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.