Psykologer mot Tobak


In english

Risker med snus

RISKER MED SNUS 

Tillsammans med de senaste publicerade resultaten av svensk forskning kan läget nu sammanfattas på följande sätt.

Snusning ökar risken för

  • dödlig hjärtinfarkt (Arefalk 2014, Cnattingius 2005, Hergens 2007, Hergens 2008a, Boffetta 2009, Hansson 2012
  • permanenta och irreparabla munslemhinneförändringar med blottade tandhalsar (Cnattingius 2005)
  • diabetes typ 2, gäller för en konsumtion av minst 5 dosor/vecka (Persson 2000, Östenson 2012)


Vissa indikationer* finns även på att snusning ökar risken för

  • cancer i matstrupen, magsäcken och oral cancer (Luo 2007, Zendehdel 2008, Boffetta 2008)
  • oral cancer (Roosaar 2008)
  • förhöjt blodtryck (Bolinder 1992, Hergens 2008b)
  • metabolt syndrom, en rubbning i ämnesomsättningen kopplat till fetma, högt blodtryck, höga blodfetter, diabetes och hjärtkärlsjukdom (Norberg 2006)
  • dödlighet vid cancerdiagnos (Nordenvall 2013, Wilson 2016)
  • idrottsskador i muskler, leder, ligament och senor samt stukningar och skelettskador (Heir 1997, Reynolds 2000)
  • alkoholberoende (Norberg m.fl. 2015
  • rökning hos ungdomar – inkörsport (Joffer m.fl.2014).


Vid graviditet kan snusning öka risken för

  • havandeskapsförgiftning, reducerad födelsevikt, förtida förlossning, missfall och intrauterin fosterdöd (England 2003, Wikström 2010, Baba 2012, Dahlin 2016)
  • gomspalt (Gunnerbeck 2014)
  • andningsstörningar hos det nyfödda barnet som tros kunna leda till plötslig spädbarnsdöd (Gunnerbeck 2011). Då nikotin övergår i bröstmjölken skulle en sådan riskökning kunna förekomma även vid amning. Snusning kan därför inte heller anses säkert vid amning.


* Med indikationer kan menas att:

  • det finns motstridiga studier
  • det råder viss osäkerhet om personerna varit rena snusare eller också rökt
  • det bara finns enstaka studier.

REFERENSER

  • Arefalk G, Hambraeus H, Lind L, Michaëlsson K, Lindahl B, Sundström J. Discontinuation of Smokeless Tobacco and Mortality Risk after Myocardial Infarction. Circulation. published online June 23, 2014. 
  • Baba, S., Wikström, A. K., Stephansson, O., et al. (2012). Influence of smoking and snuff cessation on risk of preterm birth. Eur J Epidemiol, 27(4), 297-304.
  • Boffetta P., Hecht S., Gupta P., et al. (2008) Smokeless tobacco and cancer. Lancet Oncol. 2008(9), 667-75.
  • Boffetta P., Straif K. (2009). Use of smokeless tobacco and risk of myocardial infarction and stroke: Systematic review with meta-analysis. BMJ 2009(339), b3060.
  • Bolinder G.M., Ahlborg B.O., Lindell J.H. (1992). Use of smokeless tobacco: blood pressure elevation and other health hazards found in a large-scale population. J Intern Med 1992;232:327-34.
  • Cnattingius S., Galanti R., Grafström R., et al. (2005). Hälsorisker med svenskt snus. Rapport A nr 2005:15. Stockholm: Statens folkhälsoinstitut.
  • Dahlin S, Gunnerbeck A, Wikström AK, Cnattingius S, Edstedt Bonamy AK. (2016). Maternal tobacco use and extremely premature birth - a population-based cohort study. BJOG. 2016 Jul 14. doi: 10.1111/1471-0528.14213. [Epub ahead of print]
  • England L. J., Levine R. J., Klebanoff M. A., et al. (2003). Adverse pregnancy outcomes in snuff users. Am J Obstet Gynecol 2003(189), 939-43.
  • European Commission. (2008). Health Effects of Smokeless Tobacco Products. Scientific Committe on Emerging and Newly Identified Health Risks SCENIHR.
  • Gunnerbeck, A., Wikström, A.K., Bonamy, A.K., et al. (2011). Relationship of maternal snuff use and cigarette smoking with neonatal apnea. Pediatrics, 128(3), 503-509.
  • Gunnerbeck A, Edstedt Bonamy AK, Wikström AK et al. (2014). Maternal snuff use and smoking and the risk of oral cleft malformations - a population-based cohort study. PLoS One. 2014 Jan 15;9(1):e84715. doi: 10.1371/journal.pone.0084715. eCollection 2014.
  • Hackshaw A., Rodeck C., Boniface S. (2011). Maternal smoking in pregnancy and birth defects: a systematic review based on 173 687 malformed cases and 11.7 million controls. Hum Reprod Update. 2011;17(5):589–604.
  • Hansson J., Galanti M.R., Hergens M.P., et al. (2012). Use of snus and acute myocardial infarction: pooled analysis of eight prospective observational studies. Eur J Epidemiol. 2012 Jun 22.
  • Heir T., Eide G. (1997). Injury proneness in infantry conscripts undergoing a physical training programme: Smokeless tobacco use, higher age, and low levels of physical fitness are risk factors. Scand Med Sci Sports. 1997(7), 304-11.
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  • Hergens M.P., Alfredsson L., Bolinder G., et al. (2007). Long-term use of Swedish moist snuff and the risk of myocardial infarction amongst men. J Intern Med. 2007 Sep;262(3):351-9.
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  • Hergens M.P., Lambe M., Pershagen G., et al. (2008b). Risk of hypertension amongst Swedish male snuff users: a prospective study. J Intern Med 2008; 264: 187–194.
  • IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. (2007). Smokeless tobacco and some tobacco-specific n-nitrosamines. Monograph 89/2007. Lyon, France: IARC Working Group on the Evaluation of Carcinogenic Risks to Humans.
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  • Luo J., Ye W., Zendehdel K., et al. (2007). Oral use of Swedish moist snuff (snuff) and risk for cancer of the mouth, lung and pancreas in male construction workers: A retrospective cohort study. Lancet 2007(369), 2015-20.
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  • Persson P. G., Carlsson S., Savstrom L., et al. (2000). Cigarette smoking, oral moist snuff use and glucose intolerance. J Intern Med 2000(248), 103-10.
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  • Roosaar A, Johansson AL, Sandborgh-Englund G, Axéll T, Nyrén O. (2008). Cancer and mortality among users and nonusers of snus. Int J Cancer. 2008 Jul 1;123(1):168-73.
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  • Wilson KM, Markt SC, Fang F, Nordenvall C, Rider JR, Ye W, Adami HO, Stattin P, Nyrén O, Mucci LA. Snus use, smoking and survival among prostate cancer patients.Int J Cancer. 2016 Dec 15;139(12):2753-2759. doi: 10.1002/ijc.30411.
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Av Hans Gilljam och Barbro Holm Ivarsson 2016-10-18

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