Tobacco Harm Reduction in the real world: has the availability of snus in Norway increased smoking cessation?

In Norway, snus (low nitrosamine smokeless tobacco) is allowed to compete with cigarettes for market share, and over the past decades the prevalence of snus users has increased as the prevalence of smokers has decreased. The author has aimed to sum up the findings from research that has tried to identify the role of snus in smoking cessation and how availability to snus in Norway has affected the magnitude of concomitant use of snus and cigarettes. Relevant results from Norwegian studies are presented, and, if possible, compared to findings from studies conducted in other countries. Snus is reported by ever-smokers to be the most preferred method for quitting, and former smokers make up the largest segment of Norwegian snus users. The quit rate for smoking is consistently observed to be higher for snus users than for smokers who have no experience of use of snus. Moreover, those using snus are more likely to have quit smoking completely or considerably reduced their cigarette smoking than users of medicinal smoking cessation products. The increase in snus use among men in Norway has not been paralleled by an increase in dual use of snus and cigarettes. The results observed in Norway might not be extrapolated to other countries that do not have the same history of use of snus. The replacement of cigarettes by snus has been the most typical pattern of use in Norway, and the availability of snus may have been beneficial to public health. Besides neighbouring Sweden, Norway is the only country in the eurozone with a tradition of snus use. Knowledge about the pattern of snus use in these countries is relevant for policymakers when deciding the legal status of snus in the EU

BE YE FRUITFUL AND MULTIPLY: DOES RELIGIOUS ACTIVATION INCREASE REPRODUCTIVE DESIRE?

While many norms sustain or destabilize certain religions, one domain is particularly relevant to the survival of some religions over others: norms about fertility and reproduction. Thus far, several ethnographic and correlational studies have found a positive association between religiosity and fertility rate, but there is a dearth of laboratory investigation utilizing experimental methods to isolate causation. In Study 1, I found that experimentally activating religious concepts led to an increased desire to have children (N = 462). In Study 2, the focal study, I attempted to replicate and extend the previous study by examining implicit behavior (N = 120). I predicted that individuals primed with religion would be more likely to show an implicit approach motivation towards images of children. Failing to support my hypothesis, participants with religion activated were no more likely to approach images of babies than controls. This null finding was not affected by taking into account several relevant covariates. Additionally, an exploratory investigation of the effect that religious community norms may have on reproductive behavior was conducted. I found that participants that come from religious communities in which sexual deviance is emphasized were more likely to approach baby images. Future directions are discussed

Contrasting smokers’ and snus users’ perceptions of their personal tobacco behavior in Norway

In Norway, snus use and cigarette smoking are at different developmental stages as described by the diffusion of innovation model. Concomitant with declining smoking rates, the use of snus is increasing. In light of these differences in use trends, we assumed that snus users and cigarette smokers would have different perceptions of their personal tobacco use. A total of 4 852 smokers and snus users were recruited from a large sample of online panellists (n=62 000) and a postal database (n=15 000). The responses to 16 evaluative statements assessing perceptions about tobacco use were compared between exclusive snus users and exclusive smokers, and within dual users. The statements concerned self-evaluative emotions, moral judgements, social disapproval, and benefits of quitting. The perceptions of personal tobacco use differed greatly between exclusive smokers and exclusive snus users, even after controlling for age and sex. Smoker’s perceptions were more negative compared with snus users’ perception. The differences between smoking and snus use were particularly large for indices of social disapproval (Cohen’s d=1.56) and benefits from quitting use of the product (Cohen’s d=1.47) between exclusive users. Dual users exhibited a similar pattern. Smokers have more negative perception of own use compared to snus users. Dual users also devaluates smoking in comparison to their snus use. This finding may have important values for prevention strategies targeting smokers, snus users, and dual users

