Sweden has been successful in reducing tobacco smoking. This text describes the factors behind the changed norms and behaviors towards smoking, and the challenges that lie ahead.
Summary
Sweden has implemented decisive policy changes that over time has led to low smoking rates. Increases of tobacco taxes, age limit, ban on tobacco advertising, oversight mechanisms, early introduction of smoke-free public places and cost-free smoking cessation services have together been successful in reducing tobacco smoking.
Sweden is, however, not smoke free. Smoking still causes most preventable cases of cancer in Sweden every year. The total tobacco and nicotine use in Sweden is at 28 percent and currently increasing.
Current smoking prevalence in Sweden is 11 percent, with daily smoking at 5 percent. The socioeconomic differences are considerable.
The increase in total tobacco and nicotine use is mostly driven by young people in general and young women in particular. The sharpest increase is in nicotine snus (also called nicotine pouches), and e-cigarettes (also called vapes).
Even cigarette use has increased slightly over the last years among some demographic groups. Many young users of nicotine products have not previously smoked.
Snus is not a smoking cessation product. On the contrary, research shows that people who use e-cigarettes or snus are more likely to start smoking over time, compared to people who do not use e-cigarettes or snus.
Among young people who use snus or e-cigarettes it is more than four times more common to also smoke cigarettes, compared to young people in general. The rise in snus use in recent years is not driven by former smokers changing product, but rather a rise in use among new target groups like women and young people.
Decreasing use of all tobacco products and non-medicinal nicotine products is essential to fulfil the obligations of the Framework Convention on Tobacco Control.
All tobacco and nicotine products must be regulated equally in order to protect children and young people.
Sweden’s road to reduced tobacco smoking
The Public Health Agency of Sweden points out that tobacco prevention in Sweden has led to
- reduced availability of tobacco products,
- decreased demand for and social acceptance of smoking cigarettes,
- increased access to smoking cessation programs1.
During the 1990’s Sweden implemented powerful measures that had discouraging and normative effects, stemming from the first regulations in the 1960’s when the National Board of Medicine was tasked with annually informing the public about the health risks of tobacco smoking.
Sweden was one of the first countries to introduce smoke-free workplaces together with schoolyards, preschools, youth recreational centers, public premises and transport 2.
Since then, several public environments have been made smoke-free, such as sport arenas, bus stops, restaurants and bars both indoors and outdoors 3.
In 1997 an 18-year-old limit for buying tobacco products was introduced in the Tobacco Act. Sweden has continuously increased taxes on tobacco to make it less affordable and hence less attractive.
Marketing was regulated in the 1970’s and in 2005 a ban on tobacco advertising was implemented. Also in 2005, a regulation about proprietors needing to inform the municipality of the selling of tobacco was introduced, and in 2019 a permit for sales came into force.
These laws have been monitored and enforced by authorities through a system at national, regional and municipality level1.
Tobacco use has been monitored continuously by multiple agencies and institutes4.
Smokers have been offered smoking cessation assistance since 1998 through the national Quitline as well as through primary care. Since beginning operations, the national Quitline has continuously been available and cost-free, organised through the health care system, with educated qualified tobacco cessation advisors.
The Quitline´s working methods have continuously been evaluated and researched5.
In 2003 the Swedish Parliament decided on an overarching goal for tobacco policy to reduce tobacco use, a goal that since then has been repeated in public health strategies. In 2015 Sweden adopted the smoke-free Sweden by 2025 goal 6.
Resources supporting organisations working with tobacco prevention have been made available by the government during this whole period.
Measuring tobacco use
In Sweden the most used measure for prevalence data on tobacco use is daily use, with not much focus attributed to sporadic use4.
Reasons for paying attention to the measurment current use, that is both daily and sporadic use, are many. Reports show that when comparing cigarettes sold, to cigarette usage reported in surveys, around half of the cigarettes purchased in Sweden are reported in the big national surveys of self reported prevalence data.
Around 70 percent of snus use is reported7. The resons for this difference between self reported snus and cigarette use might be that the social norm differs between tobacco smoking and snus use.
It can also be a result of the socioeconomic differences for cigarette use that you do not see for snus use. This can lead to surveys not reaching the groups where smoking is most prevalent.
