Tobacco.org

• Swedish Match under fire in secret snus substance investigation  

Tobacco company Swedish Match has been accused of adding a substance to moist snuff or 'snus' to purposely increase user dependency and, in turn, boosts sales of their products.

Since 2005, the company has introduced eight new snus products with higher than average nicotine levels.

The usual level for snus is eight milligrams per gram. In one product, levels have almost doubled that figure.

”Certain consumer groups have shown demand for a high nicotine content,” the company’s production director Torbjörn Åkeson explains.

Allegations that the company adds a substance, known as E500, to purposely increase the amount of so-called ‘free’ nicotine – which increases dependency – are presented in a new report by investigative news programme Kalla Fakta. . . .

Yet, Professor Greg Connolly at the Harvard School of Public Health believes that Swedish Match is consciously using the substance to increase addiction and their profits.

”In a study in 2008 he concluded that we are manipulating the pH value, something that we consider hugely speculative,” Brehmer adds.

”It never led to demands from any authority that we need to change something.”

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• Smoking Raises Arthritis Risk and Makes It Harder to Treat  

Smoking cigarettes can lead to the development of rheumatic diseases and make them harder to treat, according to three new studies presented this week at the 2009 annual meeting of the American College of Rheumatology in Philadelphia.

The first study focused on what happens when people with rheumatoid arthritis light up while being treated for the disease.

Researchers looked at the medical records of 1,756 rheumatoid arthritis (RA) patients in Sweden, determined their smoking history or lack thereof and then looked at their response to methotrexate or anti-TNF therapy - two common RA treatments. . . .

Mark Fisher, MD, MPH, a rheumatologist at Massachusetts General Hospital in Boston says he found this the most impressive study of the three. "There aren't any studies that show smoking has an effect on response to methotrexate and it was a really well done study. So for those reasons I think it's significant," Dr. Fisher says.

A second study found that smoking is associated with organ damage and disease activity in people with systemic lupus erythematosus, a chronic inflammatory disease that can affect the skin, joints, kidneys, lungs, nervous system and other organs.

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Tobacco in Sweden 

Another year of declining volume sales

The Swedish tobacco market saw another year of falling sales in 2008 as all sectors posted a decline in volume terms. On the one hand, tax increases in early 2008 had a negative effect on volume sales, while social opposition to smoking, on the other, is also growing, underpinned by a booming health trend. As a result, the market’s consumer base is shrinking. The economic financial turmoil towards the end of 2008 also pushed many consumers to try to quit the habit or trade down to economy brands.

Tax rises across the industry in 2008

The major event affecting the Swedish tobacco market in 2008 was increased taxation on tobacco products. The tax increases were felt across the industry, making, for example, retail prices of cigarettes, cigars and cigarillos on average 3% more expensive, while smoking tobacco retail prices increased by almost 40% compared to 2007. The reason behind the significant increase on smoking tobacco was to eliminate tax differences between smoking tobacco and traditional cigarettes. As a result of the tax increases, the market posted stronger current value growth in 2008 compared to the review period CAGR.

Multinationals dominate the Swedish tobacco market

Tobacco in Sweden is rather consolidated and led by multinationals and their local subsidiaries. The major players are JTI Sweden AB, House of Prince AB, Philip Morris AB as well as domestic company Swedish Match AB. The leading multinationals have achieved their strong positions thanks to acquisitions of local operators as well as economies of scale, giving them advantages in terms of product development and ability to invest in advertising and promotional support for their products. Domestic player Swedish Match AB’s strength can be explained by its strong position in Swedish-style snus, which it completely dominated in 2008, despite increasing international presence and competition. Due to tax increases on tobacco as well as market entries such as Lidl, economy cigarette brands expanded their presence in Sweden over the review period. As a result, almost all of the leading multinationals lost share over the last five-year period.

Grocery retailers the most important distribution channel . . .

Declining volume sales but positive constant value growth

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• Smoking pregnant increases baby's asthma risk: study 

Smoking during pregancy increases the risk of a baby developing asthma up to sixfold, said a Swedish study published at the European Respiratory Society's annual congress on Monday.

The study by Professeur Anders Bjerg of the Sunderby central hospital in Norrbotten and his specialists showed that smoking leads to babies being born underweight, a fact that has an impact on the development of asthma.

The Swedish doctors studied asthma in about 3,400 children between 1996 and 2008.

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Sweden wants EU to lift 'snus' tobacco ban 

As countries across the EU curb smoking, Sweden is fighting to get a European-wide ban lifted on 'snus,' a moist tobacco popular across Scandinavia that is sucked rather than chewed or smoked.