Evaluering av helseadvarslene på tobakkspakkene

På oppdrag fra Sosial- og helsedirektoratet har SIRUS evaluert endringen i helseadvarsler på sigarettpakkene som ble foretatt høsten 2003. Fra 2004 økte advarselsmerkingens areal til 30 % av pakkens forside og 40 % av pakkens bakside, samtidig med at flere nye tekster ble innført. Evalueringen viste at det var høy oppmerksomhet rundt tiltaket blant voksne røykere i alderen 16-74 år. 91 % av de spurte hadde lagt merke til en økning i advarselstekstens størrelse. På spørsmål om prosessering, var det 25 % som rapporterte at de leste advarselsteksten godt, mens 66 % sa de ikke hadde lest innholdet i særlig grad. Som reaksjon på advarselsmerkingen oppga 36 % at de aktiverte tanker om røykeslutt, mens 28 % erklærte seg enig i at advarslene hadde gjort dem mer bekymret for egen helse. 41 % trodde at andre røykere ikke hadde eller ville legge merke til de nye helseadvarslene. 23 % syntes advarslene opptok for stor plass på tobakkspakkene. En undersøkelse blant ungdom som røykte viste at 73 % betraktet merkingen som troverdig, og 30 % oppga at advarslene reduserte deres lyst på å røyke. Datamaterialet i denne rapporten er hentet fra Sosial- og helsedirektoratets årlige tobakksundersøkelse 4. kvartal 2003 og 2004, utført av Statistisk sentralbyrå. Det er også anvendt data fra en undersøkelse om røyking blant ungdom gjennomført av Opinion på oppdrag fra Sosial- og helsedirektoratet høsten 200

Hardcore Smokers in Norway 1996–2009

In Norway, the prevalence of daily smoking has gradually declined from 50% among men and 30% among women in the early 1970s to 13% in both genders in 2015. The rate of occasional smoking has remained stable at approximately 10% in recent decades. Presumably, this decline in the historically prevalent and socially rooted practice of smoking signals the final stage of the tobacco epidemic, which is characterized by an increasing social gradient within the steadily decreasing segment of smokers. Norway was once a pioneer in tobacco control and introduced a comprehensive governmental program to reduce smoking, including a total ban on tobacco advertising starting in the mid-1970s. Since then, most of the policy instruments recommended by the World Health Organization to combat smoking have been implemented. In addition to a robust infrastructure for tobacco control, there has also been a focus on social denormalization strategies to make cigarettes less desirable and less accessible, and the act of smoking less acceptable. However, given the severe harm associated with smoking, the tobacco control community considers the decline in smoking to be too slow. In particular, there has been a concern for a possible asymptotic plateau in smoking rates. Whether smoking rates will tend to flatten in countries that have reached the last phase of the tobacco epidemic has also been an issue for researchers. One approach has been to investigate the number of “hardcore smokers” to test the much-discussed “hardening hypothesis”. Hardcore smokers are inveterate smokers who do not want to or are not able to quit smoking and therefore are considered a difficult segment to reach by traditional tobacco control measures. The hardening hypothesis postulates that the proportion of hardcore smokers will increase as smoking prevalence declines. The overall aim of this thesis is to increase our understanding of those who continue to smoke, as the normative and socio-material climate tends to facilitate non-smoking. I use various survey data sets to address four main topics in this thesis. The first paper investigates the size of the hardcore smoker group and whether the relative size of the group has changed over time in the population of smokers. We concluded that the size of the hardcore group of smokers remains relatively moderate in Norway, and we found little support for the hardening hypothesis. However, this conclusion depends upon how hardcore smokers are operationalized. Increased knowledge about the mechanisms underlying smokers’ willingness and/or ability to quit is needed. The second paper examines differences between smokers and snus users and their perceptions of their own tobacco use, self-evaluative emotions, perceived moral judgment and social disapproval of their tobacco use. Compared with snus users, we observed that smokers tend to hold more negative emotions about and experience more social disapproval of their tobacco behaviour. Social inequality in smoking behaviour is addressed in the third paper. More precisely, I set out to explore the associations between education, income and the risk of smoking. I conclude that low education is associated with a greater risk of dependence, heavy smoking and having no intention to quit. The last paper in this thesis explored public opinions for 16 novel tobacco control strategies. Smokers opposed all of the proposed strategies except banning smoking in cars carrying children, increasing the age limit for purchasing cigarettes, and banning smoking at transportation stops. The legitimacy of the newly proposed tobacco control measures is discussed within a justification framework. Overall, I conclude that many smokers experience a subjective feeling of stigmatization, they express resistance to increased tobacco control measures and there are some signs of social marginalization processes. In the thesis, these results are discussed in a social inequality and social resistance framework. In addition, smoking is discussed in relation to social stigma and neutralization of risk. The mechanisms underlying the inequality, stigmatization and resistance associated with smoking behaviour need further investigation