Its a harm reduction epidemic!! Somebody do something!

Thanks to J Anzalone for twittering re this study that I somehow missed when it came out.

This Norwegian article published in Nicotine and Tobacco Research (Feb 2011) is much more interesting than it sounds (Expectancies and Intentions to Use Snus Among Norwegian First-Year Students). Its not so much the findings, which are as straightforward and undumbfounding as they possibly could be. Its more about the thinking around the findings which in less creative individuals would have manifested themselves simply as misinterpretations but here have emerged as wonderfully rendered examples of oracular thinking. (This is where a story (or tradition) is maintained despite any facts to the contrary; the logic of a predetermined narrative override any logic which would naturally emerge from the data).

In this case the story is that nicotine or tobacco use is bad, period.

The prevalence of use of snus (low-nitrosamine smokeless tobacco, Swedish type) has reached epidemic proportions in parts of Northern Europe, and the trend is escalating.

If this had been a North American paper, that statement would have been followed up by citing old and now discredited sources such as Winn to dwell on the potential harms of using smokeless tobacco. But in the inscrutable ways of Norwegian tobacco control thinking, the case is made that using snus is much less harmful than smoking and respectable sources of evidence are cited.

The study itself was run in order to see what expectancies led to using snus, and lo and behold, one of the main determinants was knowing that its use was low risk and safer than smoking. So, these on average 20 year old Norwegians are using snus because they think it is low risk, and though this particular study did not find using snus to quit smoking to be a significant factor, I suspect that if the group had been a little older, quitting smoking would have been of greater interest to more of the participants. The authors do write that quitting smoking is one of the drivers of increasing snus use in Scandinavia. Or in their words:

It can thus be argued that snus is a better alternative for those who otherwise would have started to smoke cigarettes (a possible immunization effect) and that snus could be a quitting alternative for cigarette users who are not able or willing to quit.

So this epidemic is one of people using a product because it has little risk and/or because it helps them replace a high risk behavior (smoking). Sure sounds like it is time to call in the health police.

But come the discussion and:

Given that health authorities want to encourage adolescents quit using snus, the results suggest that it might be useful to target expectancies related to health risks in persuasive communications.

So what are they exactly saying here? That they wish to misrepresent the risk (because these users are aware that the risk is low)? They have already made the case that using snus is protective for smoking, that it helps people quit and that it is low risk.

Now you would think that if the authors were paying attention to all the parts they had laid before us that the obvious conclusion would be to question the motives of the health authorities rather than actually suggesting lying to the public which could very well help reverse the trend away from smoking in Norway. Or alternatively to rejoice in the fact that people attracted to nicotine know which product is safer, and they are acting on that knowledge.

We should have more epidemics like this!

2 thoughts on “Its a harm reduction epidemic!! Somebody do something!

  1. Yes, a Swedish student came to my office last week and after he saw my snus (brought over by a Swedish colleague) we got talking about it. He told me as a teenager he was a heavy smoker, and his doctor advised him to switch to snus. I then had to break the news that all the Swedish snus sellers had stopped posting to the UK (and all the EU) after a complaint from a Finnish cancer organisation. I’ll never understand what goes through these people’s heads.

  2. Finland? How unfortunately serendipitous. Minutes ago, I just tweeted on how that country’s turn to right wing extremism seems in line with its tobacco extremism (TobHrmReduct THRorg team
    Finland turns right wing extremist (just like their tobacco stance (;

    Seems they are not quite content with just oppressing their own population but need to internationally nanny as well.

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