A landmark study suggests Sweden’s dramatic reduction in smoking rates and related deaths stems from a national shift toward smokeless tobacco products.
“Nicotine is addictive, but it isn’t the cause of serious smoking-related illnesses,” said Dr. Karl Fagerström, a public health expert who contributed to the research. “Our findings support a focus on harm reduction, offering less harmful alternatives to those who can’t quit smoking entirely.”
The “No Smoke Less Harm” report, released by Smoke Free Sweden, a global health advocacy group, says Sweden is on track to become the first smoke-free nation, with smoking rates below 5 percent.
Sweden’s public health agency reported that only 5.6 percent of Swedish adults smoked cigarettes in 2022, down from 49 percent of men in 1960. The report credits this success to Sweden’s openness to alternative nicotine products and its adoption of tobacco harm reduction strategies.
This shift, the report says, has led to a “smoke-free generation.” ZYN, the most popular oral nicotine pouch in the U.S., originated in Sweden.
High nicotine use does not necessarily lead to high rates of health problems, the report says, presenting compelling evidence that despite similar levels of nicotine consumption, Sweden has significantly lower rates of tobacco-related diseases compared with other European nations.
Nearly one in four adults in Sweden use nicotine daily, which is on par with the European average. However, Sweden has far fewer tobacco-related deaths (44 percent lower), cancer rates (41 percent lower), and cancer deaths (38 percent lower) compared to the rest of the European Union.
Among men, Sweden has 52 percent fewer tobacco-related male deaths than Poland and 57 percent fewer than Romania. For male lung cancer, Sweden has significantly fewer deaths than France, Germany, Italy, and Poland.
Dr. Scott Gottlieb, a former commissioner of the US FDA, had recognized the benefits of smoke-free products. He said in a recent interview over CNBC that, “If we can convert more currently addicted adult smokers onto these modified risk products (ZYN nicotine pouches) that don’t have all the harms associated with combustion, we can achieve a substantial net public health benefit.”
The report argues that the method of nicotine consumption has a significant impact on health outcomes. While smoking is linked to high rates of death and disease, the report finds smokeless alternatives, like snus and oral nicotine pouches, don’t pose a similar health risk.
Sweden’s public health policies and regulations have encouraged the transition to smokeless products, according to the report. It says other countries could adopt similar harm reduction strategies to reduce tobacco-related health problems.
“The Swedish experience demonstrates that understanding public misperceptions about nicotine can lead to health policies that better protect and inform consumers,” Fagerström said.
The report supports the National Health Service’s (NHS) stance that nicotine, while addictive, is relatively harmless to health and suggests comparing the dependence levels of nicotine and caffeine to create risk-based regulations for both substances.
Smoke Free Sweden is a movement that encourages other countries to follow Sweden’s lead in tobacco harm reduction.
The report calls on the World Health Organization (WHO) and global public health communities to acknowledge that combustible products, not nicotine itself, cause harm to smokers. It highlights the existence of significantly less risky forms of nicotine consumption.
Policymakers should recognize the potential of tobacco harm reduction (THR) in reducing harm, regulate nicotine products based on their relative risk profile, encourage healthcare professionals to embrace THR as a harm reduction strategy, and empower THR users to advocate for supportive policies, the report says.
