Perceptions of the relative harmfulness of snus among Norwegian general practitioners and their effect on the tendency to recommend snus in smoking cessation

Knowledge and awareness of nicotine, nicotine replacement therapy, and electronic cigarettes among general practitioners with a special interest in respiratory medicine in China

Objectives

This study aimed to assess the knowledge and awareness of nicotine, nicotine replacement therapy (NRT), and electronic cigarettes (e-cigarettes) among general practitioners with a special interest (GPwSIs) in respiratory medicine.

Methods

A cross-sectional study was conducted from October 2021 to February 2022. Knowledge and awareness were compared among smokers and non-smokers, as well as different age and gender groups.

Results

The study consisted of 102 GPwSIs from 21 cities in Sichuan Province, China. Most respondents would recommend NRT for long-term use. Only a few believed that e-cigarettes are an effective means of smoking cessation and 71.6% would not recommend e-cigarettes as a substitute for cigarettes to their patients. Additionally, the majority did not regularly provide extensive help to assist patients in quitting smoking and needed smoking cessation counseling training.

Conclusion

GPwSIs in respiratory medicine in China could have a relatively low level of knowledge and awareness regarding nicotine, NRT, and e-cigarettes. The study highlights the need for smoking cessation training among GPwSIs to improve their knowledge and provide better assistance to patients who want to quit smoking.

College health providers' knowledge and confidence in addressing students' vaping: Evidence from a pilot study in New York State

Objective

This study examines the knowledge and confidence of college healthcare providers in discussing vaping with their college student populations.

Methods

This is a mixed-methods descriptive study using a sequential-explanatory approach, consisting of a cross-sectional, online survey followed by qualitative interviews. Survey data was collected from 50 college health providers located at 26 colleges in the 64-campus State University of New York system. Targeted semi-structured interviews (N = 11) were conducted by telephone with providers who completed the survey.

Results

Despite high reported levels of knowledge and confidence, few providers had participated in educational activities relative to vaping. There was evidence of misinformation about e-cigarettes, and they did not know what product (nicotine/cannabis) students typically vape.

Conclusions

Findings indicate a potential disconnect between providers' perceived and actual knowledge of college student vaping and demonstrate areas of opportunity to assist college health providers in comprehensively addressing vaping with their college student populations.

Innovation

College health providers played a key role in lowering rates of combustible cigarette smoking, but little is known about how they are now are communicating with college students about e-cigarette and cannabis vaping. This paper examines college health providers' knowledge, confidence, and training needs relative to vaping communications.

The old and familiar meets the new and unknown: patient and clinician perceptions on e-cigarettes for smoking reduction in UK general practice, a qualitative interview study

BACKGROUND AND AIMS

Clinicians could promote e-cigarettes for harm reduction to people who smoke but cannot stop, but many clinicians feel uneasy doing so. In a randomized controlled trial (RCT), primary care clinicians offered free e-cigarettes and encouraged people with chronic diseases who were unwilling to stop smoking to switch to vaping. We interviewed clinicians and patients to understand how to adopt harm reduction in routine practice.

DESIGN

Qualitative analysis nested within an RCT, comprising thematic analysis of semi-structured interviews with primary care clinicians who delivered the trial intervention, and patients who took part.

SETTING

Primary care clinics in England.

PARTICIPANTS/CASES

Twenty-one patients and 11 clinicians, purposively sampled from an RCT.

MEASUREMENTS

We qualitatively explored patients' and clinicians' experiences of: being offered/offering an e-cigarette, past and current perceptions about e-cigarettes and applying a harm reduction approach.

FINDINGS

Four themes captured clinicians' and patients' reported perspectives. These were: (1) concepts of safety/risk, with clinicians concerned about recommending a product with unknown long-term risks and patients preferring the known risks of cigarettes; (2) clinicians felt they were going out on a limb by offering these as though they were prescribing them, whereas patients did not share this view; (3) equating quitting with success, as both patients and clinicians conceptualized e-cigarettes as quitting aids; and (4) unchanged views, as clinicians reported that training did not change their existing views about e-cigarettes. These themes were united by the higher-order concept: 'The old and familiar meets the new and unknown', as a contradiction between this new approach and long-established methods underpinned these concerns.

CONCLUSIONS

A qualitative analysis found barriers obstructing clinicians and patients from easily accepting e-cigarettes for harm reduction, rather than as aids to support smoking cessation: clinicians had difficulty reconciling harm reduction with their existing ethical models of practice, even following targeted training, and patients saw e-cigarettes as quitting aids.

