Few differences in tobacco product use behaviors were observed across genders or snus type, although no female respondents reported concurrent use of snus with cigars, pipe, or chewing tobacco. Several styles of pouch are available on the Swedish market.
Mini pouches tend to contain tobacco with lower moisture content than the larger pouches. The survey respondents had a general preference for the Large Normal pouches; this preference was different for female respondents, who showed greater use of Mini pouches There are also different pouch color types, the main styles being brown and white, which can result from different processing practices during the manufacture of the products.
The brown pouch products tend to have higher moisture content than the white ones due to the spraying of water during pouching. This extra process step for brown pouch products turns the pouch material from the standard white color to a brown color, which is due to staining from the tobacco.
Pouch products with different pouch material colors—for example, black—are also available. Supplementary Table 3 shows that The majority of pouched snus users in the survey However, the remainder The percentage of males and females using one to four portions concurrently is reported in Supplementary Table 4.
There was no observed trend between the pouch size and the number of pouches used concurrently, when taking into account the variation in the survey population numbers across the different pouch sizes data not shown. The calculation for quantity of snus used per day described in the Methods section relied upon the frequent use by respondents of their main brand.
In support of this, the majority The consumption results from the calculations are summarized in Table 2. Full statistical analyses are provided in Supplementary Tables 5 — Supplementary Data. The consumption data were not normally distributed but appeared to be composed of a complex series of different distributions.
Nevertheless, the consumption estimates obtained by the two different calculations were in very good agreement. By comparison, significantly higher levels of loose snus consumption were observed because the portion weights were in the order of three times greater than for pouched snus; the mean consumption of loose snus was This difference was primarily due to the larger portion size of loose snus, as the numbers of packages or portions per day were very similar for loose and pouched snus.
The data for male and female loose snus users were very similar, albeit with a very small number of female respondents in this group Table 2. Exposure time may be an important parameter influencing intake of constituents from snus. In the first stage of the survey, the respondents were asked how long, on average, they kept their portion in their mouth.
Responses were limited to seven time categories ranging from less than 5 min to more than 35 min. However, it was found that the majority of respondents used the products for more than 35 min and, due to the limited scope of this question, the actual usage times of over 35 min were not specified. Therefore, the survey was repeated with subsets of the original pouched and loose snus user survey population second and third stages of the survey, respectively, Supplementary Table 1. These later stages examined usage time by querying the shortest, average, and longest times that portions and pouches were normally kept in the mouth during use.
In each case, the respondents were asked to state the exact time in minutes. There were insufficient completed questionnaires from female loose snus users in the third stage of the survey to provide robust data for this group. Values reported by the survey respondents were found to be nonuniformly distributed, clustering around certain time intervals—for example, 30, 45, 60, 90 min.
Table 3 shows that, on average, the normal time that respondents kept either a loose portion or a pouch in their mouths was slightly in excess of 1 hr. Full statistical analyses are provided in Supplementary Table 8. The shortest normal time of use was just over 20 min for female respondents and just over 30 min for male respondents. Examination of the data for the longest time normally kept in mouth shows some extreme values, with male pouched snus users reporting times in mouth of up to 15 hr, and 7 hr for female pouched snus users.
All respondents, third stage of the survey recontacted users of loose snus. The third-stage, loose snus survey investigated the total fraction of the day during which the product is used Table 4. These data are open to some degree of interpretation as to whether the respondents provided an answer which was a percentage of the day that they were awake or the total 24 hr day. To examine this more closely, the total length of daily use time was estimated from the average normal use time per portion and the reported number of portions per day.
These estimates also indicated that snus use occurs for a significant proportion of the day, with a mean value of 12— These estimates were consistent with the survey respondents reporting their total usage time as a percentage of the time they are awake; for a to hr time period, this would represent a period of 10— Due to the lack of precision in the survey question and the difficulty in obtaining realistic estimates for some survey respondents, the values for total usage time reported from this survey should be regarded as indicative estimates only.
Although most snus users maintained the portion at the site of application, a significant number, Very similar patterns of behavior were observed for both male and female users. The greater frequency of portion movement during use with pouched users may be a consequence of the integrity or shape of the pouch facilitating movement or of the relatively smaller size of pouched snus portions.
Full data on patterns of behavior for location of the portion in the mouth and incidence of portion movement during use are given in Supplementary Table Respondents who did not use snus at least daily were not included in the survey; consequently, the results may have underestimated multiple tobacco use among snus users in Sweden because, for example, smokers who occasionally used snus were not included in the dataset.
