The Swedish Experience

The Swedish Experience can probably be explained by Swedish men’s unique tobacco consumption, which comprises to a large extent of snus. Total tobacco consumption is about the same as in comparable countries, but Swedish men smoke considerably less. The proportion of daily smokers is currently 12 percent among men, which is the lowest in Europe. In addition, 19 percent of Swedish men use snus. In Sweden, snus is thus more common than smoking.

The positive effect of this relationship is a very low frequency of tobacco-related illnesses among Swedish men and a low level of smoke-related deaths. The unique relationship is documented in a large number of epidemiological studies that show that Sweden has the lowest risk of lung cancer in industrial countries. Although snus cannot be given a clean bill of health in terms of negative health effects, research findings show that the health hazards is considerably lower with snus than with smoking.

Most snus users and lowest mortality in Sweden

*EU 25 refers to the 25 EU member states before expansion on January 1, 2007.

The diagram shows the proportion of smokers and snus users among men and the
risk of dying in a smoking-related disease. Despite the fact that tobacco consumption
is at least as high in Sweden as in other European countries, the risk of being afflicted
by a smoking-related fatal disease is significantly lower. Many researchers believe
that this is because snus replaces more harmful cigarettes in Sweden.

International attention

The Swedish experience has received major attention and currently plays an important role in international health debates. For a growing number of researchers within the tobacco area, it is becoming increasingly evident that snus could function as an alternative to cigarettes and that it results in considerably reduced health risks.

The internationally known tobacco researchers, Jonathan Foulds and Lynn Kozlowski, wrote in an editorial in the medical magazine, The Lancet, in May 2007, that it is “perverted” public health politics to make tobacco available in its most harmful form, namely cigarettes, while neglecting to inform consumers that tobacco is available in a significantly less harmful form, namely snus.

At the end of 2006, the independent organization, American Council on Science and Health, ACSH, published a report “Helping Smokers Quit: A Role for Smokeless Tobacco?” The ACSH discusses the strategies that have been used to date by authorities and others to reduce the harmful effects of tobacco smoking. The authorities’ strategies are often based on an irreconcilable attitude against all types of tobacco products. In the report, these strategies are compared with harm reduction, which is based on most smokefree tobacco products, for example, Swedish snus, and is dramatically much less harmful than cigarettes. The ACSH believes that this is the attitude that the authorities should adopt, and points to the Swedish Experience, among others.

In the autumn of 2006, the US magazine, the Wall Street Journal, highlighted an expert panel at the National Cancer Institute, which had concluded that smokefree tobacco was associated with a 90-percent lower health risk, and Sweden was used as an example of how snus resulted in health benefits in the form of reduced frequency of cancer of the lungs and oral cavity.

Facts

• In 2007, 12 percent of all adult Swedish men smoked on a daily basis. The corresponding figure for Norway was 21 percent, for Denmark 26 percent and the average for Europe (2005, most recent information) was 30 percent. (1)
  
• In 2007, 19 percent of all adult Swedish men used snus on a daily basis. In Norway the figure was 11 percent and in Denmark 2.5 percent used some form of smokefree tobacco regularly. (1)
  
• In 2007, 16 percent of all adult Swedish women smoked on a daily basis. The corresponding figure in Norway was 23 percent, for Denmark 22 percent and the average for Europe (2005, most recent information) was 21 percent. (1) 
  
• In 2007, 4 percent of all adult Swedish women used snus on a daily basis. In Norway the figure was 1 percent and in Denmark 0.4 percent used some form of smokefree tobacco regularly. (1)
  
• In Sweden, more smokers switch to snus than vice versa. (2)
  
• Sweden became the first country in the world that in 1997 achieved WHO’s target for 2000, that the proportion of adult smokers shall be below 20 percent (3). The other country in Europe to achieve the percentage target was Iceland in 2005 (1), which also has a long tradition of using smokefree tobacco.
  
• In 2000, 10 percent of the deaths among Swedish men were smoke-related, which was the lowest proportion in Europe. The average figure for the EU 25 was 23 percent. (4)
  
• Swedish women were at the average EU 25 level in 2000; 7 percent of the deaths were smoke-related. (4)
  
• In 2000, the risk of a 35-year-old man dying from a smoke-related illness before the age of 70 was 3 percent in Sweden compared with 5 percent in Norway, 8 percent in Denmark and 9 percent on average for EU 25. (4)
  
• The corresponding figure for women was 2.1 percent for Sweden, 2.6 percent for Norway, 5.9 percent for Denmark and 1.6 percent on average for EU 25. (4)
  
• The incidence for lung cancer among Swedish men has declined during the past 20 years. However, Swedish women show a rising trend in lung cancer statistics. (5)
  
• In two epidemiological studies that were conducted recently in Sweden, no direct correlation could be established between the use of Swedish snus and cancer of the oral cavity. (6,7)
  
• In two recently conducted epidemiological studies regarding stomach cancer and cancer of the esophagus, no correlation could be established between Swedish snus and an increased risk for any type of these forms of cancer. (8, 9)
  
• The mortality rate in cancer is not elevated among Swedish snus users. (10)
  
• The risk for heart attacks is not elevated among in snus users. (11)
  
• In a study comprising Swedish snus users, researchers discovered no significant increases in the diastolic blood pressure, hemoglobin concentration, number of white blood cells, serum cholesterol or triglyceride levels. These findings are compared with the findings from corresponding studies on cigarette smokers. (12)
  
• Both snus users and smokers run a higher risk of dying of cardiovascular diseases than non-tobacco users. The risk for snus users is lower than for smokers. (10)
  
• The health risks associated with snus are most probably less than the risks connected with smoking. (13,14)

The figures within parentheses refer to the list of references.

• Archive
• Subscribe
• RSS
• Print
• Svenska

SWMA Jul 30, 2010 5:29 PM CET 170.5 SEK +1.5%