Can the Public Be Educated About Constituents in Smokeless Tobacco? A Three-Wave Randomized Controlled Trial

INTRODUCTION

The U.S. Food and Drug Administration (FDA) is required by law to inform the public about levels of harmful and potentially harmful tobacco constituents in a format that is "understandable and not misleading to a lay person." Our study addresses a critical gap in research on communicating such information for smokeless tobacco (SLT) products.

METHODS

The design included random assignment to one of the experimental (online interactive) conditions differing in presentation format or a control condition (receiving no information). Experimental respondents viewed information on levels and health risks of 5 harmful constituents in up to 79 products. Outcome measures included knowledge of health risks of constituents, perception of constituent variability in SLT products, disease risk ratings, self-reported SLT use, and side-by-side product comparisons. The sample of 333 SLT users, 535 cigarette smokers, and 663 nontobacco users participated at baseline, time of intervention, and 6 weeks postintervention.

RESULTS

Presentation formats showed few systematic differences so were combined in analyses. Experimental condition respondents increased their knowledge about constituent health effects and their perceptions of constituent variability in SLT products, from baseline to postintervention, and relative to the control condition. Changes in respondents' ratings of disease risk and their estimates of constituent exposure from specific products were observed, but not in self-reported SLT use.

CONCLUSIONS

Interactive online graphic and numeric presentation formats can be efficient in increasing people's knowledge of health effects and perceived variation of constituents in SLT products. Further research on longer-term behavioral assessment, and usefulness of this approach for regulatory agencies, is needed.

IMPLICATIONS

Research on communicating the information about harmful constituents in SLT products to lay persons is critically lacking. This study proposes novel formats for effective communication about the levels and the health effects of SLT constituents to multiple user groups. The lack of misperceptions among study participants that some tobacco products are safe suggests that such formats can potentially be used for public display of SLT constituent data by the FDA and regulatory agencies in other countries.

Snus cessation patterns - a long-term follow-up of snus users in Sweden

Background

Several studies have investigated the role of snus as an aid to become smoke-free, but few have focused on who use snus, how they perceive snus use, why and how they quit, and their perception of being non-snus users. The purpose of this paper is to describe snus cessation patterns.

Methods

Respondents are part of a 7-year follow-up of former smokers in Sweden. Initially, 1400 respondents were contacted regarding participation and 705 answered a web-based survey (response rate 50%). Out of them, 118 had used snus. The analyses include percentage distributions, as well as factor analyses of inventories, and configural frequency analysis in order to examine configurations of snus-related patterns.

Results

Over 80% found snus of great importance to succeed with smoking cessation and half of them continued to use snus on a long term. Those who experienced both physical and psychological effects of switching to snus were the ones who continued and vice versa; those who did not experience such effects quit using snus. None made use of professional help but had their own strategies (60%), and most respondents who quit obtained psychological benefits (68%).

Conclusions

The distinction between the concepts smoke-free, tobacco-free, and nicotine-free contributes to nuances in the debate on snus as harm reduction. Continued snus use does not mean that snus is not an effective aid to become smoke-free. Snus cessation is mostly mentioned in relation to advices on how to succeed, but the cessation process has rarely been described; therefore, this study expands the knowledge on this quite neglected topic and contributes to a more nuanced picture of snus cessation.

Tobacco and electronic cigarette products: awareness, cessation attitudes, and behaviours among general practitioners

BACKGROUND

Little is known around how general practitioners (GP) approach tobacco products beyond traditional cigarettes.AimTo examine GP perceptions of tobacco and electronic cigarette (EC) products, and their attitudes and behaviours towards product cessation.

METHOD

A 13-item self-completed anonymous questionnaire measured awareness of waterpipe tobacco smoking (WTS) and smokeless tobacco (ST). Cessation advice provision, referral to cessation services, and the harm perception of these products were asked using five-point Likert scales that were dichotomised on analysis. Correlates of cessation advice were analysed using regression models.FindingsWe analysed 312 responses, of whom 63% were aware of WTS and between 5-32% were aware of ST products. WTS and ST were considered less harmful than cigarettes by 82 and 68% of GPs, respectively. WTS, ST, and EC users were less advised (P<0.001) and referred (P<0.001) to cessation services compared to cigarette users. Ethnic minority and senior GPs were more likely to provide cessation advice for WTS and ST users compared to younger white GPs. GPs who were recent tobacco users were less likely to give cessation advice to cigarette users (adjusted odds ratios 0.17, 95% confidence interval 0.03-0.99, P<0.049).Conclusions (implications for practice and research)GPs had lower harm perception, gave less cessation advice, and made less referrals for WTS and ST users compared to cigarettes. Our findings highlight the need for targeted tobacco education in general practice. More research is needed to explore GP perceptions in depth as well as patient perspectives.

