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Research projects in Tobacco and Alcohol | PRIME Health

Research projects conducted by the PRIME Health research group in the area tobacco and alcohol.

The Swedish Collaboration on Health Effects of Snus Use

The use of moist smokeless tobacco (a.k.a. Scandinavian snus) is common in Sweden, and presently sharply increasing in Norway. Snus users are exposed to nicotine levels at least as high as those in tobacco smokers. Nicotine affects the cardiovascular and nervous systems, as well as the metabolism. There is strong evidence that tobacco smoking increases the risk of developing heart failure, high blood pressure and diabetes, while smoking appears to protect against Parkinson's disease. The impact of snus use on these disorders is, however, unclear.

The lack of previous studies on health effects of snus is due methodological obstacles, in particular since very large study materials are required. This is because snus use was less common in the past, and because smokers should be excluded from the analysis, such that the results are not distorted by the strong effects of smoking.

We have therefore created a national consortium of snus research – where scientists from all over Sweden collaborate and pool their individual data from eligible studies to reliably generate new knowledge about the health effects of snus.

Funding from Folkhälsomyndigheten, Forte, Vetenskapsrådet and Diabetesfonden


  • Lars Alfredsson, WOLF
  • Gunnar Engström, Malmö Diet and Cancer Study, MDCS
  • Rosaria Galanti, Stockholm Public Health Cohort
  • Jan-Håkan Jansson, MONICA
  • Anton Lager, Stockholm Public Health Cohort
  • Cecilia Magnusson, KI
  • Margareta Norberg, VIP
  • Nancy Pedersen, Swedish Twin Registry
  • Johan Sundström, Epihealth
  • Ylva Trolle, National March Cohort
  • Weimin Ye, Construction Workers Cohort
  • Patrik Wennberg, MONICA
  • Per-Olof Östergren, Skånes Folkhälsokohort


Smokeless tobacco (snus) is associated with an increased risk of type 2 diabetes: results from five pooled cohorts.
Carlsson S, Andersson T, Araghi M, Galanti R, Lager A, Lundberg M, Nilsson P, Norberg M, Pedersen LN, Trolle-Lagerros Y, Magnusson C
Journal of Internal Medicine, online 6 februari 2017, doi: 10.1111/joim.12592

Moist smokeless tobacco (Snus) use and risk of Parkinson's disease.
Yang F, Pedersen NL, Ye W, Liu Z, Norberg M, Forsgren L, et al
Int J Epidemiol 2017 06;46(3):872-880

Snus (Swedish smokeless tobacco) use and risk of stroke: pooled analyses of incidence and survival.
Hansson J, Galanti MR, Hergens MP, Fredlund P, Ahlbom A, Alfredsson L, et al
J. Intern. Med. 2014 Jul;276(1):87-95

Use of snus and acute myocardial infarction: pooled analysis of eight prospective observational studies.
Hansson J, Galanti MR, Hergens MP, Fredlund P, Ahlbom A, Alfredsson L, et al
Eur. J. Epidemiol. 2012 Oct;27(10):771-9

Weight gain and incident obesity among male snus users.
Hansson J, Galanti MR, Magnusson C, Hergens MP
BMC Public Health 2011 May;11():371

Use of snus and risk for cardiovascular disease: results from the Swedish Twin Registry.
Hansson J, Pedersen NL, Galanti MR, Andersson T, Ahlbom A, Hallqvist J, et al
J. Intern. Med. 2009 Jun;265(6):717-24

Use of Scandinavian moist smokeless tobacco (snus) and the risk of atrial fibrillation.
Hergens MP, Galanti R, Hansson J, Fredlund P, Ahlbom A, Alfredsson L, et al
Epidemiology 2014 Nov;25(6):872-6


Cecilia Magnusson

Adjunct professor
Department of Public Health Sciences (PHS), K9

Long-term effects of increased alcohol availability: a natural experiment

Alcohol consumption and alcohol-related harm are at relatively low levels in Sweden, much thanks to a restrictive alcohol policy in which a monopoly retailer (Systembolaget) is an important element. Since Sweden joined the EU, the alcohol monopoly has been called into question.

The Swedish retail-alcohol monopoly system imposes several types of restrictions on alcohol availability, related to age limits, location and density of outlets, hours of sale, prices, and promotion and advertising. Restricting availability of alcohol at population level by general policy measures is justified by scientific evidence that shows associations between the consumption of alcohol per capita and a range of alcohol-related health outcomes. It has also been shown that privatization of retail alcohol sales tends to increase population drinking.

However, alcohol policy does not only aim at keeping alcohol consumption at a generally low level; it is also concerned with consequences for vulnerable groups. Young people are more sensitive to price changes and the concentration of sales outlets. Research suggests that an alcohol monopoly may be more successful in restricting alcohol availability among young people through age limits. Also, a group of great concern is pregnant women, because alcohol intake, especially in excess, may cause harm to the foetus.

In this project, we evaluate the long-term effects of the increased drinking among these two groups that was induced by an eight-month alcohol-policy experiment in western Sweden in the late 1960s. During this natural experiment, alcohol availability markedly increased when the sale of strong beer was permitted in grocery stores. Since the increased alcohol availability was exogenously induced and confined to a well-defined area, the experiment offers a unique research opportunity, in particular because of the rich body of registry data that can be used for analysing impacts on a wide range of outcomes.

Funding from Forte


  • Emelie Thern, Department of Public Health Sciences, KI
  • Josefin Sundin, Department of Public Health Sciences, KI
  • Tomas Hemmingsson, Institute of Environmental Medicine, KI
  • Mats Ramstedt, Department of Clinical Neuroscience, KI
  • Finn Rasmussen
  • George Davey-Smith, Bristol University


Effects of increased alcohol availability during adolescence on the risk of all-cause and cause-specific disability pension: a natural experiment.
Thern E, de Munter J, Hemmingsson T, Davey Smith G, Ramstedt M, Tynelius P, et al
Addiction 2017 Jun;112(6):1004-1012


Cecilia Magnusson

Adjunct professor
Department of Public Health Sciences (PHS), K9