PDF: A consumption survey of

A consumption survey of snus users
in Sweden
C. Proctor, E. Massey, D. Sandi, H. Digard, C. Meredith, and R. Hartmann
British American Tobacco, Group Research & Development Centre, Regents Park Road,
Southampton, SO15 8TL, United Kingdom.
ABSTRACT
ATTRIBUTES OF THE STUDY POPULATION
To investigate snus consumption behaviour in Sweden, a
telephone survey of around 3000 snus users – 2555 males and
359 females – was conducted between March and April of
2007. The survey addressed various topics, from average
consumption per day and residence time in mouth to
dependence and use of snus as a cessation aid. The male
population was relatively evenly distributed between use of
loose snus (41.9%) and portion snus (54.0%), while the female
population predominantly used portion snus (92.7%). With
regard to portion snus consumption, on average male
consumption was 11.8 grams per day while the female group
consumed on average 8.5 grams per day. Male portion snus
users consumed on average 12 pouches a day while female
portion snus users consumed an average of 10 pouches.
Almost 70 % of the portion snus users answered they keep the
pouch in mouth for more than 35 min. Subsequently
reassessment of this question showed the median residence
time in the mouth is 60 min. Twenty two percent of male snus
users took their first snus within 5 minutes of waking, and 67 %
of males took their first snus within 30 minutes of waking. The
data was similar for females. The survey also found that
around 47 % of males and females had used snus as a way to
stop cigarette smoking.
The age distribution of the study population was similar to that
recorded in Swedish national statistics.
Percent
40
30
21.2
20
17.2
10
7.3
0
Up pe
co
r Se
nda
hool
ry sc
t y /C
ers i
U niv
gr
- De
e
olleg
ee
Co m
pu lso
ho
ry Sc
ol
U niv
ers it
y /C
e
olleg
- No
degr
ee
Education level
The majority were in full time employment and nearly 70% of the
population were earning between SEK 15,000 and 35,000 per
month before tax. Over half of the sample had been using snus
for over 15 years.
RESULTS
The sample population contained snus users that consumed
loose and portioned snus. The results we present here focus on
portion snus users. The study found a considerable variation in
daily consumption pattern across the population, but similar
distributions for males (mean 12 pouches per day) and females
(mean 10.4 pouches per day).
12
14
16
20
22
12
2
14
18
20
8
22
24
12
14
16
42
44
0.1
0.1
0.1
0.2
40
28
30
26
28
30
46
32
34
32
34
36
38
40
36
38
40
48
0.1
0.1
0.1
0.1
0.8
26
18
0.9
0.9
6.2
10
38
42
44
46
42
44
46
48
20
22
24
0.3
16.0
6.8
6
36
8.2
0.3
1.4
7.6
16
1.8
4
34
Female
12.5
9.5
0.3
0
32
0.6
10
30
0.6
8
28
0.9
6
3.3
10
0
10.8
13.6
1.7
4
20
26
13.1
2
19.0
0
7.6
10.7
12.5
0.4
0
24
Male
2.9
10
0.2
0.4
1.3
18
0.1
8.0
7.3
10
0.2
8
7.4
6
20
Percent
11.2
14.1
1.8
4
0.8
20.5
2
20.9
0
7.5
11.0
11.9
0
Percent
Male and Female
3.0
10
0.4
Percent
20
48
Female daily consumption in grams was found to be lower than
males, partially because of the use of smaller pouches.
14.1
17.2
M a le a n d F e m a le
7.7
9.2
11.1
0
5
10
15
20
25
35
40
45
50
55
60
0.1
0.1
0.1
0.2
0.1
0.1
0.1
0.7
30
0.2
0.1
0
0.1
0.2
2.2
1.5
5.8
7.2
7.5
8
2.7
Percent
11.9
16
65
70
17.6
0
5
10
15
20
25
35
0.1
0.1
0.1
0.3
0.1
0.1
0.1
0.8
30
0.2
0.1
0.1
2.7
1.7
0
0.1
6.1
7.4
8.4
10.3
10.6
11.5
10
5.1
Percent
15.1
M a le
20
1.3
40
45
50
55
60
65
70
40
45
50
55
60
65
70
F e m a le
13.0
9.8
0
5
10
15
20
25
30
0.3
4.7
0.30
4.5
0.6
0.3
4.5
6.5
0
0.3
10
15.1
17.5
20
13.9
METHOD
The research method was a randomised telephone interview,
undertaken by the research agency GFK, weighted across
Sweden to be nationally representative. The pre-selection
criteria for the interview was current snus users of ages 18 to
72.
The questionnaire contained 54 questions with an
interview time of typically around 10 minutes and no incentive
was offered. Standard call-back procedures were used to
verify a sample of interviews. Around 3000 snus users – 2555
males and 359 females – were interviewed between March and
April of 2007. The survey addressed various topics, from
average consumption per day and residence time in mouth to
dependence and use of snus as a cessation aid. Resurvey on
one question - exposure time with portion snus users (1019
people) – was undertaken in August 2007, because the range
of options given in the first interview was found to be too small.
54.3
50
8.6
While prevalence data on snus use in Sweden is well
documented (currently 22% in males and 4% in females (2)),
there is less information on consumption patterns within snus
users. The purpose of this study was to collect a wide range of
consumption data on a nationally representative group of
Swedish snus users.
60
Percent
INTRODUCTION
Several public health reports, including reviews by the
International Agency for Research into Cancer (1) and the UK
Royal College of Physicians (2), have recently considered the
health risks associated with the use of various smokeless
tobacco products, including snus. The RCP and others have
also be considering whether making snus available, under a
regulatory regime, in countries where it is currently prohibited
might be a viable harm reduction strategy.
