Tobacco use among Norwegian adolescents: from cigarettes to snus

AIMS: To: (i) investigate the development of smoking and snus use among Norwegian adolescents, and (ii) describe the users in each group. DESIGN: Two population-based surveys with identical procedures in 2002 (response rate 91.0%) and 2010 (response rate 84.3%). SETTING: Norway. PARTICIPANTS: A total of 6217 respondents, aged 16–17 years. MEASUREMENTS: Data were collected on smoking and snus use, socio-demographic factors, school adjustment, social network, sport activities, alcohol and cannabis use and depression symptoms. FINDINGS: Prevalence of daily smoking fell from 23.6% in 2002 to 6.8% in 2010 (P < 0.001), while the prevalence of daily snus use increased from 4.3 to 11.9% (P < 0.001). Dual daily use of cigarettes and snus remained at 1%. The relative proportion of non-daily smokers using snus increased steeply. Both snus users and smokers reported more adverse socio-economic backgrounds, less favourable school adjustment and higher levels of alcohol intoxication and cannabis use than non-users of tobacco. However, snus users were better adjusted to school and used cannabis less often than smokers. CONCLUSIONS: Adolescent smoking prevalence has fallen dramatically in Norway, accompanied by a smaller increase in snus use. Young snus users in Norway have many of the same risk factors as smokers, but to a lesser degree.