How Smokeless Tobacco Snuffed Out Smoking in Sweden

For the past 50 years men in Sweden have among the lowest smoking rates of any developed country in the world. But they haven't given up tobacco entirely. Sweden also has the world's highest consumption of smokeless tobacco, in the form of moist snuff (called snus in Swedish).

Until now the fascinating tobacco use pattern seen in Sweden, called the Swedish model, has received very little attention. In 2002 Dr. Rodu spent six months in Umea, Sweden, working closely with Swedish researchers to investigate the role of smokeless tobacco in making smoking smoking history in that country. This study is the first product of that research effort, and it looks at tobacco use patterns, both snus use and smoking in northern Sweden from 1986 to 1999.

The popularity of snus among Swedish men has played a big role in low smoking initiation rates. For example, although 67% of men in this study have used some form of tobacco at some point in their lives, only 50% have ever smoked. Compare this with American men, among whom 65% have ever used tobacco and as many as 59% have ever smoked.

But the real benefit of snus is that it has helped smokers quit. For example, in 1986 19% of men smoked and 18% used snus, but by 1999 only 11% of men smoked and 27% used snus. The decline of smoking and increase in snus use was not coincidental. Our analysis shows that snus was the major factor in smoking cessation among men. Over the entire period of our study a higher percentage of women smoked than men. This is a reversal of the pattern in virtually every other society in the world, where smoking is generally much more common among men than women.

But the news for women is not all bad. In 1999 snus was used by 6% of women, a big jump compared to earlier years. It will come as no surprise that smoking among women, which was as high as 26% in earlier years, had dropped to about 20% in 1999.

The Swedish model of tobacco use shows that smokers have adopted safer tobacco products. The Swedish model is not the result of a governmental campaign or other public health strategy. It is the result of Swedes making educated choices about tobacco use.

This study was supported in part by the Tobacco Research Fund (UAB). This study was also supported by grants from the Swedish Medical Research Council, the Swedish Research Council, the Research Council for Social Sciences, the Heart and Chest Fund, King Gustaf V’s and Queen Victoria’s Foundation, Vasterbotten and Norrbotten County Councils and the Swedish Public Health Institute.