The World Health Organisation recommends using current use to measure tobacco use.
When comparing tobacco and nicotine use between countries, one must bear in mind that cultural context plays a role.
When the Swedish National Public Health Survey changed the question from asking about from time to time use to use sometimes, the reported use dropped 5,9 percentage points for tobacco smoking at the same time as the drop for snus use was 1,1 percentage points4.
This indicates a diffence in how two similar concepts are interpreted as well as a diffenence in reporting snus use compared to tobacco smoking in Sweden.
When reporting current use, we get a better image of the scope of users in the population, compared to reporting only daily use.
Tobacco and nicotine use in Sweden
The current tobacco and nicotine use in Sweden at 28 percent, an increase in two years from 25 percent between 2022 and 2024. 4
Tobacco smoking
Tobacco use is a major risk factor for cardiovascular and respiratory diseases, over 20 different types or subtypes of cancer, and many other debilitating health conditions8.
Smoking still causes most preventable cancer cases in Sweden every year9. Smoking prevalence is at 11 percent, of which 5 percent is daily use4.
Daily smoking is most common among the age group 65-84 where 7 percent smoke daily, whereas sporadic use is most common among the youngest groups, with 12 percent among 16-294 and 21 percent among 17-year-olds 10.
The socioeconomic differences are significant. Among people who have finished compulsory school, 16 percent smoke, of which 11 percent daily. Among people with a college or university degree, 8 percent smoke, of which 3 percent daily 4.
Snus use
Tobacco snus contains carcinogenic substances, and use comes with health risks. There are studies showing that snus seems to increase the risk of four types of cancer, diabetes type 2 and that the risk of dying from a heart attack, a stroke or a cancer diagnosis, is increased.11
Research has also shown that tobacco snus has other negative health effects, for example related to the health of mother and child during and after pregnancy 11.
Nicotine pouches, called nicotine snus or white snus in the Nordics, was developed in Sweden and put onto the Swedish market in 2016. After that introduction of nicotine snus the demographic in use have changed and snus is now used ore among young people and women than ever before.
Not all Swedish surveys distinguish between use of tobacco snus and nicotine snus. In this text the term snus includes both tobacco snus and nicotine snus. The two types of snus are used the same way, but ingredients, regulations, marketing and flavoring differ.
While smoking rates have been decreasing over time, prevalence of snus use has been stable at around 11-13 percent daily use between 2004-2021. However, snus is now increasing in the general population in all groups, with the fastest development in the younger groups and women. Daily use is now at 16 percent and current use at 20 percent. 4
Among the group aged 16-29 years, the percentage of women who use snus daily increased from 3 percent in 2018 to 18 percent in 2024, with current total use in 2024 at 24 percent for women and 29 percent for men4.
Among girls aged 15 years, current snus use increased from 3 percent in 2019 to 14 percent in 2024, following the same pattern10.
What is snus?
Tobacco snus is an oral product made from tobacco leaves that is placed between the gum and the upper lip. Historically snus was first developed as snuff, inhaled through the nose. After that came the moist loose tobacco pulp that is put under the upper lip. It was made popular in the 19th century among men.
When Sweden became a member of the EU in 1995, the country was granted an exception for tobacco snus, allowing the continued production and distribution.
Nicotine pouches, called nicotine snus or white snus in the Nordics, is a product that is placed between the gum and the upper lip, just like the tobacco snus. It does not contain tobacco leaves and are therefore often referred to as tobacco free. White snus contains nicotine (often extracted from the tobacco plant) as well as fibers from other plants.
E-cigarettes use
The content of e-cigarette liquids varies greatly. Substances harmful to health have been found in both liquids and aerosols. Studies have shown that e-cigarette aerosol among other things can disturb the functions of the heart and blood vessels.11
In the long run, this can contribute to an increased risk of heart and vascular diseases. In Sweden, 16 600 types of e-cigarettes were registered for sale in 2024.
E-cigarette use doubled between 2022 and 2024, but is still at low levels in the general population. E-cigarette use is mainly seen among young people.
When specifically looking at how usage of nicotine snus and e-cigarettes is spread through the population, it is very clear that both are significantly more popular among the youngest groups and least popular among the oldest groups4.11
