The Swedish Experience

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Background

Since 2008 tobacco companies have been lobbying to have the EU ban on snus sales removed, arguing that the lives of EU smokers can be saved if they are given access to less harmful tobacco alternatives. [1] The so-called ‘Swedish Experience’ is often cited as proof of concept that switching smokers to snus can be an effective harm reduction approach.

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The Data & the Public Health Debate

Swedish males have one of the lowest daily smoking rates in Europe[2] and one of the lowest rates of tobacco-related disease globally.[3]

Some attribute the high male snus consumption for the reductions in Swedish male smoking, proposing that this proof of concept could be replicated elsewhere in the EU and achieve net health gains.[4][5][6]

Others have criticized this interpretation of the Swedish data, countering that strong Swedish tobacco control measures instead played a significant role in reducing male smoking prevalence.[7][8][9] They argue that Swedish data demonstrate that only five percent of Swedish male smokers quit smoking using snus, that four out of 10 male snus users started their tobacco use with snus, and that almost as many continue to smoke and are dual users. Furthermore, they argue that smoking prevalence amongst Swedish women also significantly declined in the last 20 years (from 29% to 14%), albeit with no significant uptake in snus, thus indicating that snus is not associated with this decline.

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Notes

  1. S. Peeters, A. Gilmore, Transnational Tobacco Company Interests in Smokeless Tobacco in Europe: Analysis of Internal Industry Documents and Contemporary Industry Materials, PLoS Med 2013; 10(9): e1001506, accessed April 2015
  2. TNS Opinion & Social, Special Eurobarometer 385: Attitudes of Europeans towards Tobacco. Brussels: European Commission Directorate-General Health and Consumers, 2013
  3. R. Peto, A.D. Lopez, J. Boreham, M. Thun, Mortality from Smoking in Developed Countries 1950-2000. Oxford: Oxford University Press, 1994
  4. C. Bates, K. Fagerstrom, M.J. Jarvis et al, European Union policy on smokeless tobacco: a statement in favour of evidence based regulation for public health. Tobacco Control 2003; 12:360-367
  5. J. Foulds, L. Ramstrom, M. Burke, K. Fagerstrom, Effect of smokeless tobacco (snus) on smoking and public health in Sweden. Tobacco Control 2013; 12:349-359
  6. Royal College of Physicians, Harm Reduction in nicotine addiction: helping people who can’t quit. A report by the Tobacco Advisory Group of the Royal College of Physicians. London: RCP, 2007
  7. S.L. Tomar, G.N. Connolly, J. Wilkenfeld, J.E. Henningfield, Declining smoking in Sweden: is Swedish Match getting the credit for Swedish tobacco control’s efforts? Tobacco Control 2003; 12:368-371
  8. S. Wamala, Free trade of Swedish moist snuff in the EU: Reflections from the Swedish National Institute of Public Health, 2009
  9. L. Holm, J. Fisker, P. Puska, M. Halldorsson, Snus does not save lives; Quitting smoking does! Tobacco Control 2009; 18:250-251