How Social Care Beneficiaries in Poland Rate Relative Harmfulness of Various Tobacco and Nicotine-Containing Products

The aim of the study was to examine how social care beneficiaries rate the relative harmfulness of tobacco/nicotine-containing products compared to traditional cigarettes. This information is crucial for the development of effective tobacco control strategies targeting disadvantaged populations. The cross-sectional study covered 1817 respondents who were taking advantage of social aid services offered by the local social care institutions in the Piotrkowski district, via face-to-face interviews. The linear regression analysis indicated that relative to women, men consider slim cigarettes, smokeless tobacco and e-cigarettes to be more harmful than traditional cigarettes (p < 0.05). The smokers of traditional cigarettes reported menthol cigarettes to be less harmful than traditional cigarettes, relative to the non-smokers (p = 0.05). The current results demonstrate that social care beneficiaries are not aware of the fact that some products are less harmful than others. Education concerning tobacco/nicotine products should include advice on how to reduce the adverse health effects of smoking (e.g., avoiding inhalation of combusted products), while driving the awareness that no nicotine-containing products are safe.

Perceived Relative Harm of Selected Cigarettes and Non-Cigarette Tobacco Products-A Study of Young People from a Socio-Economically Disadvantaged Rural Area in Poland

The perceived health risk of recently introduced nicotine and tobacco products may influence both their uptake and continued use. The aim of the study was to assess how adolescents rate relative harmfulness of slim and menthol cigarettes, water pipes, e-cigarettes, and smokeless tobacco compared to regular cigarettes. Cross-sectional survey data from students aged 13-19 years from Piotrkowski district, Poland were analyzed. Among the sample of 4050 students, 3552 respondents completed anonymous, confidential, self-administered questionnaire adapted from the Global Youth Tobacco Survey (GYTS). The study results indicate that the students perceived slim cigarettes and menthol cigarettes as less harmful, which is in line with the message created by tobacco companies. On the other hand, less popular products such as water pipes and smokeless tobacco were considered as more harmful. The current study indicates insufficient and misleading perception of harmfulness of different tobacco/nicotine products available on the Polish market. Simultaneously, there is insufficient countrywide public health education in this matter. Preventive measures are necessary to discourage young people from smoking uptake and to ensure that potential consumers can, based on objective data, make informed decisions about cigarettes and non-cigarette tobacco products.

Knowledge and Perceptions about Nicotine, Nicotine Replacement Therapies and Electronic Cigarettes among Healthcare Professionals in Greece

Introduction. The purpose of this study was to evaluate the knowledge and perceptions of Greek healthcare professionals about nicotine, nicotine replacement therapies and electronic cigarettes. Methods. An online survey was performed, in which physicians and nurses working in private and public healthcare sectors in Athens-Greece were asked to participate through email invitations. A knowledge score was calculated by scoring the correct answers to specific questions with 1 point. Results. A total of 262 healthcare professionals were included to the analysis. Most had daily contact with smokers in their working environment. About half of them considered that nicotine has an extremely or very important contribution to smoking-related disease. More than 30% considered nicotine replacement therapies equally or more addictive than smoking, 76.7% overestimated their smoking cessation efficacy and only 21.0% would recommend them as long-term smoking substitutes. For electronic cigarettes, 45.0% considered them equally or more addictive than smoking and 24.4% equally or more harmful than tobacco cigarettes. Additionally, 35.5% thought they involve combustion while the majority responded that nicotine in electronic cigarettes is synthetically produced. Only 14.5% knew about the pending European regulation, but 33.2% have recommended them to smokers in the past. Still, more than 40% would not recommend electronic cigarettes to smokers unwilling or unable to quit smoking with currently approved medications. Cardiologists and respiratory physicians, who are responsible for smoking cessation therapy in Greece, were even more reluctant to recommend electronic cigarettes to this subpopulation of smokers compared to all other participants. The knowledge score of the whole study sample was 7.7 (SD: 2.4) out of a maximum score of 16. Higher score was associated with specific physician specialties. Conclusions. Greek healthcare professionals appear to overestimate the adverse effects of nicotine, and many would not recommend any nicotine-containing product as a long-term smoking substitute. Additionally, they have poor knowledge about the function and characteristics of electronic cigarettes.

