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Swedish men can thank snus for health

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Swedish men have the lowest level of tobacco-related deaths in Europe. And this is likely to be due to their preference for low-nitrosamine oral tobacco (snus) over cigarettes.

The death rate attributable to tobacco among Swedish men aged 60-69 is 222 per 100,000, compared to a median of 550 for men of the same age in all other EU member states. And the difference is even more pronounced for younger Swedish men, as smoking rates have declined significantly in recent years while the use of snus has increased. Only 13 per cent of Swedish men aged 3544 smoked cigarettes in in 2004/5, while 31% used snus. Similar effects are not seen in Swedish women, however, probably as they tend not to use snus. Tobacco-related deaths among Swedish women are higher than the EU median, according to figures from a World Health Organization report.

The report also rules out political tobacco control measures as significantly responsible for the statistics, because Sweden scored only averagely in terms of factors such as pricing, smoking restrictions and warning labels compared to other EU countries. Use of snus has been shown to contribute to less initiation of smoking and more cessation of the habit.

Snus is a moist powder product placed under the upper lip that originated from a variant of dry snuff in early 18th century Sweden. It is not fermented, contains no added sugar and, unlike chewing tobacco, does not typically result in the need for spitting. It is sold either loose or prepackaged into pouches and often flavoured with smoke, bergamot, citrus, juniper berry, herbs or floral flavours.

The sale of snus is illegal in the European Union but, due to special exemptions, it is still manufactured and consumed primarily in Sweden, Norway, Finland and Denmark. American snus, available since the late 1990s, usually has a lower moisture content and pH, resulting in lower bioavailability of nicotine. American snus is often flavoured with spearmint, wintergreen, vanilla or fruit.

Instead of being fermented, like chewing tobacco, Swedish snus is steam-pasteurised. This process inhibits the growth of bacteria that facilitate the formation of the carcinogenic, tobacco-specific nitrosamines.

The health risks of snus remain unclear. Studies have suggested links to oral, pharyngeal and pancreatic cancer, but the WHO acknowledges that the evidence is inconclusive. A recent study, however, showed that people who used snus were twice as likely to develop alcohol dependency. A similar link between smoking and alcohol dependency has been known for some time.

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