Introduction
While neighbouring Sweden has become one of the world’s most renowned case studies showcasing tobacco harm reduction’s potential to end cigarette use, Norway has also witnessed smoking rates crash alongside the dramatic rise in the use of a safer nicotine product. Snus is now the most prevalent tobacco product in the country and this Briefing Paper explores the story of its success.
What is the history of tobacco use in Norway?
People have been smoking tobacco in Norway since the sixteenth century,[i] although the mass spread of cigarette smoking didn’t begin until the early 1900s.[ii] Daily smoking rates in the country peaked at 65% for men, in the late 1950s, and at 37% for women, in 1970.[iii]
But non-combustible forms of tobacco also have a long history in Norway. The most prominent example of these is snus, an oral tobacco product that has been used in the country for more than 200 years. Named after the Swedish word for snuff, snus is a safer nicotine product made from ground tobacco leaves that are mixed with salt and water. It may also contain food-grade tobacco smoke aroma, or other flavourings, and is placed under the upper lip either in small teabag-like pouches called portion snus, or loose.
As the use of snus does not involve the burning of tobacco it avoids many of the risks associated with smoking. Snus contains lower levels of a range of toxicants found in cigarette smoke, including tobacco-specific nitrosamines which are one of the primary carcinogens found in tobacco.[iv]
Snus has been the most common type of smokeless tobacco used in Norway since the Second World War, but prior to that plug tobacco for chewing had been the most popular tobacco product, peaking at a market share of 60%.[v] While snus has been banned throughout the EU since 1992, except in Sweden, it is legal in Norway since the country is not a member state.
What impact has smoking had on the health of Norwegians?
Despite cigarette use falling for more than 50 years, a 2015 study found that smoking was still responsible for 20% of all premature deaths before the age of 70 in Norway.[vi] Other research from the same year estimated that around 6,300 people died each year because of tobacco-related diseases.[vii] It was found that tobacco smoking caused an estimated 13% of deaths in Norway for people over the age of 35 in 2009.[viii] And while lung cancer mortality rates for men have been declining since 2011, they were still increasing for women in 2013[ix] before peaking in 2018.[x] A study also revealed that more than 8 in 10 lung cancer cases in Norway could have been avoided if women did not smoke.[xi]
What has been done to address the use of tobacco products in Norway?
In the mid-1960s, the Norwegian parliament began investigating what could be done to reduce the health problems caused by tobacco use. The result of this work was the Norwegian Tobacco Act, which came into force in 1975, and the country has been a leading force in tobacco control policies ever since.[xii] Indeed, the Norwegian Health Directorate states on its website that it is “considered a country with restrictive tobacco legislation”[xiii] and it is ranked in the top five in Europe for the robustness of its tobacco control.[xiv]
Among other things, the 1975 Act required compulsory health warnings on all tobacco products and introduced a minimum age limit of 16 years for the purchase of tobacco products. This legislation also made Norway one of the first countries to ban the advertising of tobacco products.[xv]
In 1988, the Norwegian Parliament passed a new section to the Tobacco Act which banned smoking in areas that were accessible to the public, as well as work areas where two or more people were gathered.[xvi] The following year it brought in a general ban on the import and sale of all novel tobacco and nicotine products, though this did not include snus. Over the next few years, restrictions on smoking in restaurants, bars and cafes were introduced, with smoking only permitted in two-thirds of these venues, while the Tobacco Act was strengthened to ensure tobacco products, including snus, could only be bought by those aged 18 or over and a freephone quit line was launched.
Then, in 2004, Norway became only the second country, after Ireland, to bring in a national smoking ban. This means smoking is prohibited in both workplaces and public places,[xvii] with exemptions for some private clubs where food is not served.[xviii] It should be added that vaping is currently subject to the same restrictions as smoking, so this includes a ban on indoor use.[xix] Norway was also the first country to ratify the Framework Convention on Tobacco Control (FCTC), which entered into force in 2005.[xx]
From 2010, tobacco products could no longer be displayed at points of sale, and, in 2018, Norway was the first country to introduce plain packaging regulations for snus.[xxi] This legislation covers all tobacco products, including cigarettes, and it means they can no longer feature the manufacturer’s logo or colours. Instead, all tobacco product packaging now has a standardised colour and brand names must be written in a generic colour and style.[xxii] All tobacco products, including snus, must also carry health warnings.[xxiii]
What safer nicotine products are available in Norway?