Tobacco denormalisation and representations of different tobacco users in Norway: a cross-sectional study

This study asks whether representations of different typical tobacco users vary in line with established stereotypes and by social group membership (especially tobacco user status). Social identity theory posits that representations differ due to varying identification with product users on the basis of personal use, while distinction theory suggests representations will be structured by proximity and distance to user groups. Using principal component analysis to identify representations and regression analysis to determine variances in representations, we find that four of five groups of typical tobacco users (snus users, pipe, cigarette, and cigar smokers) can be classified according to three similar representations: socially secure, culturally marginal and unappealing. Respondents who themselves use a certain tobacco product are more likely to consider a 'typical' user from their own group as more 'socially secure' and less 'culturally marginal' and 'unappealing' than non-users. Former smokers tend to side with non-smokers, which suggests their 'smoker identity' is on the wane. At the representational level, then, socio-historical distinctions between different tobacco products seem to have diminished in favour of a largely dual classification, with users expressing positive and non-users negative representations, of any typical user. This is a likely consequence of persistent tobacco denormalisation policies.

Deficiencies in public understanding about tobacco harm reduction: results from a United States national survey

Background

Tobacco products differ in their relative health harms. The need for educating consumers about such harms is growing as different tobacco products enter the marketplace and as the FDA moves to regulate and educate the public about different products. However, little is known about the patterns of the public’s knowledge of relative harms.

Methods

Data were analyzed from the Health Information National Trends Survey (HINTS) 4 Cycle 2, a population-representative survey of US adults conducted between October 2012 and January 2013 (N = 3630). Participants reported their perceptions of the relative risks of e-cigarettes, smokeless tobacco, and different types of cigarettes compared to “traditional” cigarettes. Relative risk perceptions for each product type, as well as the consistency and accuracy of harm reduction beliefs, were analyzed.

Results

About 65 % of the respondents accurately reported that no cigarettes were less harmful than any others. Slightly more than half of US adults perceived e-cigarettes to be safer than regular cigarettes, a belief in line with current scientific evidence. By contrast, only 9 % of respondents perceived some smokeless tobacco products to be safer, a belief strongly supported by the evidence. Only 3.5 % of respondents had patterns of relative risk perceptions in line with current scientific evidence for all three modalities.

Conclusions

The discrepancy between current evidence and public perceptions of relative risk of various tobacco/nicotine products was marked; for most tobacco types, a large proportion of the population held inaccurate harm reduction beliefs. Although there was substantial awareness that no cigarettes were safer than any other cigarettes, there could be benefits from increasing the percentage of the public that appreciates this fact, especially among current smokers. Given the potential benefits of tobacco risk reduction strategies, public health education efforts to increase understanding of basic harm reduction principles are needed to address these misperceptions.

How has the availability of snus influenced cigarette smoking in Norway?

BACKGROUND

In Norway, low-nitrosamine smokeless tobacco (snus) is allowed to compete with cigarettes for market share. We aimed to study how the availability of snus influenced overall tobacco consumption, smoking initiation and smoking cessation. We discuss whether the Norwegian experience with snus can have any transfer value for e-cigarettes.

METHODS

We analysed consumption data from registered and unregistered supply sources of tobacco. We calculated quit-smoking ratios across snus use status in nine datasets comprising a total of 19,269 ever-smokers. Trends in snus use and smoking were derived from time-series of annual; cross-sectional; nationally representative surveys for the period 1985-2013.

RESULTS

The market share for snus increased from 4% in 1985 to 28% in 2012, but overall tobacco consumption decreased by 20.3% over this same period. Snus was the most common method for smoking cessation. Compared with smokers with no experience of using snus, the quit ratio for smoking was significantly higher for daily snus users in seven of the nine datasets analysed. Among young male adults, the prevalence of smoking (daily + occasional) was reduced from 50% in 1985 to 21% in 2013. Over the same period, use of snus increased from 9% to 33%. This negative correlation (r = -0.900, p < 0.001) was also observed among young females (r = -0.811, p < 0.001), but the trend shift in tobacco preferences occurred some years later.

CONCLUSIONS

The experience with snus in Norway might indicate what will happen when alternative nicotine products--are allowed to compete with cigarettes in the nicotine market.

