the first countries to implement smoke-free laws, so it is possible to assess the long-term effects. Second, it has a cold climate so if there is a negative effect on revenue one would expect to find it in Norway. Third, the data from Norway are detailed enough to distinguish between revenue from pubs and restaurants. Autoregressive integrated moving average (ARIMA) intervention analysis of bi-monthly observations of revenues in restaurants and pubs show that the law did not have a statistically significant long-term effect on revenue in restaurants or on restaurant revenue as a share of personal consumption. Similar analysis for pubs shows that there was no significant long-run effect on pub revenue.