While snus can be bought legally, not all safer nicotine products are available in Norway. It is currently illegal to manufacture or bring into the country anything other than what is referred to as “traditional tobacco or nicotine products”. These are defined as cigarettes, cigars, cigarillos, smoking tobacco, chewing tobacco and the aforementioned snus.[xxiv]
Indeed, all new tobacco and nicotine products must be approved by the Norwegian Directorate of Health before they can be sold in the country.[xxv] At the time of writing, while a handful of applications from nicotine pouch and heated tobacco products manufacturers have been submitted to the Directorate, none has yet been approved, meaning they are effectively banned in Norway.[xxvi] The nicotine pouch applications were refused due to fears they could appeal to young people.[xxvii] But a strange legal quirk means nicotine pouches that contain a small amount of tobacco can circumvent the rules that would normally prevent them being imported.[xxviii] These pouches can be bought legally as they come under existing Norwegian legislation that permits the sale of snus.
The situation with vaping is complicated. It is currently prohibited for companies to import, manufacture, and sell nicotine-containing vaping products in Norway,[xxix] a consequence of regulations enacted in 1989 that banned new nicotine and tobacco products.[xxx] This remains the case today even though the Norwegian Parliament voted to lift the ban on nicotine vapes back in 2016, a change that was meant to come into force in parallel with Norway’s planned adoption of the EU’s Tobacco Product Directive (TPD). This postponement in implementation to date is due to the necessity for the TPD to first be negotiated into the European Economic Area (an agreement of the internal market relations between Norway, Iceland and Lichtenstein on one side and the EU on the other) and this negotiation has not yet taken place. The general ban on the import and sale of novel tobacco and nicotine products was technically lifted in July 2021 and replaced by an approval scheme, largely based on Article 19 of the TPD, but as this is a transitional arrangement, the ban was continued for nicotine-containing vapes.[xxxi]
This is set to change in 2025, when the expected implementation of the TPD will see new regulations come into force that legalise the sale of vapes containing nicotine.[xxxii], [xxxiii] As part of the legislation, manufacturers and importers will have to register their products with the Norwegian Medical Products Agency six months before they can be sold to consumers in the country.[xxxiv] The changes will also mean vaping products will be required to have standardised packaging.
Despite the ban on nicotine vapes in Norway, a relatively small number of domestic shops selling devices and e-liquids that contain no nicotine do exist. Until recently, they could sell nicotine-free vapes that contained a wide range of flavours, including fruit, berries, coffee and dessert. But since July 2024, as part of changes to the Tobacco Damage Act, vapes containing any flavours other than tobacco cannot be sold, and this legislation will also apply to nicotine vapes once they become legal. This is significant because around 80% of those who vape use the types of flavours that have been banned.[xxxv]
But while Norwegians are not able to use nicotine-containing vapes for recreational use, it should be noted that people who use nicotine vapes as smoking cessation tools can currently legally import these products from abroad for their own personal use[xxxvi] and it is estimated that 80 per cent of the e-liquids used by people who vape in Norway is imported from retailers abroad and over the internet.[xxxvii] It is reported that around 150,000 people use vapes, of whom 97% were current or former smokers.[xxxviii] Other research, from the Norway Institute of Public Health revealed that between 2017-2022, 0.9% of those aged 16-74 were vaping daily, while 2% sometimes vaped.[xxxix]
What proportion of adults use snus and how have smoking rates changed?
Figures from Statistics Norway show that increasing snus use over the last few decades has coincided with a dramatic fall in the country’s smoking rates. In 2023, only 7% of Norwegians aged between 16 and 74 smoked daily, including just 3% of those aged 16-24.[xl] And while 12% of 55-64-year-old women, and 14% of men in the same age group, still smoke, among younger Norwegians, smoking has all but disappeared. Just 2% of women aged 16-34 and only 4% of 16-24-year-old men smoked daily in 2023.
To put this into a historical context, the adult daily smoking rate was six times higher forty years ago, when nearly half of them smoked. In 1973, 42% of Norwegians aged between 16 and 74 smoked every day, including 50% of those aged 25-34. This rose to 59% for men aged 45-54 and 46% for women aged 25-34.
Looking at the use of snus, there has been a significant change during the last two decades. In 2005, 5% of Norwegians aged between 16 and 74 used snus daily. Fast forward to 2023 and the figure for that group more than tripled, with 16% using snus daily. This means twice as many people now use snus compared to cigarettes (16% vs 7%), with highs of 34% among 25-34-year-old men, and 23% for women in the same age group.
