Changing patterns of tobacco use in a middle-aged population – the role of snus, gender, age, and education

Figures & data

Table 1. Prevalence (%) of smoking by two different classifications among participants in the VIP, Sweden

	Men	Women
	n=47,850	n=51,531
Classification I*
Never smoker	45.7	47.7
Former smoker	34.8	30.0
Current smoker	19.6	22.3
Classification II**
Not smoking	49.3	51.2
Former smoker	34.8	30.0
Daily smoking	16.0	18.8

Note: Values are mean values for the period 1990–2007. The difference between the two classifications is statistically significant in both men and women (p < 0.001).

*Classification I: Intermittent smokers are categorized as current smokers. Classification I is used throughout this paper.

**Classification II: Intermittent smokers are categorized with never smokers as not smoking.

Table 2. Distribution (%) of tobacco use and attained educational level among men and women who participated in the VIP, Sweden, 1990–2007. There were statistically significant differences (p < 0.001) for tobacco habits in all comparisons between periods in both men and women, and between men and women in all three periods, and also for education in all comparisons between periods in both men and women. Furthermore, in education comparisons between men and women in the three periods were statistically significant (p < 0.001), except among 60-year-olds, among whom there was no difference between men and women during 1990–1995 p=0.82 and in the period 1996–2001 the difference was significant with p=0.004

	1990–1995	1996–2001	2002–2007	1990–1995	1996–2001	2002–2007
	Men, 40-year-olds			Women, 40-year-olds
Number	4,976	5,323	6,055	5,599	5,774	6,286
Tobacco
Never smoker, never used snus	30.4	37.8	44.2	39.5	42.1	52.8
Never smoker, former snus user	3.9	5.1	6.6	0.3	1.1	2.3
Never smoker, current snus user	6.5	12.4	15.8	0.3	1.6	3.9
Former smoker, never used snus	9.5	7.0	4.0	24.2	23.0	15.0
Former smoker, former snus user	9.0	6.7	4.3	1.6	3.7	3.9
Former smoker, current snus user	12.9	13.1	12.3	1.7	5.0	7.9
Current smoker, never used snus	13.2	8.0	4.7	29.8	19.7	10.2
Current smoker, former snus user	6.4	4.0	2.4	1.3	2.1	2.0
Current smoker, current snus user	8.1	6.0	5.6	1.2	1.9	2.1
Education
Basic, 9 years	18.0	13.4	6.9	15.3	10.5	5.2
Mid-level, 10–12 years	58.1	62.6	65.5	51.6	54.6	54.1
High, university	23.9	24.0	27.6	33.1	34.9	40.7
	Men, 50-year-olds			Women, 50-year-olds
Number	4,641	6,203	6,348	5,245	6,436	6,698
Tobacco
Never smoker, never used snus	31.7	29.9	34.0	46.2	42.5	41.3
Never smoker, former snus user	2.5	3.4	5.7	0.1	0.1	0.5
Never smoker, current snus user	2.9	5.0	8.5	0.1	0.2	0.6
Former smoker, never used snus	17.5	13.8	9.4	25.0	28.7	27.7
Former smoker, former snus user	9.1	10.9	9.8	0.4	0.9	2.8
Former smoker, current snus user	9.4	14.7	15.3	0.4	2.2	5.6
Current smoker, never used snus	16.7	12.1	8.1	27.4	24.1	18.3
Current smoker, former snus user	4.1	4.0	3.2	0.2	0.5	1.1
Current smoker, current snus user	6.0	6.3	5.9	0.3	0.8	2.0
Education
Basic, 9 years	37.6	24.1	13.4	35.3	21.7	12.1
Mid-level, 10–12 years	42.9	53.1	60.6	42.0	45.6	49.9
High, university	19.5	22.8	26.1	22.7	32.7	38.0
	Men, 60-year-olds			Women, 60-year-olds
Number	3,371	4,520	6,413	3,911	4,972	6,610
Tobacco
Never smoker, never used snus	36.9	36.1	31.6	59.8	54.0	45.3
Never smoker, former snus user	1.3	2.3	2.9	0.0	0.0	0.1
Never smoker, current snus user	2.4	3.3	3.6	0.0	0.0	0.1
Former smoker, never used snus	22.9	20.9	19.3	21.4	26.8	32.5
Former smoker, former snus user	7.6	9.5	12.2	0.1	0.3	0.8
Former smoker, current snus user	8.8	10.6	13.9	0.2	0.7	2.4
Current smoker, never used snus	14.7	11.6	10.5	18.4	18.0	17.9
Current smoker, former snus user	2.6	2.5	2.6	0.1	0.1	0.3
Current smoker, current snus user	2.7	3.2	3.5	0.1	0.1	0.6
Education
Basic, 9 years	58.0	48.1	34.2	57.4	45.8	30.8
Mid-level, 10–12 years	30.9	37.3	45.1	31.2	37.4	42.9
High, university	11.1	14.6	20.7	11.5	16.8	26.3

Table 3. Number of former smokers among participants in the VIP, Sweden, during 1990–2007, and the proportion without a history of ever using snus, or with a history of former snus use. The rest of the participating former smokers were current snus users at the time of the health survey. All comparisons between periods in both men and women, as well as all comparisons between men and women in all three periods are statistically significant p < 0.001

