Sex-Specific Associations Between Smokeless Tobacco Use and Staphylococcus aureus Carriage in Norwegian Adolescents

Staphylococcus aureus (S. aureus) can cause life-threatening infections, with colonization often preceding infection. Understanding the determinants of S. aureus carriage may improve infection prevention. While smoking has been associated with S. aureus carriage, studies on smokeless tobacco products remain scarce. This study aimed to investigate whether the use of snuff (Swedish snus), a smokeless tobacco product, is associated with S. aureus carriage in adolescents.

We used data from Fit Futures 1, a population-based cross-sectional study including 1,038 participants (93% attendance).

A total of 457 boys and 443 girls had data on snuff use and two nasal and throat swab cultures for S. aureus carriage assessment. Snuff use was defined as occasional or daily use. Logistic regression analysis was used to examine the association between snuff use and S. aureus carriage, with odds ratios (ORs) adjusted for known risk factors.

Snuff use was associated with a 64% higher odds of nasal carriage (95% CI = 1.18-2.26; carriage defined as one or two positive nasal cultures) compared to non-use. In sex-stratified analyses, this association was observed only among girls, with an adjusted OR of 1.62 (95% CI = 1.03-2.55; carriage defined as two positive nasal cultures) and an adjusted OR of 1.99 (95% CI = 1.25-3.16; carriage defined as one or two positive nasal cultures). Among girls using snuff, the adjusted OR for S. aureus throat carriage was 1.66 (95% CI 1.06-2.59; carriage defined as two positive throat cultures) compared to non-users.

We identified an association between snuff use and S. aureus nasal and throat carriage among adolescent girls. Girls who used snuff had higher odds of S. aureus nasal (62%) and throat (66%) carriage compared to female non-users. Futures longitudinal studies are needed to clarify whether the observed associations reflect casual relationships.