{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T02:01:06Z","timestamp":1760148066309,"version":"build-2065373602"},"reference-count":31,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2023,3,25]],"date-time":"2023-03-25T00:00:00Z","timestamp":1679702400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Tobacco use was measured with self-reports of lifetime use of cigarettes and snus to examine trends in tobacco use among Swedish 9th graders over the period 1991\u20132020. Annual school surveys with nationally representative samples of 9th-grade students in Sweden covering the period 1991\u20132020 with a total sample of 163,617 students. We distinguished between the use of cigarettes only, use of snus only, dual use (use of both cigarettes and snus), and total tobacco use (use of any of these tobacco products). In addition to a graphical description of trends in the various measures of tobacco use, the correlation between these trends was calculated with the Pearson correlation coefficient (Rxy). The prevalence of total tobacco use declined from 72% in 1991 to 36% in 2020. The declining trend in total tobacco use was positively correlated with the trend in dual use (Rxy = 0.98) and the trend in cigarette use only (Rxy = 0.87). The trend in total tobacco use was, on the other hand, negatively correlated with snus use only (Rxy = \u22120.41), and snus use only was negatively correlated with cigarette use only (Rxy = \u22120.71). The situation became different after 2017 when total tobacco use increased as a result of an increasing prevalence of snus use. The sharp decline in tobacco use among 9th graders in Sweden over the past three decades is driven by declining cigarette use. The correlations between the various forms of tobacco use suggest that snus use may have contributed to the decline in cigarette use and, by that, overall tobacco use. The situation changed after 2017 when a sharp rise in snus use seems to have increased total tobacco use among adolescents in Sweden. A possible explanation behind this development is the introduction of a new form of snus called \u201cAll white snus\u201d, which was introduced in Sweden in 2014.<\/jats:p>","DOI":"10.3390\/ijerph20075262","type":"journal-article","created":{"date-parts":[[2023,3,27]],"date-time":"2023-03-27T03:31:48Z","timestamp":1679887908000},"page":"5262","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Trends in Tobacco Use among 9th Graders in Sweden, 1991\u20132020"],"prefix":"10.3390","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6938-0246","authenticated-orcid":false,"given":"Jonas","family":"Raninen","sequence":"first","affiliation":[{"name":"Swedish Council for Information on Alcohol and Other Drugs (CAN), 116 64 Stockholm, Sweden"},{"name":"Department of Clinical Neuroscience, Karolinska Institutet, 171 77 Stockholm, Sweden"},{"name":"Centre for Alcohol Policy Research, La Trobe University, Melbourne, VIC 3086, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Isabella","family":"Gripe","sequence":"additional","affiliation":[{"name":"Swedish Council for Information on Alcohol and Other Drugs (CAN), 116 64 Stockholm, Sweden"},{"name":"Department of Clinical Neuroscience, Karolinska Institutet, 171 77 Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martina","family":"Zetterqvist","sequence":"additional","affiliation":[{"name":"Swedish Council for Information on Alcohol and Other Drugs (CAN), 116 64 Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mats","family":"Ramstedt","sequence":"additional","affiliation":[{"name":"Swedish Council for Information on Alcohol and Other Drugs (CAN), 116 64 Stockholm, Sweden"},{"name":"Department of Clinical Neuroscience, Karolinska Institutet, 171 77 Stockholm, Sweden"},{"name":"Department of Public Health, Stockholm University, 106 91 Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,3,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e482","DOI":"10.1016\/S2468-2667(21)00065-7","article-title":"Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990\u20132019: A systematic analysis from the Global Burden of Disease Study 2019","volume":"6","author":"Reitsma","year":"2021","journal-title":"Lancet Public Health"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2010","DOI":"10.1016\/S0140-6736(07)60677-1","article-title":"Assessment of Swedish snus for tobacco harm reduction: An epidemiological modelling study","volume":"369","author":"Gartner","year":"2007","journal-title":"Lancet"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"966","DOI":"10.1016\/S0140-6736(15)60264-1","article-title":"Global trends and projections for tobacco use, 1990\u20132025: An analysis of smoking indicators from the WHO Comprehensive Information Systems for Tobacco Control","volume":"385","author":"Bilano","year":"2015","journal-title":"Lancet"},{"key":"ref_4","unstructured":"Mokinaro, S., Vincente, J., Benedetti, E., Cerrai, S., Colasante, E., Arpa, S., Chomynova, P., Kraus, L., Monshouwer, K., and Spika, S. 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