It is worth noting that 2017 was the first year when there more daily snus users than people who smoked cigarettes.[xli] In 2017, while 11% of Norwegians aged between 16 to 74 smoked cigarettes
each day, the number of daily snus users was recorded at 12%. Dual use of cigarettes and snus does occur, but it has been found to be quite rare. One study revealed that while 6.8% of men used both concurrently, only 1% reported a daily consumption of both products.[xlii]
Why have people in Norway increasingly taken to snus?
Following the publication of reports from the US Surgeon General and the UK’s Royal College of Physicians, linking smoking to lung cancer during the 1960s,[xliii] awareness of the dangers of smoking were growing throughout the world. In Norway, thanks to its early adoption of the various tobacco control measures, an increasingly hostile environment towards the use of cigarettes had been developing since the 1970s, with the socio-cultural stigmatisation of smoking. And, with a succession of legal changes in the 1980s and 1990s restricting the number of places where people could smoke, an opportunity arose for another tobacco product to emerge as a safer and more acceptable alternative to cigarettes.
While the long history of snus use in Norway meant it had the potential to be a replacement for combustible cigarettes, it wasn’t until the late 1990s, when less harmful forms of the product became available, that it started to be a more attractive prospect, and the emergence of low-nitrosamine snus during this period was followed by a marked increase in the use of this product. This change was first seen among men, though women subsequently followed suit, and a 2014 research paper from Ingeborg Lund and Karl Lund found that while the sales of cigarettes had fallen as snus use rose, there was no increase in the overall consumption of tobacco, suggesting that “the strong inverse association between snus use and cigarette smoking might be causal”.[xliv]
These new snus products not only had lower levels of major carcinogens such as tobacco-specific nitrosamines and polycyclic aromatic hydrocarbons. There was also a shift in the type of products on the market, with the now familiar snus pouches taking over from the loose version that came before.[xlv] The new form of snus didn’t require spitting, was more convenient for users and also came with a wider range of added flavours. This was likely to have made the product attractive not only to those who smoked, but also people who wanted to use nicotine but had not previously used tobacco.[xlvi] Indeed, the 2014 paper from Lund & Lund suggests that one reason for the “increased market share for snus and the reduced market share for cigarettes could be that snus attracts tobacco-prone youth who otherwise would have started to smoke”.[xlvii] Put a different way in another paper, “the availability of snus might have produced a shift in tobacco preferences and contributed to lower smoking initiation among young adults, particularly males”.[xlviii] The popularity of snus pouches was such that by 2020, loose snus accounted for only 5% of the snus market, a big drop from 54% in 2005.[xlix]
It is worth noting that snus’s growth had nothing to do with marketing since it is covered by the ban on tobacco advertising that came into force in the 1970s. But one study suggests snus “emerged as a realistic alternative to conventional cigarettes because of its ability to deliver nicotine without the combustion and the toxicants in tobacco smoke, the fact that snus can be used in smoke-free places, the competitive price and the perceived potential for harm reduction”.[l] It goes on to say that “snus has contributed to a decrease in cigarette consumption through three mechanisms: as a method of smoking cessation; as an alternative product for new generations of tobacco-prone youth who otherwise would take up smoking; and as an alternative to cigarettes for smokers who are unwilling or unable to quit smoking altogether”. In places where smoking is restricted or prohibited, the discreet use of snus by people who smoke could ease withdrawal symptoms or perhaps ultimately encourage a full switch away from cigarettes to snus.[li]
This increased availability of snus could have reduced smoking rates by “aiding transfer to a less harmful form of nicotine dependence”, another study suggests.[lii] It says this claim is “supported by findings suggesting snus to be a commonly used and often preferred method for smoking cessation and that snus use may increase the probability of successful smoking cessation compared to medical nicotine products”. It adds that the largest group of snus users in the country comprises people who used to smoke, and other research has found that “switching to snus seems to be the most effective and efficacious method for quitting smoking in Norway”.
Snus is seen as a viable option for people who smoke because it delivers a similar amount of nicotine to combustible cigarettes.[liii] For many, including younger people, snus may be a more attractive option than cigarettes, as it allows nicotine consumption without the smell associated with cigarettes. It can also help avoid exposure to the cold temperatures common in Norway, as snus can be used indoors, while those who smoke can only do so outside bars and restaurants.
