Risk Perceptions of Snus and Cigarettes in a Snus-Prevalent Society

Most studies on the perceived risks of smokeless tobacco products (SLT), such as snus, have been conducted in the Unites States. The current study analysed such perceptions in Norway, where the use of snus is more prevalent than in most other countries.

Diane Caruana

October 29, 2020

The vast majority of studies conducted in the U.S. conclude that perceptions of the relative harmfulness of SLT versus cigarettes amongst the public, are inconsistent with those derived from scientific research and typically confused with those of cigarettes. Conducted in Norway, where the use of snus is highly prevalent, the current study tested whether such inaccuracies existed also locally.

“Like the situation in the US, incorrect beliefs about SLT risks seem to be prevalent also in the snus-prevalent Norwegian setting.”

The researchers compiled data over a period of 16 years (2003–2018), from 13,381 respondents (aged 16–79 years). The respondents answered questions about the risk perceptions in Norway’s nationally representative survey of tobacco behavior. The researchers asked questions pertaining to the risk beliefs for eight nicotine products.

The wording of the question was as follows: “We will now mention a variety of nicotine products and ask you how harmful you think daily use of these are. Use a scale from 1 to 7, where 1 is slightly harmful and 7 is very harmful”.

The researchers found that the overall risk score for cigarettes was 6.48, while the risk score for snus was 5.14, equating to 79.3% of the risk score of cigarettes. The relative risk scores for e-cigarettes (3.78) and NRT products (3.39) were 58.4% and 52.3% those of cigarettes. These perceptions of risk were stable over time, and a strong association was observed between perceived risk of snus and having used snus in attempts to quit smoking.

Risk perceptions are inconsistent with scientific data

Sadly these figures indicated that despite the scientific data in favour of snus and the prevalence of use in Norway, perceptions remain inaccurately negative. “Perceptions of relative risk between snus and cigarettes is inconsistent with estimates from medical expert committees, which assess the overall health risk from use of Swedish snus to be minor when compared to the risk from smoking.”

The researchers concluded, that sadly, the perceptions in Norway are no different than those in the States. “Like the situation in the US, incorrect beliefs about SLT risks seem to be prevalent also in the snus-prevalent Norwegian setting. Accurate information on differential harms needs to be communicated. Future research should try to identify reasons why health authorities in the US and Scandinavia allow these well-documented misconceptions to persist.”