Public education about the relative harm of tobacco products: an intervention for tobacco control professionals

BACKGROUND

In the USA, new regulations require the collection of information on tobacco constituents by brand and variety and publication of this information in a way not likely to be misconstrued by consumers. Understanding of such information becomes increasingly important as new tobacco products are marketed and modifications are made to reduce the toxicity of some products. This pilot study assessed the current knowledge of tobacco control professionals regarding the relative harmfulness of several tobacco products, and evaluated an online educational intervention aimed at improving understanding of variations in nicotine and tobacco-specific N-nitrosamines (TSNAs).

METHODS

Fifty-two tobacco control professionals participated in an online intervention which presented and discussed the results of constituent analyses of Camel Snus and Marlboro Snus compared to several conventional smokeless tobacco products. Comparisons with cigarettes were also discussed. Pre- and post-intervention questions assessed understanding of the concepts.

RESULTS

Pre-intervention responses demonstrated that 31% did not know that cigarettes are more harmful than smokeless tobacco, 67% did not know that smokeless products higher in nicotine are likely to be more effective substitutes for cigarettes, 52% did not know TSNAs are the major carcinogens in tobacco and 81% did not know new snus products tend to be lower in TSNAs than conventional spit tobacco. After intervention participation, knowledge increased on all points except one where pretest results were 100% correct.

CONCLUSIONS

Public education campaigns are urgently needed for tobacco control professionals and consumers to increase awareness and understanding of the continuum of risk among tobacco products.

Judgments, awareness, and the use of snus among adults in the United States

INTRODUCTION

Alternative tobacco products, such as snus, are emerging in the U.S. market. Understanding correlates of awareness and use, particularly judgments about harm and addictiveness, can inform public health communications about these products.

METHODS

Data were collected from a web panel representative of the U.S. population in March 2013 (N = 2,067). The survey assessed awareness and use of snus among adults. Absolute and comparative snus judgments, intentions, smoking status, and sociodemographic variables were measured. Bivariate and multivariable logistic regression analyses were conducted to examine associations between these variables and snus awareness and use.

RESULTS

Nearly 36% of the population was aware of snus, and 5.2% reported ever using snus. Current cigarette smokers were about 4 times more likely as nonsmokers to report snus awareness and use. Sociodemographic correlates of snus awareness and use included being male, employed full time, and younger. Compared with respondents who perceived snus to be as harmful and as addictive as cigarettes, those who perceived snus to be less harmful and less addictive than cigarettes were more likely to have used snus.

CONCLUSIONS

Current smokers are more likely to be aware of and have used snus. Multiple tobacco product use poses a significant challenge for public health efforts to reduce tobacco-associated morbidity and mortality. Perceptions that snus is less harmful and less addictive compared with cigarettes are associated with snus use. These judgments can inform public health communications about emerging tobacco products and multiple product use.

Contrasting smokers' and snus users' perceptions of personal tobacco behavior in norway

INTRODUCTION

In Norway, snus use and cigarette smoking are at different developmental stages as described by the diffusion of innovation model. Concomitant with declining smoking rates, the use of snus is increasing. In light of these differences in use trends, we assumed that snus users and cigarette smokers would have different perceptions of their personal tobacco use.

METHODS

A total of 4,852 smokers and snus users were recruited from a large sample of online panelists (n = 62,000) and a postal database (n = 15,000). The responses to 16 evaluative statements assessing perceptions about tobacco use were compared between exclusive snus users and exclusive smokers and within dual users. The statements concerned self-evaluative emotions, moral judgments, social disapproval, and benefits of quitting.

RESULTS

The perceptions of personal tobacco use differed greatly between exclusive smokers and exclusive snus users, even after controlling for age and sex. Smoker's perceptions were more negative compared with snus users' perception. The differences between smoking and snus use were particularly large for indices of social disapproval (Cohen's d = 1.56) and benefits from quitting use of the product (Cohen's d = 1.47) between exclusive users. Dual users exhibited a similar pattern.

CONCLUSIONS

Smokers have a more negative perception of their own use compared to snus users. Dual users also devaluated smoking in comparison to their snus use. This finding may have important values for prevention strategies targeting smokers, snus users, and dual users.

