Sweden and snus is not a role model for tobacco prevention

It is widely known that Sweden has relatively few smokers. But the question of why is highly contentious. The tobacco industry uses Sweden to demonstrate the benefits of harm reduction – offering alternative nicotine products to reduce smoking.

Snus and public health

In Sweden, they claim that snus has led to fewer people smoking. Using ‘The Swedish experience’ as an example, they argue that the best way to get people to quit is to make it easy to use other nicotine products, such as snus and e-cigarettes. If sales of these products increase, it does not need not be a bad thing – on the contrary, it may be good for public health.

Not only the industry is pushing this line. There are also organisations that support it, as well as politicians. MEP Tomas Tobé (the Conservative party Moderaterna) is one example. He was the Moderates’ lead candidate ahead of the European Parliament elections. Standing up for snus was one of the issues he championed most strongly. Ahead of the European elections, the magazine Alkohol & Narkotika (Alcohol & Drugs) asked him how he viewed a possible EU ban on white snus. He replied:

We should rather have a system in the EU where nicotinpouches is permitted as a general rule. It would be a huge gain for public health across the EU if snus could be allowed to become an alternative for the EU’s nearly 100 million smokers.

Prevention reduced smoking

The Swedish Public Health Agency does not share this conclusion. In The Road to a Smoke-Free Sweden, the authority states that daily cigarette smoking has declined in Sweden since the 1980s. This decline coincides with the extensive tobacco prevention work carried out during the same period.

The Public Health Agency of Sweden does not view the increased use of other nicotine products favourably. On the contrary. It states: ‘To reduce the use of a tobacco and nicotine product, we need to work to reduce the use of all such products.’

Regulation of tobacco and nicotine products that is more akin to the protective legislation in place for cigarettes would increase protection for children and young people and create better conditions for good and equitable health, the Public Health Agency of Sweden adds.

The Public Health Agency of Sweden’s analysis is shared by the Smoke Free Partnership. The European network works on tobacco and nicotine prevention at European level. The Swedish Cancer Foundation is one of the lead organisations and Tobaksfakta one of the coalition organisations.

“Not snus instead”

The Smoke Free Partnership has produced an evidence-based report on “The Swedish experience”.

They emphasise that it is not snus that is the reason why few people smoke. The explanation is that Sweden was an early adopter of regulating smoking whilst providing support for smokers. Attitudes towards smoking changed; smoking came to be seen as deviating from the norm.

This is Sweden’s proud history, according to the Smoke Free Partnership. However, the current trend in Sweden is not something other countries should emulate. Tobacco and nicotine use in Sweden is on the rise; 28 per cent use some form of tobacco or nicotine product, according to statistics from 2024. The increase is primarily linked to young people, particularly young women, using white snus.

But isn’t it better to use snus than to smoke? There is no statistical evidence to suggest that people use snus instead of smoking. The Cancer Foundation has helped compile the Smoke Free Partnership’s report. They refer to statistics from the Public Health Agency of Sweden – which show that smoking has decreased regardless of how much people use snus. This is particularly clear when it comes to women. From 2004 to 2024, smoking among women decreased. Snus use remained steady at below 5 per cent until 2020. It then rose to almost 10 per cent in 2024. Smoking fell when few women used snus, and continued to fall as more women used snus. The number of women using snus did not affect the number of women who smoked.

“Regulate all products strictly”

With this report, the Smoke Free Partnership aims to show that new nicotine products are not the way forward. Instead, the following is needed:

• Strict regulations for all nicotine products – not just cigarettes.
• Strict regulations on flavours, marketing and availability to protect young people.
• Harmonisation across the Nordic countries and the Baltic states so that everyone is pulling in the same direction.

Sources:
Smoke Free Partnership challenges misinformation about “the Swedish Experience” 

Sweden’s road to reduced tobacco smoking  The Swedish Cancerorganisation

New Swedish tobacco policy approved