The small, teabag-like pouches, also called moist snuff, are used by nearly one million Swedes. Placed under the user's lip, they quickly deliver a nicotine rush to the blood and a strong salt and herbs flavour in the mouth.

While cigarette sales have tumbled by 50 percent in Sweden over the past 30 years, snus is on the up, with sales rising from some 2,500 tonnes a year in the 1970s to almost 7,500 tonnes in 2008.

That equals some 800 sachets a year for the average Swedish snus user.

It is also popular in other parts of the Nordic region. . . .

In its role at the helm of the EU presidency, Sweden is in prime position to make its case and Stockholm has intensified talks with the European Commission and other member states on the subject.

"As the presidency, you're not supposed to put things on the agenda that can be seen as national priorities ... But on the other hand, we cannot rule out that this issue will come up in some form during other discussions," Swedish Trade Minister Ewa Bj�rling told AFP in a telephone interview.

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The Market For Tobacco In Sweden Increased At A Compound Annual Growth Rate Of 4.1% Between 2003 And 2008 

Tobacco in Sweden to 2013

This databook provides key data and information on the tobacco market in Sweden. This report is a comprehensive resource for market, category and segment level data including value, volume, distribution share and company & brand share. This report also provides expenditure and consumption data for the historic and forecast periods.

Scope

*Contains information on four categories: cigarettes, cigars and cigarillos, loose tobacco and chewing tobacco

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Swedish woman banned from smoking in her yard because neighbour is allergic 

A Swedish woman has been banned from smoking in her own back garden because her neighbour is allergic to cigarette smoke.

The cigarette row has rocked the city of Akarpin in southern Sweden, where the Environment Court banned Ingela Olofsson from smoking in her yard after hearing that her neighbour - Michael Berggren, a lawyer - has to wear an oxygen mask when walking from the house to the car.

"This is insane," Olofsson said.

The row started when the lawyer bought the house next to Olofsson three years ago. Berggren says that he initially asked her to smoke somewhere else than next to his garden.

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Cigarettes, Not Swedish Snuff Linked To Increased Risk Of MS 

While smoking cigarettes appears to significantly increase a person's risk of developing multiple sclerosis, using Swedish snuff does not, according to a study published in the September 1, 2009, print issue of Neurology®, the medical journal of the American Academy of Neurology.

"While tobacco cigarettes increased a person's risk of developing MS, our research found that using Swedish snuff was not associated with an elevated risk for MS," said study author Anna Hedstr�m, MD, of the Swedish medical university Karolinska Institutet in Stockholm."These results could mean that nicotine is not the substance responsible for the increased risk of MS among smokers."

The study involved 902 people diagnosed with MS and 1,855 people without MS in Sweden between the ages of 16 and 70. All participants answered a questionnaire about tobacco cigarettes and snuff use.

The researchers found that in women who smoked, the risk for developing MS was nearly one and a half times higher than in women who did not smoke. In men, the risk was nearly two times higher in those who smoked compared to those who did not smoke. This was the case even in people who only smoked moderately.

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Tobacco smoking, but not Swedish snuff use, increases the risk of multiple sclerosis  

Conclusions: Smokers of both sexes run an increased risk of developing multiple sclerosis (MS), and the risk increases with cumulative dose of smoking. However, the use of Swedish snuff is not associated with elevated risk for MS, which may indicate that nicotine is not the substance responsible for the increased risk of developing MS among smokers.

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Smoking as an independent risk factor for myocardial infarction or stroke in type 2 diabetes: a report from the Swedish National Diabetes Register  

Discussion

This observational study of patients with type 2 diabetes showed that the HR was high for fatal/nonfatal MI and total mortality in relation to smoking, especially in middle-aged more frequently smoking patients (HR 2.3 and 2.4). The HR for smoking and risk of fatal/nonfatal MI was higher than for smoking and fatal/nonfatal stroke (HR 1.7 vs. 1.3), especially in more frequently smoking (22%), middle-aged patients (HR 2.3 vs. 1.1). Furthermore, the HR was also higher for fatal than for nonfatal MI (HR 2.1 vs. 1.4). The highest PARp was observed for MI and total mortality in more frequently smoking, middle-aged patients (24%). . . .

According to our findings, and as also pointed out in recent clinical guidelines for diabetes care [31], smoking cessation should be a main target for the prevention of CVDs in patients with type 2 diabetes, and is also very cost-effective [32]. New methods to improve the quit rate of smokers include both nondrug (structural) [32] and drug-based methods [33], which might be particularly helpful in patients with diabetes. As PARp for CVDs and mortality should vary with differing frequencies of smoking, as observed in this study with the highest PARp for MI and total mortality in more frequently smoking, middle-aged patients, this implies that smoking cessation should be integrated in a multiple risk factor control programme. This was shown in the Steno-2 trial, where a decrease in smoking rate was combined with a successful decrease in other risk factors in the intensively treated group [34]. . . .

