Dr Gupta's comparison of trends in lung cancer mortality and smoking prevalence in Sweden and Connecticut purports to undermine the claim that increasing snus use in Sweden has contributed to declining lung cancer rates there. Dr Gupta argues that some factor other than snus must have been at work because the ratio of lung cancers between Sweden and Connecticut has remained constant despite the large difference in snus use between the two places. He identifies this other factor as a declining cigarette smoking prevalence that he attributes to tobacco control policies. We agree that a decline in cigarette smoking in both countries explains the lung cancer trends but we don't see how this rules out a role for snus. This is exactly the mechanism by which proponents of snus would claim that snus use reduces smoking prevalence, namely, that population smoking prevalence declines because existing smokers switch to snus and new tobacco users use snus rather than cigarettes (RamstrÃ¶m and Foulds 2006). The fact that smoking prevalence declined in Connecticut as a result of more traditional tobacco control policies simply shows that there is more than one way to reduce smoking prevalence. The fact that the decline in cigarette smoking over the time period examined was greater in Sweden ( -13%) than in Connecticut (-8%) supports the hypothesis that the addition of snus to more conventional tobacco control policies has increased the decline in smoking prevalence. We concede that the comparison does not prove that snus was responsible for the decline in lung cancer rates in Sweden, but it is much more supportive of the claims for snus than Dr Gupta allows. Yours sincerely Coral Gartner and Wayne Hall References RamstrÃ¶m, L. M. and J. Foulds (2006). "Role of snus in initiation and cessation of tobacco smoking in Sweden." Tobacco Control 15(3): 210-214.