Use of oral moist tobacco (snus) in puberty and its association with asthma in the population-based RHINESSA study

Juan Pablo López-Cervantes; Vivi Schlünssen; Chamara Senaratna; Simone Accordini; Francisco Javier Callejas; Karl A. Franklin; Mathias Holm; Nils Oskar Jogi; Andrei Malinovschi; Anna Oudin; Torben Sigsgaard; Elin Helga Thorarinsdottir; Christer Janson; Randi Jacobsen Bertelsen; Cecilie Svanes

doi:10.1136/bmjresp-2024-002401

Use of oral moist tobacco (snus) in puberty and its association with asthma in the population-based RHINESSA study

Juan Pablo López-Cervantes^*, Vivi Schlünssen, Chamara Senaratna, Simone Accordini, Francisco Javier Callejas, Karl A. Franklin, Mathias Holm, Nils Oskar Jogi, Andrei Malinovschi, Anna Oudin, Torben Sigsgaard, Elin Helga Thorarinsdottir, Christer Janson, Randi Jacobsen Bertelsen, Cecilie Svanes

^*Corresponding author for this work

Department of Public Health - Institute of Environmental and Occupational Medicine

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

Abstract

Objectives To investigate the association of early snus use initiation (≤15 years of age) with asthma and asthma symptoms. Design Cross-sectional analysis of a population-based cohort. Setting Study centres in Norway, Sweden, Iceland, Denmark and Estonia, from 2016 to 2019. Participants 9002 male and female participants above 15 years of age of the Respiratory Health in Northern Europe, Spain and Australia study. Main outcome measures Current asthma and asthma symptoms. Results The median age of study participants was 28 years (range 15-53) and 58% were women. 20% had used snus, 29% men and 14% women. Overall, 26% of males and 14% of females using snus started ≤15 years of age. Early snus use initiation was associated with having three or more asthma symptoms (OR 2.70; 95% CI 1.46 to 5.00) and a higher asthma symptom score (β-coefficient (β) 0.35; 95% CI 0.07 to 0.63) in women. These associations were weak in men (OR 1.23; 95% CI 0.78 to 1.94; β 0.16; 95% CI -0.06 to 0.38, respectively). There was evidence for an association of early snus initiation with current asthma (OR 1.72; 95% CI 0.88 to 3.37 in women; OR 1.31; 95% CI 0.84 to 2.06 in men). A sensitivity analysis among participants without smoking history showed stronger estimates for all three outcomes, in both men and women, statistically significant for three or more asthma symptoms in women (OR 3.28; 95% CI 1.18 to 9.10). Finally, no consistent associations with asthma outcomes were found for starting snus after age 15 years. Conclusions Snus initiation in puberty was associated with higher likelihood of asthma and asthma symptoms, with the highest estimates in females and those without smoking history. These results raise concerns about the health adversities of early snus initiation and emphasise the need for public health initiatives to protect young people from this tobacco product.

Original language	English
Article number	e002401
Journal	BMJ Open Respiratory Research
Volume	11
Issue	1
ISSN	2052-4439
DOIs	https://doi.org/10.1136/bmjresp-2024-002401
Publication status	Published - Jul 2024

Keywords

Asthma
Asthma Epidemiology
Surveys and Questionnaires
Tobacco and the lung

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10.1136/bmjresp-2024-002401Licence: CC BY

Cite this

López-Cervantes, J. P., Schlünssen, V., Senaratna, C., Accordini, S., Callejas, F. J., Franklin, K. A., Holm, M., Jogi, N. O., Malinovschi, A., Oudin, A., Sigsgaard, T., Thorarinsdottir, E. H., Janson, C., Bertelsen, R. J., & Svanes, C. (2024). Use of oral moist tobacco (snus) in puberty and its association with asthma in the population-based RHINESSA study. BMJ Open Respiratory Research, 11(1), Article e002401. https://doi.org/10.1136/bmjresp-2024-002401

