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

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

Methods: 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.

Results: 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.

Conclusions: 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.