Prevalence of Daily Smoking and Snus Use in Sweden 1963-2016

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)