Pathways to Smoking and Snus Use Cessation - Is Spontaneous Quitting Underrated?

Mats Toftgard*, 1, Hans Gilljam2, Tanja Tomson2
Karolinska Institutet, Department of Public Health Sciences, 1Division of Applied Public Health, 2Division of SocialMedicine, Stockholm, Sweden

© 2010Toftgard et al..

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: ( This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Karolinska Institutet, Department of Public Health Sciences, Division of Applied Public Health, P.O. Box 17070, SE-104 62 Stockholm, Sweden; Tel: +46 8 524 875 53;E-mail:



To investigate to what extent smokers and snus users in Sweden consider and plan their quit attempts in advance, and to assess if spontaneity is associated with success.


A sample of 5999 Swedish men and women between 16 and 80 years were interviewed via telephone about current and former smoking and snus use and their latest quit attempts.


Among 2272 ex-smokers and current smokers who had ever made a serious quit attempt 48% reported to not having planned their latest attempt in advance. Furthermore, 40% reported to not even having considered giving up smoking before they actually made the attempt. Of 809 former and current snus users 48% did not plan, and 44% did not consider quitting in advance. Smokers and ex-smokers were more likely to remain smoke-free for at least six months if the attempt was unplanned (sex and age adjusted OR=2.6; 95% CI=1.7-3.8). When dividing the smoking quit attempts into considered versus not considered the advantage of the spontaneous attempts remained (adjusted OR=1.9; CI=1.3-2.9). The corresponding analyses of snus use quitting showed similar advantages for the unplanned and the not considered quit attempts.


In Sweden, a considerable proportion of the attempts to quit smoking, as well as to quit using snus, are made without prior consideration or planning. Spontaneous quit attempts appear to have a greater chance of long-term success than those preceded by consideration or planning.

Keywords: Smoking cessation, smokeless tobacco, unplanned, Sweden.