As mentioned above, snus use can also reduce the expenditure for those who smoke, with a tub of snus costing around 80 kroner, while a packet of 20 cigarettes costs roughly 140 kroner.[liv] At least part of the pricing advantage of snus comes from the fact many snus users in Norway have been buying their products in Sweden where prices have been lower. This led to pressure on the Norwegian Government to lower the tax applied to snus by 25% in 2021 to reduce the price differential between the two countries and stimulate sales in Norway.[lv]
The Norwegian Government has therefore taken positive steps to make snus more affordable. But this comes against a backdrop which has seen Norway’s health authorities advising against the use of snus as a smoking cessation tool, alongside warnings that snus is not a safe alternative to cigarettes.[lvi] It should also be noted that the introduction of plain packaging for all tobacco products, including snus tubs, is further representative of wider efforts “towards the long-term aim of a tobacco-free society”[lvii], efforts that result in all tobacco products appearing to be treated equally, irrespective of their relative harms. And a Government White Paper for the period 2018-2019 revealed one aim for 2021 was that “the use of snus among young people should not increase”.[lviii]
Takeaways
Norway’s status as an early adopter of many of the tobacco control laws that are now increasingly common throughout Europe meant it had a head start in the fight to bring down smoking rates. The increasing stigmatisation of smoking laid the groundwork for another product to step into the place of cigarettes and Norway’s long cultural association with snus meant it had the potential to fill this role. Crucially, Norway was not subject to the EU-wide ban on snus, but the rise of this SNP was only made possible thanks to innovations which made it safer and easier to use, and therefore more attractive to those who smoked. A desire to move to a safer form of nicotine, and the fact snus could be used in places where smoking was banned, meant an increasing number of people made the switch away from cigarettes. Snus use has almost wiped out smoking among the young in Norway, and it is also likely to have diverted away many of those who would have smoked from using cigarettes. But while it is widely acknowledged as a safer nicotine product, it has not received an endorsement from a Norwegian Government keen to see all types of tobacco use come to an end. The Government mostly treats snus in the same way it does smoked forms of tobacco, but consumers have made the switch on their own, choosing to embrace tobacco harm reduction in a bid to significantly improve the health of themselves and those around them. Crucially, in the words of Karl Lund: “The long-term availability of low-nitrosamine snus in Norway […] serves as an example of what might happen on the nicotine market if a low-risk tobacco product is allowed to compete with cigarettes.”[lix]
For further information about the Global State of Tobacco Harm Reduction’s work, or the points raised in this GSTHR Briefing Paper, please contact [email protected]
About us: Knowledge·Action·Change (K·A·C) promotes harm reduction as a key public health strategy grounded in human rights. The team has over forty years of experience of harm reduction work in drug use, HIV, smoking, sexual health, and prisons. K·A·C runs the Global State of Tobacco Harm Reduction (GSTHR) which maps the development of tobacco harm reduction and the use, availability and regulatory responses to safer nicotine products, as well as smoking prevalence and related mortality, in over 200 countries and regions around the world. For all publications and live data, visit https://gsthr.org
Our funding: The GSTHR project is produced with the help of a grant from Global Action to End Smoking (formerly known as Foundation for a Smoke-Free World), an independent, US non-profit 501(c)(3) grant-making organisation, accelerating science-based efforts worldwide to end the smoking epidemic. Global Action played no role in designing, implementing, data analysis, or interpretation of this Briefing Paper. The contents, selection, and presentation of facts, as well as any opinions expressed, are the sole responsibility of the authors and should not be regarded as reflecting the positions of Global Action to End Smoking.
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[xlii] K. E. Lund & McNeill, 2013.
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[xlvi] I. Lund & Lund, 2014b.
[xlvii] I. Lund & Lund, 2014b.
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[liii] Foulds, J., Ramstrom, L., Burke, M., & Fagerstrom, K. (2003). Effect of smokeless tobacco (snus) on smoking and public health in Sweden. Tobacco Control, 12(4), 349–359. https://doi.org/10.1136/tc.12.4.349.
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[lvi] I. Lund & Lund, 2014b.
[lvii] Branded Norwegian cigarettes and snus to be consigned to history, 2018.
[lviii] Public Health Report – A Good Life in a Safe Society (No. 19 (2018-2019) I-1193 E; White Paper). (2019). Ministry of Health and Care Services, Norway. https://www.regjeringen.no/contentassets/84138eb559e94660bb84158f2e62a77d/nn-no/sved/publichealthreport.pdf.
[lix] Report of Dr Karl Lund, Norwegian Institute of Public Health (30 January 2017) for the High Court of Justice, Queen’s Bench Division. ‘The Queen on the application of Swedish Match AB -v- The Secretary of State for Health’. Claim number CO/3471/2016.