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title = "Use of oral moist tobacco (snus) in puberty and its association with asthma in the population-based RHINESSA study",

abstract = "Objectives To investigate the association of early snus use initiation (≤15 years of age) with asthma and asthma symptoms. Design Cross-sectional analysis of a population-based cohort. Setting Study centres in Norway, Sweden, Iceland, Denmark and Estonia, from 2016 to 2019. Participants 9002 male and female participants above 15 years of age of the Respiratory Health in Northern Europe, Spain and Australia study. Main outcome measures Current asthma and asthma symptoms. Results The median age of study participants was 28 years (range 15-53) and 58% were women. 20% had used snus, 29% men and 14% women. Overall, 26% of males and 14% of females using snus started ≤15 years of age. Early snus use initiation was associated with having three or more asthma symptoms (OR 2.70; 95% CI 1.46 to 5.00) and a higher asthma symptom score (β-coefficient (β) 0.35; 95% CI 0.07 to 0.63) in women. These associations were weak in men (OR 1.23; 95% CI 0.78 to 1.94; β 0.16; 95% CI -0.06 to 0.38, respectively). There was evidence for an association of early snus initiation with current asthma (OR 1.72; 95% CI 0.88 to 3.37 in women; OR 1.31; 95% CI 0.84 to 2.06 in men). A sensitivity analysis among participants without smoking history showed stronger estimates for all three outcomes, in both men and women, statistically significant for three or more asthma symptoms in women (OR 3.28; 95% CI 1.18 to 9.10). Finally, no consistent associations with asthma outcomes were found for starting snus after age 15 years. Conclusions Snus initiation in puberty was associated with higher likelihood of asthma and asthma symptoms, with the highest estimates in females and those without smoking history. These results raise concerns about the health adversities of early snus initiation and emphasise the need for public health initiatives to protect young people from this tobacco product.",

keywords = "Asthma, Asthma Epidemiology, Surveys and Questionnaires, Tobacco and the lung",

author = "L{\'o}pez-Cervantes, {Juan Pablo} and Vivi Schl{\"u}nssen and Chamara Senaratna and Simone Accordini and Callejas, {Francisco Javier} and Franklin, {Karl A.} and Mathias Holm and Jogi, {Nils Oskar} and Andrei Malinovschi and Anna Oudin and Torben Sigsgaard and Thorarinsdottir, {Elin Helga} and Christer Janson and Bertelsen, {Randi Jacobsen} and Cecilie Svanes",

note = "Publisher Copyright: {\textcopyright} Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.",

year = "2024",

month = jul,

doi = "10.1136/bmjresp-2024-002401",

language = "English",

volume = "11",

journal = "BMJ Open Respiratory Research",

issn = "2052-4439",

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number = "1",

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López-Cervantes, JP, Schlünssen, V, Senaratna, C, Accordini, S, Callejas, FJ, Franklin, KA, Holm, M, Jogi, NO, Malinovschi, A, Oudin, A, Sigsgaard, T, Thorarinsdottir, EH, Janson, C, Bertelsen, RJ & Svanes, C 2024, 'Use of oral moist tobacco (snus) in puberty and its association with asthma in the population-based RHINESSA study', BMJ Open Respiratory Research, vol. 11, no. 1, e002401. https://doi.org/10.1136/bmjresp-2024-002401

Use of oral moist tobacco (snus) in puberty and its association with asthma in the population-based RHINESSA study. / López-Cervantes, Juan Pablo; Schlünssen, Vivi; Senaratna, Chamara et al.
In: BMJ Open Respiratory Research, Vol. 11, No. 1, e002401, 07.2024.

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

TY - JOUR

T1 - Use of oral moist tobacco (snus) in puberty and its association with asthma in the population-based RHINESSA study

AU - López-Cervantes, Juan Pablo

AU - Schlünssen, Vivi

AU - Senaratna, Chamara

AU - Accordini, Simone

AU - Callejas, Francisco Javier

AU - Franklin, Karl A.

