How dangerous is snuff use?

Research shows that snuff-takers have a higher risk of type 2 diabetes. But how negative are the health effects of 'Swedish' snuff otherwise? According to Cecilia Magnusson, Adjunct Professor at the Department of Global Public Health, more research is required.

Portrait of Cecilia Magnusson.
Cecilia Magnusson, PhD, Adjunct Professor at Karolinska Institutet, and Director of the Centre for Epidemiology and Community Medicine (CES), Stockholm Region. Credit: Ulf Sirborn.

Text: Viktor Karlsson, first published in Swedish in the magazine Medicinsk Vetenskap no 1, 2017.

What were the findings of your study?
– We saw that those who use one box of snuff per day or more have a 70 percent higher risk of developing type 2 diabetes, which is the same risk increase seen in the past for those who smoke one packet of cigarettes per day. This link which we saw is important, as diabetes is both a serious and common illness in society. Smoking is generally much more dangerous than using snuff, but not when it comes to type 2 diabetes, where the risks are the same.

How does snuff affect the body otherwise?
– We still have too little knowledge of how Swedish snuff affects health. However, in previous studies we have shown that the risk of death after a heart attack and stroke is slightly higher among snuff-takers. All in all, the research also shows links between snuff and pancreatic, mouth and oesophageal cancer – but then the studies are based on use also of other smokeless tobacco. Nicotine is also highly addictive and living with an addiction often entails a poor quality of life. On the other hand, we have also shown that snuff reduces the risk of contracting Parkinson’s disease.

You have also researched how snuff use among pregnant women affects the foetus. What are the findings of the studies?
– We have very clear results for that. Snuff use during pregnancy is linked to stillbirth, premature birth and the child may be underweight at birth. Maternity clinics should strongly advise pregnant women against snuff use as well as the use of nicotine replacement products, such as chewing gum or patches. Of course they should also advise against smoking during pregnancy.

How common is snuff use?
– Middle age men are the primary snuff-takers, and snuff use is more common in the northern parts of the country. According to a survey conducted by the Public Health Agency of Sweden in 2016, in total 18 per cent of all men and 4 per cent of all women use snuff. Snuff use primarily takes place in Sweden, but Norway has also noticed a very rapid increase among youth.

What is your opinion of snuff?
– I often feel that the discussion on snuff becomes black and white, and wish that we would dare to talk about it in a more nuanced manner. Snuff use is widespread in Sweden, and we need to respond to this in the debate on our tobacco policy. Not least as snuff can theoretically either serve as an aid to quitting smoking or, on the contrary, as a pathway to smoking for young people.

Do you use snuff?
– Yes, unfortunately.

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