Correlates of the use of different nicotine strengths in smokeless tobacco (snus) and oral nicotine pouches among the Finnish general population.

Abstract

Introduction: Snus and oral nicotine pouches (ONPs) include different levels of nicotine, yet little is known about their correlates of use. Our aim was to study the correlates of use of snus and ONPs with different nicotine levels.

Methods: We used population-based Drug Survey 2022, including 15-69-year-old respondents (n=3857, response rate 47%). Persons who had ever used the products were included in further analyses (29% (n=1611) according to snus use and 14% (n=589) according to ONP use). Outcomes included self-reported strength of snus (normal, strong, extra strong and do not know)/ONPs (≤ 4 mg, > 4 mg and do not know) and covariates included demographic, tobacco and substance use-related variables. Logistic regression analyses were used.

Results: 31% of persons who had ever used snus reported using snus labelled as normal and 43% of persons who had ever used ONPs reported using lower nicotine-level ONPs. About one-third of respondents did not know the nicotine content of the used product. For stronger snus use, multivariable models showed an association with male gender, younger age, current/former snus use, hazardous alcohol and lifetime cannabis use, while younger age and current use of snus and e-cigarettes were associated with stronger ONP use.

Discussion: Not knowing the nicotine level of the used snus or ONPs was common among the Finnish population having used the products. Younger age and the use of snus are associated with the use of stronger snus and ONPs. The nicotine levels and addictiveness of oral tobacco and nicotine products should be regulated.