In conclusion, smoking is not only a long-term risk factor for type 2 diabetes [36], but also an important and independent cardiovascular risk factor in patients with established type 2 diabetes. The relative risk related to smoking was high for MI and total mortality, especially in middle-aged, more frequently smoking patients, and was higher for MI than for stroke, fatal than for nonfatal events. The highest partial PARp was observed for MI and total mortality in middle-aged, more frequently smoking patients. These findings should be considered for preventive programmes in patients with type 2 diabetes because of their high risk of CVDs.

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Smoking increases risk for MI and death in Type 2 diabetics 

Study results show that smoking significantly increases the risk for myocardial infarction (MI) and death in individuals with Type 2 diabetes, a group already at higher risk for cardiovascular disease than the general population.

“Smoking is one of the classical risk factors for cardiovascular disease (CVD) besides hypertension, hyperlipidemia, and diabetes, and contributes substantially to the global burden of disease,” say Peter Nillson (Lund University, Malm�, Sweden) and colleagues.

Researchers from the Swedish National Diabetes Register carried out a longitudinal study of 13,087 men and women with Type 2 diabetes, who had no previous MI or stroke at baseline, to assess the effect of smoking versus nonsmoking on risk for CVD.

The participants were aged 30–74 years at baseline and were followed up for an average period of 5.7 years.

Writing in the European Journal of Cardiovascular Prevention and Rehabilitation, the team reports that the adjusted risks for fatal or nonfatal MI, stroke, and total mortality were 70%, 30%, and 80% higher for participants who smoked (n=2150) than for those who did not smoke.

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• Use of smokeless tobacco and risk of myocardial infarction and stroke: systematic review with meta-analysis  

In conclusion, in studies carried out in the United States and Sweden we detected an association between use of smokeless tobacco products and risk of fatal myocardial infarction and fatal stroke, which is not readily explained by chance. Confounding and other sources of bias, however, cannot be completely excluded on the basis of available data, although we found no strong evidence for their effect. If the association is real, its public health and clinical implications might be substantial, despite the fact that the magnitude of the excess risk is small. Future research should aim to clarify the mechanisms of effect of smokeless tobacco products on deaths from cardiovascular disease and to elucidate whether a similar effect is present for non-fatal myocardial infarction and non-fatal stroke.

What is already known on this topic Smokeless tobacco products are widely used in many populations An association with risk of cardiovascular disease is plausible

What this study adds This systematic review and meta-analysis provided evidence for an association between use of smokeless products and risk of fatal myocardial infarction and stroke . . .

CV Risk Seen With Smokeless Tobacco  

Action Points

* Explain to interested patients that smokeless products such as snuff and chewing tobacco may carry risks for fatal heart attacks and strokes.

* Explain that a study showed that the risks were small but the public health implications may be significant.

The use of smokeless tobacco products was associated with an increased risk for fatal myocardial infarction (MI) and stroke, a meta-analysis found.

For fatal MI, the relative risk associated with ever having used these products was 1.13 (95% CI 1.06 to 1.21), according to Paolo Boffetta, MD, and Kurt Straif, MD, PhD, of the International Agency for Research on Cancer in Lyon, France. . . .

Primary source: BMJ Source reference: Boffetta P, Straif K "Use of smokeless tobacco and risk of myocardial infarction and stroke: systematic review with meta-analysis"

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Smokeless Tobacco Increases Risk Of Heart Attack And Stroke, Research Finds 

People who use smokeless tobacco products like snus have a slightly higher risk of having a fatal heart attack or stroke, according to research published on bmj.com.

In the past few decades there has been an increase in the number of people in Europe and North America using smokeless tobacco, particularly among people younger than 40. Given that these products are being promoted as 'safer' alternatives to smoking cigarettes, the number of individuals using them is set to increase, says the study.

The research team, led by Dr Paolo Boffetta at International Agency for Research on Cancer in France, analysed the results of 11 studies carried out in Sweden and North America on the use of smokeless tobacco products and the risk of developing or dying from a heart attack or stroke.

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Use of smokeless tobacco and risk of myocardial infarction and stroke: systematic review with meta-analysis 

Design

Meta-analysis of observational studies from Sweden and the United States. . . .

Conclusion

An association was detected between use of smokeless tobacco products and risk of fatal myocardial infarction and stroke, which does not seem to be explained by chance.

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