In support of this, the incidence of dual use is consistent with previous reports of low levels of regular contemporaneous snus and cigarette use in Sweden. Taken together, the combined evidence appears to point toward minor levels of dual use of snus and cigarettes in the Swedish population of snus users.
According to the data collected in this study, there were differences in usage patterns between pouched and loose snus users. The figures for pouched snus were consistent whether they were taken from self-reported daily usage of individual pouches or calculated from tins per day.
The difference in total daily consumption between pouched and loose snus was due to the bigger portion sizes of loose compared with pouched snus; frequency of use was similar for both types of product.
The differences in total daily consumption between pouched and loose snus users observed in this study do not necessarily translate into substantially higher intake of nicotine and other snus constituents for loose snus users.
Andersson et al. In contrast, in the same study, Andersson et al. Clearly, further work is required to understand the extractability and bioavailability of nicotine from different snus styles. The majority of respondents who said they used pouched snus The remainder regularly used two or more pouches simultaneously. The mean duration of use was Therefore, the duration of use was similar for the two types of product.
The average duration of use per day was approximately 12—13 hr for loose and pouched snus. This figure is consistent with the Swedish report that states that daily usage for the average snuff dipper is 11—14 hr ENSP, and with previously reported daily usage of The number of females in this study was low, but in line with the relative frequency of snus use in the Swedish population Statistics Sweden [English] Living Conditions, Nevertheless, there appeared to be gender differences in snus use.
People use smokeless tobacco for a variety of reasons, but one of the main reasons people use smokeless tobacco is because they are addicted to nicotine. Do you think you are addicted to the nicotine in smokeless tobacco? Find out by answering the six questions on the Smokeless Tobacco Self-Assessment [pdf]. Make sure you inform your family and friends of your promise to quit using smokeless tobacco.
If you have family or friends who dip or chew, ask them not to use when you are around. Try to find a friend who can quit with you so you can motivate each other to stay true to your promise to quit. You have been using smokeless tobacco for years. It is not going to be easy to quit. You will have thoughts about using smokeless tobacco but you can overcome them.
Many of the tips used for quitting smoking also apply to quitting smokeless tobacco. However, there are certain things that are specific to quitting snuff and chew that you may want to consider.
If you have tried quitting before, go over what went wrong. Did you get rid of all your smokeless tobacco products? Maybe you tried to quit on your own without telling anyone? Was there a particular situation that prompted you to start chewing again?
If so, what happened and how can you prevent it from happening again? While you are quitting, you may get cravings for smokeless tobacco every once and a while. Many people have withdrawal symptoms when they try to quit using snuff or chew tobacco. These symptoms are usually strongest the first week after you quit. The withdrawal symptoms listed in Common Problems in Quitting are some of the most common symptoms for smokers and many also apply to smokeless tobacco users.
Review the advice to help with smoking withdrawal symptoms. In addition, the following may help you deal with withdrawal symptoms from quitting smokeless tobacco. The daily nicotine uptake decreased to 14 mg. The same level was obtained in another group of snus users, who had been using the low nicotine snus for more than one year Andersson et al.
These results show that snus users do not compensate their nicotine uptake upon switching to a snus with lower nicotine content. A different method to measure the nicotine dose is to monitor the blood plasma levels during one day of controlled tobacco consumption snus use or smoking and then compare the nicotine uptake curves with the corresponding curve for a reference product with a known nicotine dose. Using this method, the nicotine dose from four different portion-packed snus products of various weight and format, different nicotine content and different pH levels was compared in a controlled cross-over study with the dose from a 2 mg nicotine chewing gum Lunell et al.
The results showed that the dose from a 0. The dose from a 0. The five blood plasma time concentration curves obtained on consumption of the four different snus brands and a 2 mg nicotine chewing gum are illustrated in the Figure below. Involvement of nicotine and its metabolites in the pathology of smoking-related diseases: Facts and hypothesis. In: P. Clarke, M. Quik, F. Thurau Eds. Andersson, G. Oral mucosal changes and nicotine disposition in users of Swedish smokeless tobacco products: A comparative study.
Oral Pathol. Reduction in nicotine intake and oral mucosal changes among users of Swedish oral moist snuff after switching to a low-nicotine product. The influence of cigarette consumption and smoking machine yields of tar and nicotine on the nicotine uptake and oral mucosal lesions in smokers.
Benowitz, N. III, and Yu, L. Daily use of smokeless tobacco: systemic effects. Gilljam, H. Smokeless tobacco cessation with NRT: A feasibility study. Holm, H. Nicotine intake and dependence in Swedish snuff takers.
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