AU - Holm, Mathias

AU - Jogi, Nils Oskar

AU - Malinovschi, Andrei

AU - Oudin, Anna

AU - Sigsgaard, Torben

AU - Thorarinsdottir, Elin Helga

AU - Janson, Christer

AU - Bertelsen, Randi Jacobsen

AU - Svanes, Cecilie

PY - 2024/7

Y1 - 2024/7

N2 - Objectives To investigate the association of early snus use initiation (≤15 years of age) with asthma and asthma symptoms. Design Cross-sectional analysis of a population-based cohort. Setting Study centres in Norway, Sweden, Iceland, Denmark and Estonia, from 2016 to 2019. Participants 9002 male and female participants above 15 years of age of the Respiratory Health in Northern Europe, Spain and Australia study. Main outcome measures Current asthma and asthma symptoms. Results The median age of study participants was 28 years (range 15-53) and 58% were women. 20% had used snus, 29% men and 14% women. Overall, 26% of males and 14% of females using snus started ≤15 years of age. Early snus use initiation was associated with having three or more asthma symptoms (OR 2.70; 95% CI 1.46 to 5.00) and a higher asthma symptom score (β-coefficient (β) 0.35; 95% CI 0.07 to 0.63) in women. These associations were weak in men (OR 1.23; 95% CI 0.78 to 1.94; β 0.16; 95% CI -0.06 to 0.38, respectively). There was evidence for an association of early snus initiation with current asthma (OR 1.72; 95% CI 0.88 to 3.37 in women; OR 1.31; 95% CI 0.84 to 2.06 in men). A sensitivity analysis among participants without smoking history showed stronger estimates for all three outcomes, in both men and women, statistically significant for three or more asthma symptoms in women (OR 3.28; 95% CI 1.18 to 9.10). Finally, no consistent associations with asthma outcomes were found for starting snus after age 15 years. Conclusions Snus initiation in puberty was associated with higher likelihood of asthma and asthma symptoms, with the highest estimates in females and those without smoking history. These results raise concerns about the health adversities of early snus initiation and emphasise the need for public health initiatives to protect young people from this tobacco product.

AB - Objectives To investigate the association of early snus use initiation (≤15 years of age) with asthma and asthma symptoms. Design Cross-sectional analysis of a population-based cohort. Setting Study centres in Norway, Sweden, Iceland, Denmark and Estonia, from 2016 to 2019. Participants 9002 male and female participants above 15 years of age of the Respiratory Health in Northern Europe, Spain and Australia study. Main outcome measures Current asthma and asthma symptoms. Results The median age of study participants was 28 years (range 15-53) and 58% were women. 20% had used snus, 29% men and 14% women. Overall, 26% of males and 14% of females using snus started ≤15 years of age. Early snus use initiation was associated with having three or more asthma symptoms (OR 2.70; 95% CI 1.46 to 5.00) and a higher asthma symptom score (β-coefficient (β) 0.35; 95% CI 0.07 to 0.63) in women. These associations were weak in men (OR 1.23; 95% CI 0.78 to 1.94; β 0.16; 95% CI -0.06 to 0.38, respectively). There was evidence for an association of early snus initiation with current asthma (OR 1.72; 95% CI 0.88 to 3.37 in women; OR 1.31; 95% CI 0.84 to 2.06 in men). A sensitivity analysis among participants without smoking history showed stronger estimates for all three outcomes, in both men and women, statistically significant for three or more asthma symptoms in women (OR 3.28; 95% CI 1.18 to 9.10). Finally, no consistent associations with asthma outcomes were found for starting snus after age 15 years. Conclusions Snus initiation in puberty was associated with higher likelihood of asthma and asthma symptoms, with the highest estimates in females and those without smoking history. These results raise concerns about the health adversities of early snus initiation and emphasise the need for public health initiatives to protect young people from this tobacco product.

KW - Asthma

KW - Asthma Epidemiology

KW - Surveys and Questionnaires

KW - Tobacco and the lung

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U2 - 10.1136/bmjresp-2024-002401

DO - 10.1136/bmjresp-2024-002401

M3 - Journal article

C2 - 39038916

AN - SCOPUS:85199525467

SN - 2052-4439

VL - 11

JO - BMJ Open Respiratory Research

JF - BMJ Open Respiratory Research

IS - 1

M1 - e002401

ER -

Use of oral moist tobacco (snus) in puberty and its association with asthma in the population-based RHINESSA study

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