Sweden, Norway, Japan embrace tobacco harm reduction


Smoking rates and tobacco-related diseases and deaths have progressively decreased in countries that have adopted tobacco harm reduction (THR), according to Karl Fagerstrom, president of Fagerstrom Consulting, a Swedish consultancy firm that conducts research on smoking cessation and THR.

Fagerstrom was one of the resource speakers during the In Focus: Tobacco Harm Reduction webinar organized by the Global Tobacco & Nicotine Forum (GTNF) Trust on April 27, 2021.

“Sweden and Norway are very good examples where snus has displaced smoking and, more importantly, driven down smoking-related diseases and deaths to record-low levels among men, at least, according to World Health Organization data. Sweden has even reached its end game goal of less than 5% smoking rate,” Fagerstrom said.

Snus is an oral smokeless tobacco product that is usually placed behind the upper lip, either in a loose form or in portioned sachets, which resemble miniature teabags. Air-cured tobacco is ground, mixed with salt and water, and then processed under strict quality and regulatory controls using a technique similar to the pasteurization of milk. It is different from other oral tobacco products due to its unique manufacturing process.

The sale of snus is prohibited by legislation in all European Union (EU) countries except Sweden which has an exemption. Snus is also available in Norway as it is not an EU member country and therefore not bound by EU legislation. 

Eurobarometer data from 2017 showed that Sweden had the lowest prevalence of daily cigarette use in the European Union at 5% while daily “oral tobacco” use was reported to be 20%. European data published by the WHO in 2018 indicated that Sweden had the lowest rate of tobacco-related mortality and the lowest incidence of male lung cancer, according to Clarke et al in their systematic review “Snus: a compelling harm reduction alternative to cigarettes”, published in November 2019 in Harm Reduction Journal.

“Overall, prevalence statistics and epidemiological data indicate that the use of snus confers a significant harm reduction benefit which is reflected in the comparatively low levels of tobacco-related disease in Sweden when compared with the rest of Europe. The available scientific data, including long-term population studies conducted by independent bodies demonstrates that the health risks associated with snus are considerably lower than those associated with cigarette smoking,” Clarke and colleagues concluded. The percentage of Norwegians who smoke daily has declined from around 43% in 1973 to 13% in 2014.

The reduction in smoking prevalence has been most dramatic among men, with rates of daily smoking declining from 51% in 1973 to 14% in 2014, while rates of daily smoking among women have declined from 32% to 13% over the same time period, according to Gartner et al in their analysis “Projecting the future smoking prevalence in Norway”, published in February 2017 in the European Journal of Public Health.

“Norway was one of the first countries to endorse a comprehensive tobacco control act that resulted in a significant decline in smoking prevalence. The availability of snus…on the Norwegian tobacco market might also be of importance for the decline in smoking rates,” the Gartner et al study noted.

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