Questions on the highest level of education attained found over
20% of the population to have been educated at University and
with a degree qualification.
35
The survey found that the majority of those interviewed only used snus,
though around 10% of both males and females used snus and
cigarettes.
We also asked interviewees to estimate typically how soon after
waking did they take their first snus, with around 20% of both
males and females reporting first usage within 5 minutes of waking.
Male and Female
87.2
Percent
100
50
S nu
s
Only
1.0
0.6
0.5
0.2
0.1
0.1
0.1
0.1
0.1
0,1
20
0,1
Percent
9.8
0
s
s
s
s
s
s
s
s
s
s
s
s
Sn u O S nu s Ch ew e S nu rs Snu e Sn u rs S nu O Snu s C hew rs S nu e Sn u e Snu
Snu
S nu
C ig Cigars C ig ars
P ip
RY
Sn u C ig Pip e Ciga
C iga Cig RY ig Sn u O Ciga RYO Pip RYO Pip
C
C ig
P ip
RYO
RY
C ig
Cig
Cig
Percent
1.1
0.6
0.5
0.2
0.2
0.1
0.1
0.1
0.1
s
s
s
s
s
s
s
s
s
s
s
s
Sn u O S nu s Ch ew e S nu rs Snu e Sn u rs S nu O Snu s C hew rs S nu e Sn u e S nu
Sn u
S nu
C ig Cigars C ig ars
P ip
RY
Sn u C ig Pip e Ciga
Ciga Cig RY ig Sn u O Ciga RYO Pip RYO Pip
C
C ig
RYO
RY
P ip
C ig
Cig
Cig
sO
Snu
nly
100
88.9
6 - 15 min
0.6
0.6
20
0.3
Percent
9.7
21.6
31 - 45 min
46 - 60 min
11.7
12.0
31 - 45 min
46 - 60 min
s
s
s
s
s
s
s
s
s
s
s
s
S nu
Snu
Sn u O S nu s Ch ew e S nu rs Snu e Sn u rs S nu O Snu s C hew rs S nu e Sn u e Snu
a
C ig Cigars C ig ars
P ip
RY
RY
Sn u O Ciga YO Pip YO Pip
Sn u C ig Pip e Ciga
C ig
Cig
R
R
Cig
C ig
P ip
RYO
RY
C ig
Cig
Cig
>60 min
Male
19.6
10
50
ly
s On
16 - 30 min
13.4
0
Female
0
11.9
20
0,1
Percent
9.9
0
S nu
0 - 5 min
21.6
50
19.4
11.9
10
0
Male
Percent
13.7
87.0
100
Male and Female
21.7
21.5
0 - 5 min
6 - 15 min
16 - 30 min
21.7
20.6
>60 min
Female
17.8
15.6
13.1
10
11.1
0
0 - 5 min
The study also found a range of reported times that the consumer kept
the snus pouch in the mouth. The median time was around 60 minutes.
Male and Female
6 - 15 min
16 - 30 min
31 - 45 min
46 - 60 min
>60 min
The survey also found that around 47 % of males and females had
used snus as a way to stop cigarette smoking. 35% of those using
snus to quit smoking also had tried NRT products.
.
30.1
30
21.7
14.0
15
m
<5
in
5t
o1
in
0m
11
to
m
15
10.7
6.1
3.9
2.6
0.2
0
in
16
to
20
min
21
to
25
4.4
2.6
1.9
min
to
26
30
min
31
to
35
min
36
to
40
1.7
min
41
to
45
min
46
to
50
0.2
min
51
to
min
55
to
56
60
min
(1
ho
ur)
>
60
min
(1
Male
ho
ur)
33.6
30
22.1
12.7
15
<
in
5m
5
10
to
4.8
3.1
1.5
0.1
0
min
11
t
5
o1
min
16
20
to
21
t
5
o2
10.8
4.9
2.7
1.7
min
n
mi
26
t
0
o3
min
31
35
to
min
36
t
0
o4
1.8
n
mi
41
t
5
o4
min
46
to
50
0.2
min
51
to
55
n
mi
56
m
60
to
in
(1
ho
>6
Female
in
0m
(1
ho
ur)
19.9
19.4
20
ur)
15.9
11.4
10
0
10.4
7.5
7.0
2.5
0.5
m
<5
in
5t
o1
in
0m
11
to
m
15
in
16
to
20
min
21
to
25
2.5
2.0
min
to
26
30
n
mi
31
to
35
min
36
to
40
1.0
min
41
to
45
min
46
to
50
0
min
51
to
55
n
mi
to
56
60
min
(1
ho
ur)
>
60
(1
min
ho
ur)
CONCLUSIONS
In response to a question about whether consumers moved the products
around in the mouth during use, the majority responded that they kept
the snus in the same position throughout use.
Male and Female
This survey provides some interesting insights into consumption
patterns in Swedish snus users, including some unexpected
findings such as the length of time that snus users typically keep
pouches in the mouth.
Percent
100
50
0
Never
Occasionally
Always
Male
Percent
100
(1)IARC Monographs on the Evaluation of Carcinogenic risks to
humans, Volume 89, Smokeless tobacco and some tobacco specific
nitrosamines, Lyon, France, 2007
50
0
Never
Occasionally
Always
Female
100
Percent
REFERENCES
50
0
Never
Occasionally
Always
(2)Harm reduction in nicotine addiction. Helping people who can’t quit,
A report by the Tobacco Advisory Group of the Royal College of
Physicians, October 2007