Going Smokeless, But Not Risk-Free: Analysing Socio-Environmental Factors of Female Adolescents’ White Snus Consumption : A qualitative study

Abstract: The number of female snus users in Sweden has doubled since 2007, which can partially be a consequence of the introduction of white snus, a type of nicotine pouch. This carries significant implications for public health, particularly because a substantial proportion of young individuals who consume white snus had no prior exposure to other tobacco or nicotine products. Consequently, white snus has the potential to attract and introduce new young users to nicotine consumption. This qualitative study aimed to investigate the socio-environmental factors contributing to the consumption of white snus among female adolescents aged between 15 to 18. The data consists of 10 interviews. Guided by the Reciprocal Determinism Model, the study employed thematic analysis to explore the reasons for snus initiation, the continued use of white snus, and the circumstances that could lead to quitting its consumption. Three main themes emerged from the analysis: (1) desirability, (2) exploration and experimentation, and (3) hindrances. The findings elaborated on the socio-environmental factors behind white snus consumption. The marketing and advertisement strategies used by manufacturers were found to reinforce the continued use of white snus among female adolescents. Additionally, economic barriers were identified as the primary motivator for quitting consumption. Peer influence was consistently identified as the trigger for snus initiation. The study also highlighted the ineffectiveness of current regulations in Sweden, as they were easily bypassed, indicating a need for stronger measures to restrict access and limit advertising exposure. As white snus is expanding to countries outside of Sweden, the insights gained from this study can inform the development of early interventions and preventive measures by governments to reduce the likelihood of adolescent nicotine use.