Snus consumption in Norway is highest among young people

The increase in Scandinavian snus consumption in Norway is highest among young people, according to a new report from the Norwegian Institute of Public Health.

"The sharp increase in snus use among adolescents and young adults could almost be described as an epidemic. There is nothing to suggest that the increase will stop," says Professor Jan Alexander, Deputy Director-General at the institute.

Alexander led the working group commissioned by the Ministry of Health and Care Services to evaluate the health risks from snus consumption.

What is snus?

Scandinavian snus is a smokeless, ground tobacco product that is held between the lip and gum. It is sold as a loose product or as portions supplied in small pouches. The sale of snus is illegal in the European Union, but some countries are exempt.

The report shows that there has been a dramatic increase in snus use in Norway. Within the last five years, the import of snus and other smokeless tobacco has tripled. In 2009, Norway imported about 602 metric tons but by 2013 this had tripled to 1815 metric tons. In addition to the official import statistics provided by Statistics Norway, there is probably significant private import from trade along the border.

Surveys of snus use in the population tally with the import figures.

Consumption

• 2013 figures show that 19 per cent of men and 7 per cent of women use snus daily or occasionally.
• In the 16-24 age group, the figures are 33 per cent of men and 23 per cent of women.
• For men aged 16-24 years, there is a snus 'epidemic'. Use has increased five-fold over the last 10-14 years.
• Approximately 20 per cent of women who use snus seem to continue after they become pregnant. However, this is based on figures from before 2009 when snus was less popular among young women.
• The rapidly increasing use among young women increases the risk that more pregnant women will use snus in the coming years.
• There is no obvious link between the decline in smoking and increased use of snus. For example, there is a corresponding decline in smoking in countries where snus is prohibited.
• There is no difference in educational attainment among adult snus users.

Health risks of snus use

Snus contains the biologically active and addictive substance nicotine, and carcinogenic tobacco-specific nitrosamines (TSNA).

• Exposure from a portion of snus is somewhat greater than from a cigarette.
• Nicotine has acute effects on the cardiovascular system and can increase heart rate, blood pressure and vascular resistance. It can also affect cardiac muscle function.
• There are indications that snus can impair fertility, as with smoking.
• Snus increases the risk of cancers of the pancreas, oesophagus and oral cavity.
• Studies suggest that snus also increases the risk of cancers of the stomach, lung, colon and rectum.

"The degree of increased risk of cancer is difficult to estimate. It will probably depend on how early users start, how often and how much snus they use, and for how many years," says Alexander.

He stressed that there is reason to be concerned about the potential number of cancer cases that will result from snus use, based on current usage levels.

Harmful to the foetus

Snus use in pregnancy can cause reduced birth weight, and an increased risk of premature birth and stillbirth. There is also some evidence that snus use in pregnancy may contribute to pre-eclampsia, and increase the risk of neonatal apnoea and cleft lip / palate malformations.

"The risk of using snus during pregnancy has recently become apparent from Swedish studies. Similar harmful effects are seen with other smokeless tobacco products. The evidence suggests that nicotine during pregnancy may be responsible for many of these effects," says Alexander.

He is particularly concerned about the strong increase in snus use among young women, with thoughts of subsequent pregnancies and the possibility of harm to the foetus and the course of pregnancy.

"Nicotine is highly addictive and for some it may be hard to quit when they become pregnant, explains Alexander. "Snus during pregnancy could cause long-term harm to the child, but we know too little about it yet. However, animal experiments have shown that nicotine exposure before birth can cause behavioural changes and other disorders. The brain appears to be particularly sensitive to the effect of nicotine during development, both in the womb and after birth."

Heart failure and diabetes

Snus can lead to an increased risk of dying after a heart attack or stroke. Studies show that quitting snus after a heart attack can halve the risk of dying. The effect is the same as quitting smoking.

Studies also indicate that snus may contribute to an increased risk of type 2 diabetes, weight gain and overweight / obesity.

"In particular, with a high snus consumption there is a link with diabetes and obesity. But since these are conditions where many other lifestyle factors play a role, it is difficult to know exactly which impact snus use has," concludes Alexander.