Evidence of sex differences in the relationship between current tobacco use and past-year serious psychological distress: 2005-2008 National Survey on Drug Use and Health

PURPOSE

Cigarette use is highly prevalent in psychiatric populations. Studies suggest that smokeless tobacco use is not significantly associated with past-year psychiatric morbidity, with evidence that tobacco use differ among sexes. The relationships between current tobacco use and past-year serious psychological distress, major depressive episode and anxiety disorder were therefore examined. Sex differences in the aforementioned relationship were also examined.

METHODS

A total of 133,221 adults from four successive independent samples of the 2005-2008 National Survey on Drug Use and Health were included. Prevalence odds ratios and 95 % confidence intervals were calculated using multivariable logistic regression adjusting for demographic factors, survey year, pregnancy (women only), past-year medical morbidity, past-year psychiatric comorbidity, and past-year substance use disorders.

RESULTS

No associations were demonstrated among smokeless tobacco users. Statistically significant sex differences were found for current tobacco use and serious psychological distress (p < 0.001). Both male and female smokers were significantly more likely to have serious psychological distress and anxiety disorder compared to never users, while only female smokers were more likely to have major depressive episode. The strongest associations were found for anxiety disorder among all adults as well as both sexes.

CONCLUSIONS

The null associations for both sexes for smokeless tobacco may support a reduced risk profile. Female cigarette smokers may be more vulnerable to subclinical distress and depression than males. Studies using other nationally representative samples are needed to confirm these data.

Patterns of dual use of snus and cigarettes in a mature snus market

INTRODUCTION

We examine the prevalence of dual use of snus and cigarettes among Norwegian men by categorizing dual use into four categories according to the frequency of use of each product, considering the order of uptake of both products, and examining reasons for additional snus use. We compare dual users and exclusive cigarette smokers with respect to their smoking intensity, plans for quitting smoking, and future smoking identity.

METHODS

We used a data pool of six cross-sectional, national representative surveys conducted annually in the period 2005-2010 containing a total of 3,524 males aged 16-74.

RESULTS

6.8% of men had some kind of current concomitant use of snus and cigarettes--but only 1% reported a daily consumption of both products. The most typical pattern of dual use was a combination where daily use of one product was paired with occasional use of the other. Dual users consumed significantly fewer cigarettes per week (56.6; n = 226; SD, 53.82) than smokers who had either quit snus (79.6; n = 108; SD, 61.47) or single smokers with no history of snus use (80.2; n = 621; SD, 55.86). Only 24% with a history of dual use reported snus to be their first tobacco product, but the proportion who had initiated tobacco use with snus increased significantly with younger age. Among dual users with daily intake of snus, a majority of 53.6% reported that the purpose of their snus use was to quit smoking. A higher proportion of dual users (74.4%; 95% CI, 68.8-80.0; n = 235) than exclusive smokers (61.3%; 95% CI, 57.6-65.0; n = 658) reported that they most definitely or probably would be totally smoke-free 5 years into the future.

CONCLUSIONS

In the mature snus market of Norway, the magnitude of dual use of cigarettes and snus is relatively small. Dual users consume fewer cigarettes, and a higher proportion portray themselves as smoke-free in the future than do exclusive cigarette smokers.

Association between willingness to use snus to quit smoking and perception of relative risk between snus and cigarettes

INTRODUCTION

Smokers are often incorrect in their assessment of the relative risk of snus and cigarettes. We have studied how perception of risks of snus compared with cigarettes was associated with the willingness of trying snus as a quit-smoking method.

METHODS

Fourteen thousand seven hundred and forty-four Norwegian men aged 20-50 years were selected at random from a national representative web panel and sent a questionnaire by e-mail. Of the 7,170 (48.6%) who responded, there were 1,155 former daily smokers who reported method for quitting smoking and 1,213 current daily smokers who stated their willingness to try different methods for quitting smoking. They were also asked to assess the relative risk between daily use of snus and cigarettes.

RESULTS

Adjusted odds ratio (AOR) for reporting willingness to try snus in future quit attempts was significantly higher (AOR = 4.82, p < .001) for the 22.9% of the current smokers who, consistent with scientific evidence, believed that the health risks were "far lower" for snus than for cigarettes compared with the 39.8% who incorrectly perceived the health risks to be "equal or higher" for snus (reference AOR = 1). About 37.2% of the daily smokers believed that the risk was "somewhat lower" for snus than for cigarettes and had a significantly higher AOR of reporting willingness to try snus (AOR = 2.31, p < .001) compared with the reference group.

CONCLUSION

Devising a way to inform smokers about the risk continuum of tobacco products could be an important research priority in countries where snus is allowed to compete with cigarettes for market share.