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Use of smokeless or chewing tobacco and snuff has increased recently among adolescents, even as cigarette use declines. Investigators compared symptoms of dependence, addiction, and withdrawal among users of moist oral snuff (snus), cigarettes, and both (dual users). Of 3020 fifth graders in the Stockholm region of Sweden who were enrolled in a longitudinal study, 2621 (86%) completed a follow-up survey at a mean age of 17 years; 819 (31%) reported using any tobacco at least monthly (cigarettes only, 57%; snus only, 25%; and dual users, 18%). Surveys contained questions from validated instruments about symptoms of nicotine dependence, addiction, and withdrawal.
Exclusive snus and dual users were significantly more likely than exclusive cigar…