This is the context in which smoking cessation plays its major role as a public health tool (Chapman & MacKenzie, 2010). Fourth, authoritative senders of health information have to be willing and able to systematically disseminate accurate information concerning the relative risk from snus and cigarettes. Despite the fact that misperceptions selleckchem Oligomycin A of health risks have been extensively reported in Scandinavia (Lund & Scheffels, 2011; Norsk Respons, 2005; ?verland et al., 2008; Scheffels & Lund, 2010; Wikmans & Ramstr?m, 2010) and in North America (Biener & Bogen, 2009; Haddock et al., 2004; Heavner et al., 2009; O��Connor et al., 2007; Pieper et al., 2010; Smith et al., 2007), public health officials have been criticized for being reluctant to use the hazard posed by cigarettes as the basis for comparison of risk to snus (Capella, 2007; Phillips, Guenzel, & Bergen, 2006; Waterboy et al.

, 2004), not to mention to mass communicate such estimates to the population. The main message from the health authorities in the United States (Kozlowski & Edwards, 2005) and in Scandinavia (Lund, 2009) has been that snus is no safe alternative to cigarettes. There is a concern that communication campaigns targeted at inveterate smokers suited to correct misconceptions of relative risk may lead to snus use among people who would not otherwise have used a tobacco product or that such information may lead to snus use by smokers who would have managed to quit by other means (Tomar & Hatsukami, 2007; Twombly, 2010). However, any public health impact from this is likely to be more than offset if substantial numbers of smokers switch to snus (Gartner, Hall, Vos, et al.

, 2007; Kozlowski, Strasser, Giovino, Erickson, & Terza, 2001). This replacement of cigarettes by snus has been the most typical pattern of use in Norway (Lund et al., 2011) and Sweden (Foulds, Ramstr?m, Burke, & Fagerstr?m, 2003), and a comprehensive report from an expert committee appointed by the European Union Commission concluded: ��Thus in Sweden, where there has apparently been substantial transfer from smoking to snus, the availability of snus may have been beneficial to public health�� (SCENIHR, 2008; p. 117). Limitations The overall response rate in our study is low, as this will be based on the multiplicative function of the original response rate in the surveys from which an invitation to participate in the web panel was sent (22.

5%), the rate of agreement to participate in subsequent studies (50%) and the 48.6% Cilengitide rate who answered our questions. This is likely to have introduced selection bias which may challenge the validity of the findings. Indeed, the underrepresentation of respondents with low education may suggest that the association between perceived harmfulness of willingness to use snus as a cessation aids only holds for more educated people.