Snus undermines quit attempts but not abstinence: A randomised clinical trial among US smokers

Matthew J. Carpenter, Amy E. Wahlquist, Jessica L. Burris, Kevin M. Gray, Elizabeth Garrett-Mayer, K. Michael Cummings, Anthony J. Alberg

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


Background Observational studies and a few clinical trials suggest that use of low nitrosamine smokeless tobacco (snus) can facilitate smoking cessation. To better understand the real-world impact of snus on smoking behaviour, a large-scale, long-term clinical trial of naturalistic snus use among smokers is needed. Study design A nationwide clinical trial compared abstinence outcomes among smokers who were randomised to receive free samples of snus versus not. Participants (N=1236) were recruited throughout the US and assessed for 1 year following a 6-week naturalistic sampling period, with high retention throughout. Primary outcomes included self-reported quit attempts, floating abstinence (any 7-day period of non-smoking) and 7-day point-prevalence abstinence at 6 months and 12 months. Secondary outcomes were changes in smoking, motivation and confidence to quit and adverse events. No tobacco industry support was provided. Results Within snus group, 82% used at least once, and 16% were using regularly at end of sampling period. Compared to control participants, smokers in the snus group were less likely to make any quit attempt (RR=0.83; 95% CI 0.70 to 1.00), and any 24 h quit attempt (RR=0.77; 95% CI 0.63 to 0.95). There were no group differences on any measure of abstinence. Conclusions Provision of snus in a naturalistic context resulted in minimal uptake, and as a whole, undermined quit attempts and did not increase smoking abstinence. Results do not support the unguided, free provision of snus among smokers not motivated to quit as a means to facilitate quit attempts.

Original languageEnglish
Pages (from-to)202-209
Number of pages8
JournalTobacco Control
Issue number2
StatePublished - Mar 2017

Bibliographical note

Funding Information:
This work was supported by the National Cancer Institute of the National Institutes of Health (grant numbers R01 CA154992 to MJC, K07 CA181351 to JLB, and P30 CA138313 to AJA), and by the National Center for Advancing Translational Science of the National Institutes of Health (grant number UL1 TR000062).

Publisher Copyright:
© 2017, BMJ Publishing Group. All rights reserved.

ASJC Scopus subject areas

  • Health(social science)
  • Public Health, Environmental and Occupational Health


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