Between harm and dangers. Oral snuff use, cigarette smoking and problem behaviours in a survey of Swedish male adolescents

BACKGROUND: The prevalence of smokeless tobacco use (moist snuff) in Sweden is among the highest world-wide, and snuff is gaining popularity as a less harmful alternative to cigarettes. METHODS: Patterns of current tobacco use and indicators of behavioural problems were analysed in a sample of 6287 boys participating in a census survey among 9th graders in Stockholm County, Sweden. RESULTS: Among participants reporting current use of oral snuff (OS) the majority (71%) also smoked cigarettes. The prevalence of daily smoking was significantly higher in this group than among exclusive smokers. Conditionally on smoking behaviour, the likelihood of being a current user of OS was several times higher among boys who had ever been drunk (adjusted odds ratio = 9.64, 95% confidence interval: 7.32-12.94) or experimented with illicit drugs (adjusted odds ratio = 2.39, 95% confidence interval: 1.99-2.87), compared with those who did not. OS use was also significantly associated to other problem behaviours such as drinking and driving, unsafe sex, and school truancy. The same pattern of associations was present when the analyses were restricted to tobacco users. CONCLUSIONS: Smokeless tobacco use in adolescence does not substitute cigarette smoking and can be an indicator of a drug- and risk-seeking lifestyle. The availability of smokeless tobacco might thus increase the potential for nicotine addiction in some vulnerable subgroups of young males.