Perceptions of the Relative Harmfulness of Snus Among Norwegian General Practitioners and Their Effect on the Tendency to Recommend Snus in Smoking Cessation

Introduction: Research suggests that health risks associated with the use of Swedish moist snuff (snus) are considerably smaller than health risks associated with cigarette smoking. However, erroneous ideas of approximately equal harm from snus and cigarettes are common in the general population. General practitioners (GPs) have a crucial role in giving information about health and risk to patients, and the objective of this study was to measure their perceptions of the relative harmfulness of cigarettes and snus and how these perceptions related to their tendency to recommend snus as a smoking cessation aid. Methods: Approximately 900 GPs completed a questionnaire in 2008 (response rate about 45%). Perceived relative risk was measured by the question: "In terms of health risks, how do you think daily use of snus compares to daily use of cigarettes?" Answer categories ranged from "snus is much more harmful" to "snus is much less harmful." Results: Only 36% of the GPs believed that snus was much less harmful than cigarettes. More than 15% believed that snus was equally or more harmful than cigarettes. GPs who rated snus as much less harmful more often recommended snus as an aid in smoking cessation. Conclusions: Almost two thirds of the GPs had beliefs about the relative risk of snus and cigarettes that were at odds with scientific consensus. The associated limitations in disseminated information about snus as a possible quitting aid can be understood as an unexploited intervention potential.