Dr. Keith Humphreys, Stanford University - Alternative Tobacco Products
Alternative tobacco products are on the rise.
Keith Humphreys, professor of psychiatry at Stanford University, discusses a form of smokeless tobacco that is catching on overseas.
Keith Humphreys is a Professor and the Section Director for Mental Health Policy in the Department of Psychiatry and Behavioral Sciences at Stanford University. He is also a Senior Research Career Scientist at the VA Health Services Research Center in Palo Alto and an Honorary Professor of Psychiatry at the Institute of Psychiatry, King's College, London. His research addresses the prevention and treatment of addictive disorders, the formation of public policy and the extent to which subjects in medical research differ from patients seen in everyday clinical practice.
Keith Humphreys - Can Swedish snuff teach us anything about the impact of e-cigarettes?
Whether E-Cigarettes will be a gateway to cigarette smoking or a way for smokers to transition to a less deadly habit is the hottest debate in the tobacco control field. Similar arguments have occurred for years in Scandanavia about a form of tobacco known as “snus”
Snus or “Swedish snuff” isn’t smoked and contains a low level of cancer-causing nitrosamines. It therefore does much less harm to the human body than do smoked cigarettes. But does it reduce or increase the rate of cigarette smoking?
A study of 15,000 Swedish men showed that about 18% of cigarette users had started out using snus. However, a far larger number of study participants quit smoking via snus. Among younger people, snus accounted for 6 people quitting cigarettes for every 1 person who started. Among older people this beneficial effect was much smaller, but still present. Sweden’s declining lung cancer rate is thus almost certainly at least in part due the use of snus.
In a different country, Finland, the picture is different. A study of 1151 Finnish men found that snus was used as a supplement to cigarette smoking rather than a replacement for it, creating greater nicotine dependence. This may be due to how the policies and use norms around snus are different in Finland. Unlike in Sweden for example, it’s illegal to import snus in Finland, which may change who uses it and how.
What the snus research shows is that whether a putatively safer form of tobacco is beneficial to public health or not will vary based on the population who uses it, how they use it, and the public policies and cultural norms around it. We could very well see a similar pattern – or better said, a lack of pattern – in the impact of E-cigarettes around the world.