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Scand J Public Health. 2009 Mar;37(2):161-7. doi: 10.1177/1403494808096169. Epub 2008 Nov 27.

Patterns of tobacco use: a 10-year follow-up study of smoking and snus habits in a middle-aged Swedish population.

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Epidemiology and Public Health Sciences, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.



To study longitudinal patterns of tobacco use over a 10-year period among middle-aged men and women in Vaösterbotten County, Northern Sweden.


The study is based on data from the 16,486 (8800 women and 7686 men) in the Vaösterbotten Intervention Programme (VIP) where people were invited to a health screening and counselling programme at 30, 40, 50 and 60 years of age.


Smoking decreased from 22.3% to 15.6% among women and from 18.5% to 12.7% among men. Use of snus (Swedish moist snuff) increased from 3.1% to 6.0% among women and from 24.6% to 26.3% among men. The number of people who used both snus and cigarettes was stable: 0.5% to 0.8% from baseline to follow-up for women, and 4.1% to 3.3% for men. The number of tobacco-free adults increased from 75.2% to 79.2% for women and from 61.1% to 64.3% for men. Of those who became smoke-free during the 10-year follow-up period, 80% of the women and 66% of the men quit smoking without transitioning to snus use.


The majority of middle-aged Swedish men and women in this cohort that quit smoking did so without becoming snus dependent. In spite of an increasing use of snus, overall there was a decline in the number of people using tobacco products.

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