- No Fire, No Smoke: The Global State of Tobacco Harm Reduction
Snus is fast replacing cigarettes as the way that Norwegians consume nicotine. As shown in this infographic, there has been a long-term decline in daily smoking from 21 percent in 2008. In 2017, for the first time, the proportion of the popula-tion using snus – 12 percent – exceeded that of those smoking cigarettes. At 11 percent, Norway now has one of the lowest levels of daily smoking in developed countries. The fall in smoking is even more dramatic amongst younger people. Among young people snus became more popular than smoking around 2009–10, with a decline in smoking to three percent.
It is likely that such a fall has not been witnessed anywhere else in countries where smoking has been common among women. But women have not given up using tobacco – snus use hovers from around 14 percent to 17 percent. The overall percentage of people using nicotine via either snus or smoking has remained about the same over time – it is the choice of products that has changed over the last ten years.
See also p. 45 of the report: No Fire, No Smoke: The Global State of Tobacco Harm Reduction 2018 — Global State of Tobacco Harm Reduction (gsthr.org)
Lars Ramström - Institute for Tobacco Studies
Sweden now has the lowest level of smoking among men than for any other country in Europe. According to the European Commission’s Eurobarometer 2017 report, only five percent of Swedish men now smoke. This is only one fifth of the EU average of 24 percent. The Eurobarometer report indicates that all other EU countries have a smoking prevalence three to seven times greater than Sweden. So, something is clearly different about Sweden – and the clear difference is that snus is allowed in Sweden yet banned in the other 27 EU countries.
The changes in the way that tobacco is consumed has, in Sweden as in Norway, come about through two mechanisms. The first is the increasing preference of snus over cigarettes among those starting to use tobacco. Birth cohort data over four decades show that the proportion of men starting to initiate tobacco use from smoking dropped, whilst those initiating tobacco through snus increased. What is also striking is that during these periods the proportion of the population initiating any tobacco use dropped. It is sometimes asserted that the use of snus could be a stepping stone to the smoking of tobacco. This is not supported by the population level smoking and snus data. Neither is it supported by research evidence. The largest study is an analysis of a nationally representative sample of the Swedish population recruited between 2003 and 2011, covering 60,675 individuals. Those who began daily tobacco use using snus were much less likely to subsequently take up smoking than those who had not.
The second mechanism leading to fewer smokers is the use of snus to quit or reduce smoking. Among men, snus is the most commonly used cessation product, while among women, nicotine gum or patches are more common. Success rates using snus are higher than for those using other means. A very high proportion of male (87 percent) and female (86 percent) smokers who takeup snus use quit daily smoking.
See also p. 48 of the report: No Fire, No Smoke: The Global State of Tobacco Harm Reduction 2018 — Global State of Tobacco Harm Reduction (gsthr.org)
- No Fire, No Smoke: The Global State of Tobacco Harm Reduction
The EU stands out prominently as the only region to have a comprehensive ban on the sale of snus, which was implemented in 1992 and then incorporated into subsequent Tobacco Products Directives (TPD).
The UK started the ban when, in 1989, it outlawed oral snuff in response to the introduction of ‘Skoal Bandits’. When the first TPD was drafted, the EU legislators included a ban on snus as part of market harmonisation, in that three EU countries had implemented a ban, and the ‘market harmonisation’ reasons were used to enforce this across all EU countries:
» 1992, EU Directive 92/41 banned sales of snus;
» 1995, on accession to the EU, Sweden obtained an exemption;
» 2001, EU Tobacco Products Directive continued the ban;
» 2014, EU Tobacco Products Directive continued the ban.
The wording in the TPD is carefully constructed so that it does not apply to snuff, or to chewing tobaccos such as South Asian tobaccos:
“No person may produce or supply tobacco for oral use. Tobacco for oral use is:
A tobacco product which is –
(a) intended for oral use, unless it is intended to be inhaled or chewed; and
(b) in powder or particulate form or any combination of these forms, whether
presented in a sachet portion or a porous sachet, or in any other way”.
The sale of snus is allowed in 79 countries in total and banned in 39 countries including the EU 28. The sale of snus is allowed in the non-EU Norway and although officially banned in Iceland, Icelanders import a slightly different ’cut’ of what is officially known as ’nasal tobacco’. This is used either in a small lump under the lip or made into a snus-like parcel using separate paper like the Swedish snus packaging. Despite being much less harmful than cigarettes this Icelandic ’snus’ is taxed at the same level and the tax level has increased over the last eight years (over 140%). The same rules apply as for cigarettes – age restricted sales (18+), no advertising, health warnings on packets, and no claims of health benefits such as help quitting cigarettes. Notwithstanding the restrictions, snus sales have increased by 330% since 2001.
See also p. 89 of the report: No Fire, No Smoke: The Global State of Tobacco Harm Reduction 2018 — Global State of Tobacco Harm Reduction (gsthr.org)
- Burning Issues: The Global State of Tobacco Harm Reduction 2020
Passed in 2001, the Tobacco Products Directive (TPD) was the first major European legislation specifically related to tobacco products. It is the only example of a regional approach to regulation. All EU member states must implement TPD into national Legislation.
Nearly a decade before, the first attack on what turned out to be a significant SNP was the EU-wide ban on the sale of snus in 1992, as a response to the attempt by the US Smokeless Tobacco Company to introduce oral Skoal Bandits into the UK. When Sweden joined the EU in 1995, snus was already in widespread use there and so was exempted from the ban.
In the years subsequent to TPD enactment, EU Commission reports identified new tobacco-related products which might be controlled to ensure conformity with EU harmonisation policies, noting increasing discrepancies between member states. As the sale of vaping devices was growing throughout the EU, member states were seeking advice and clarification from the Commission. In 2012, the Health and Consumer Directorate produced a proposal for the revision of the 2001 TPD whereby products with a nicotine content over a certain level – including most vaping products on the market – would have to be authorised as medicines. When the proposal came before the EU Parliament in 2013, numerous amendments to the Article were proposed, including one that all vaping products could only be sold as medicines under pharmaceutical regulations. Major objections from vapers via their EU political representatives helped derail this idea. In 2016, a revised TPD known as TPD2 came into force.
TPD2 regulates tobacco product manufacture, sale, distribution and advertising in the European Union covering vaping and HTP – with limitations on nicotine content and liquid bottle size – while reaffirming the ban on snus. Currently TPD2 is under review, with the report and possible proposals due out in May 2021.
See also p.119 of the report: Burning Issues: The Global State of Tobacco Harm Reduction 2020