	Men			Women
	1990–1995	1996–2001	2002–2007	1990–1995	1996–2001	2002–2007
40-Year-olds
Number	1,565	1,424	1,250	1,827	1,424	1,684
Never used snus (%)	30.4	26.3	19.5	87.9	72.7	55.8
Former snus user (%)	28.7	24.9	20.8	5.8	11.5	14.7
50-Year-olds
Number	1,673	2,443	2,194	1,354	2,050	2,423
Never used snus (%)	48.5	35.2	27.2	96.9	90.2	76.6
Former snus user (%)	25.3	27.6	28.4	1.7	2.9	7.8
60-Year-olds
Number	1,326	1,850	2,910	848	1,380	2,362
Never used snus (%)	58.2	51.0	42.6	98.7	96.4	90.9
Former snus user (%)	19.3	23.1	26.9	0.5	0.9	2.3

Figure 1.  Patterns of tobacco use among participants in the VIP, Sweden, from 1990 to 2007 by gender and educational status. Data are mean values for three 6-year periods, adjusted to the age-distribution for men and women in the whole dataset.

Table 4. Transition of tobacco use (%) from baseline during 1990–1997 until 10-year follow-up during 2000–2007 among participants in the VIP

Ten-year follow-up	Men at base line				Women at base line
	Tobacco-free n=6,846	Snus user n=2,218	Smoker n=1,792	Dual user n=765	Tobacco-free n=9,520	Snus user n=369	Smoker n=3,361	Dual user n=113
Tobacco-free	93.2	20.4	28.7	12.3	95.4	21.4	33.9	18.6
Snus user	4.2	73.5	12.8	45.0	1.4	70.5	7.6	49.6
Smoker	2.2	1.1	51.1	7.3	3.0	1.9	56.1	6.2
Dual user	0.4	5.0	7.4	34.4	0.2	6.2	2.4	25.7

Table 5. Tobacco use (%) by sex and attained educational level at baseline (Bl) during 1990–1997 and at follow-up (F) after 10 years during 2000–2007, and the change between surveys among participants in the Västerbotten Intervention Programme, Sweden, who were 30, 40 or 50 years old at baseline. The change from baseline to follow-up was not statistically significant among men who were 30 years old at baseline and with basic education (p = 0.213). Among 30 years old men with high education and 30 years old women with basic or high education the p-value was <0.05. All other p-values were <0.001.

	Men									Women
Education	Basic			Mid-level			High			Basic			Mid-level			High
	Bl	F	Change	Bl	F	Change	Bl	F	Change	Bl	F	Change	Bl	F	Change	Bl	F	Change
30-year olds	n=201			n=1759			n=34			n=200			n=1689			n=688
Tobacco-free	42.8	47.3	4.5	58.2	60.4	2.2	69.7	69.9	0.2	53.5	55.0	1.5	66.9	71.0	4.1	81.3	83.9	2.6
Snus-user	29.4	27.4	−2.0	25.0	28.1	3.1	17.1	21.4	4.3	6.0	13.5	7.5	7.4	11.8	4.4	6.4	8.6	2.2
Smoker	17.4	15.4	−2.0	9.7	6.0	−3.7	8.7	6.6	−2.1	37.0	29.5	−7.5	23.9	14.6	−9.3	11.6	6.7	−4.9
Dual user	10.4	10.0	−0.4	7.2	5.5	−1.7	4.6	2.0	−2.6	3.5	2.0	−1.5	1.8	2.6	0.8	0.7	0.9	0.2
p-value			0.213			<0.001			0.039			0.040			<0.001			0.002
40-year olds	n=718			n=2888			n=1073			n=745			n=2895			n=1759
Tobacco-free	47.6	52.9	5.3	55.0	59.6	4.6	62.8	69.1	6.3	59.1	64.3	5.2	66.4	71.8	5.4	77.9	83.4	5.5
Snus-user	20.9	22.8	1.9	22.2	24.5	2.3	19.6	21.8	2.2	1.3	6.3	5.0	2.6	5.7	3.1	3.4	5.6	2.2
Smoker	22.4	16.7	−5.7	14.9	9.6	−5.3	13.9	6.0	−7.9	39.5	27.7	−11.8	30.0	20.9	−9.1	17.2	9.9	−7.3
Dual user	9.1	7.5	−1.6	8	6.3	−1.7	3.7	3.2	−0.5	0.1	1.7	1.6	1.0	1.6	0.6	1.5	1.1	0.4
p-value			< 0.001			< 0.001			< 0.001			< 0.001			< 0.001			<0.001
50-year olds	n=1592			n=2094			n=884			n=1739			n=2308			n=1259
Tobacco-free	58.1	65.0	6.9	61.6	68.9	7.3	73.2	77.8	4.6	68.8	76.4	7.6	73.8	82.8	9.0	81.7	88.2	6.5
Snus-user	15.6	17.4	1.8	13.9	16.3	2.4	11.4	14.9	3.5	0.5	2.2	1.7	0.9	1.9	1.0	1.0	1.7	0.7
Smoker	19.7	14.1	−5.6	18.8	11.6	−7.2	11.1	5.7	−5.4	30.6	21.0	−9.6	25.1	15.1	−10.0	16.8	9.7	−7.1
Dual user	6.6	3.5	−3.1	5.7	3.2	−2.5	4.3	1.6	−2.7	0.2	0.4	0.2	0.1	0.2	0.1	0.5	0.3	−0.2
p-value			<0.001			<0.001			<0.001			<0.001			<0.001			<0.001