After years of work by public health authorities, the number of people who smoke every day in Sweden has been reduced to about 5 per cent of the population. The success has been publicly celebrated by one unlikely group: the tobacco industry.
Long sensing the way the winds were changing on attitudes to cigarettes, the industry has been pivoting to new products, such as e-cigarettes, or vapes. In Sweden this has seen a big push to attribute the success of its low smoking rate to another product, snus.
Traditionally popular among older Swedish men, snus is tobacco in a pouch which is placed between the gum and upper lip or cheek. More recently, nicotine snus pouches with different flavours have become popular with women and those of younger generations. Crediting snus as partly responsible for the shift in Sweden away from cigarettes is a clever attempt by the tobacco industry to grow the market for nicotine pouches, campaigners say.
“They want to sell Sweden as an amazing country that did this miracle ... They also want to sell this story of snus being the reason for it, and that’s sort of serving as a quick fix that they will make money from,” says Lisa Lennartsdotter Ermann, an expert on tobacco policy at the Swedish Cancer Society.
The alternative story concerns the success of ambitious regulation over several decades. While Ireland was the first European country to ban smoking in bars, restaurants and workplaces in 2004, Sweden followed suit the next year.
The Nordic state kicked on from there and banned the marketing and advertising of cigarettes. Then in 2019 it widened the smoking ban to include outdoor seating areas in bars and restaurants, bus stops, sports facilities and playgrounds. It also brought in a law to subject vapes to the same restrictions as cigarettes.
Culturally, the etiquette in Sweden would be to avoid lighting up outside if someone in a group was eating. The country has the lowest smoking rate in the European Union, to the point where it can be considered nearly smoke-free.
However, official figures show there has been a recent uptick in the number of 17-year-olds smoking. “Occasional smoking in Sweden increased the last two years, which is socially looked upon differently compared to daily smoking. I’m hearing that it is coming back as a cool thing to do, to smoke occasionally,” Lennartsdotter Ermann says. The figures also show a significant rise in the number of young people smoking e-cigarettes and an increase in the popularity of nicotine snus pouches, known as white snus.
A senior official at the Swedish public health agency, Linda Maripuu, says this is concerning because research indicates someone using vapes or snus has a higher risk of moving on to cigarettes. Similar to vapes, snus being sold in flavours such as mint and strawberry is thought to be partially behind its rise in popularity among young people.
In 2022 tobacco giant Philip Morris bought Swedish Match, the main snus manufacturer. “After that, in our view, we have seen a more aggressive approach in other countries, selling the story about Sweden. I think they now see the global market,” Lennartsdotter Ermann says. Tobacco snus is not sold outside Sweden, but nicotine pouches are.
The US multinational has incorporated the narrative of snus helping to bring down smoking rates into its push to promote “smoke-free alternative” products, such as its vapes and nicotine pouches.
Philip Morris is “fully committed to replacing cigarettes with science-based, less harmful alternatives”, says a spokesman for the company. “While nicotine pouches are addictive and not risk-free, switching to science-backed nicotine pouches can be significantly less harmful than continued smoking,” he adds.
In Sweden about a fifth of people report using snus either regularly or occasionally. The number of young people who say they used the pouches daily has nearly doubled in recent years. “We know the tobacco industry were selling cigarettes with the arguments they were safe and nicotine wasn’t addictive,” Lennartsdotter Ermann says.
“Currently there is a lack of evidence about the long-term effects of the nicotine pouch, white snus. Looking at all the evidence that is available, it looks like snus increases the risk for four cancer types, and consuming nicotine also has risks for the body,” she says.
“You can also market the nicotine pouch, that’s the only nicotine product you can market here. A lot of podcasts that I listen to have advertisements for it,” she says. A recent law prohibiting intrusive promotion did away with the practice of companies handing out free snus samples.
The pouches hold an affectionate spot in the Nordic state’s culture. Any effort to seriously cut snus use would face a lot more pushback than anything seen during the health authorities’ successful efforts to reduce smoking. Political opposition to tough restrictions like those brought to bear on cigarettes would be intense. Chief among the opponents would no doubt be Philip Morris, which now has considerable skin in the game selling the story of snus as central to Sweden’s success in kicking the smokes.