European Tobacco Harm Reduction Advocates
POSTED BY: NIKAN JANUARY 18, 2020
There are now more Norwegians using snus than smoking daily.
New figures from Statistics Norway show that while 14 per cent of the population aged between 16 and 74 used snus daily in 2019, only 9 per cent were daily smokers. Nikan has looked at the figures and asked for comments from researcher Karl Erik Lund at the Institute of Public Health.
In the last 10 years, the proportion of daily smokers has more than halved, from 21 per cent in 2009 to 9 per cent in 2019. Meanwhile, the proportion of daily snus users has increased, from 6 per cent in 2009 to 14 per cent in 2019. Snus has thus taken over as the preferred mode of administrating nicotine - which is gratifying news from a harm reduction perspective.
Percentage of people aged 16-74 who smoke or use snus daily
Source: ssb.no
Karl Erik Lund at the Institute of Public Health comments on developments as follows:
“The change that has taken place in the Norwegian nicotine market is very positive and has received a lot of attention abroad. There has been a rapid shift from life-threatening incineration products such as cigarettes and rolling tobacco to various varieties of snus. The proportion of smokers has halved in 10 years. Twenty years ago, every third Norwegian smoked daily. According to the Directorate of Health, Norway is the country in the world that has had the steepest decline in the number of daily smokers.”
Karl Erik Lund points out that the total volume of tobacco consumed by Norwegians has also reduced. Thus, it is not true that the strong increase in snus consumption has contributed to an increase in overall tobacco use.
“Overall, this will result in a formidable public health benefit. We can expect far fewer new cases of COPD, lung cancer and cardiovascular disease. These diseases together account for 75 per cent of smoker-related deaths. Snus - though not risk-free - does not increase the risk of contracting any of these three diseases.”
The figures from 2019 show a particularly strong decline in smoking from 2018 to 2019 and a corresponding increase in snus use. Lund does not want to pay particular attention to developments from one year to the next but states that he is focusing on the long-term trends. There are annual variations that are often due to chance.
Snus use is most common among young men
There are still many more men than women who use snus daily- 20% and 7% respectively state they use snus daily. Nonetheless, among women, daily use of snus has increased from a low of 1 to 7 per cent over the past 10 years.
Snus use is most common among young people and most commonly used among those between the ages of 25 and 34. In 2019, 24 per cent in this age group used snus daily. In this group, the proportion of daily smokers has decreased from 20 per cent in 2009 to only 4 per cent in 2019. In the youngest age group - 16-24 years - only 2 per cent smoke daily.
The figures below show the development in the group 25-34 years in the last 10 years, among men and women.
Men
Women
Nikan’s View
Nikan is very positive about the development. Although it is not risk-free to use snus, it is far less harmful to health than smoking.
The National Institute of Public Health has estimated that 2 out of 3 smokers will die as a result of smoker-related illnesses. Studies show that many people use snus as a smoking cessation product. There are also some that start using snus without smoking first. The critics claim that the latter is a public health problem. We at Nikan believe that very many in this group would start smoking if snus was not available. It is the countries that allow snus that have had the strongest decline in smoking in recent years. This shows that we need less harmful ways of taking nicotine.
Statistics from Statistics Norway can be found here.
This post originally appeared on Nikan's website, you can read it (in Norwegian) here: Snus erstatter røyking – gir store folkehelsegevinste
The Dutch government are proposing to extend their ban on the use of tobacco products in public places to include the use of snus (see here for the notification detail for the draft act). The consultation period ended on 31 December 2019.
Bengt Wiberg, the co-founder of ETHRA partner EUforSnus, wrote to the Swedish government to urge them to respond to the proposal. We summarise the letter below.
The Dutch government is proposing to ban the use of cigarettes and e-cigarettes as well as snus and other smokeless products in all public places. In Sweden, there has been a ban on the use of cigarettes and e-cigarettes in public places since December 2018 but snus is not included. In Sweden, 17% of the electorate uses snus. Snus has been used in Sweden for over 200 years and is thus by far the oldest harm reduction product (compared to smoking) in the world.
We urge the Swedish government to respond to the consultation on the Dutch proposal.
If the Dutch bill goes through, unopposed by the Swedish government, other EU governments are likely to conclude that snus is as dangerous as smoking. However, thanks to snus, Sweden has by far the lowest proportion of tobacco mortality and tobacco-related diseases in the EU and also the lowest smoking prevalence. This is because Swedes use snus instead of smoking. Research has shown that 86-87% of Swedish snus users are former smokers who stopped smoking for good.1
The potential impact on public health, for the 100 million daily smokers in the European Union is extremely worrying.2 Annually approximately 700,000 die prematurely from smoking-related diseases in the EU.3 However, nobody has been proven to have died from snus. Snus is not a health product but must be considered in relation to the dangers of smoking. Swedish snus, and tobacco-free snus, can be excellent tools to quit smoking. There is no ban on the sale of tobacco-free snus in the EU, and it is often manufactured by Swedish companies and sold to EU countries.
The epidemiological wonder of Sweden’s low smoking prevalence is often referred to as “The Swedish Experience”. On October 22, 2019, the US Federal Authority (FDA) decided to grant Swedish snus - the first product in FDA history - with approval as a "modified risk tobacco product" (MRTP) and approval to market eight Swedish snus products as being less harmful than smoking.4
Snus should not be a political issue at all. It is rather a public health issue. We in Sweden should be proud to have the lowest proportion of smokers in the entire EU (and probably the western world) as well as the lowest tobacco mortality and prevalence of tobacco-related diseases. In September 2017, the world's largest so-called meta-data study, comprising 26 years of published scientific research, concluded that Swedish snus does not increase the relative risk of any disease at all when using snus compared to non-snus users.5
Read the full letter here.
Footnotes
1.Patterns of Smoking and Snus Use in Sweden: Implications for Public Health, https://www.ncbi.nlm.nih.gov/pubmed/27834883
2. Flash Eurobarometer No 253 Survey on Tobacco. Analytical report. Hungary: The Gallup Organisation, 2009. http://ec.europa.eu/public_opinion/flash/fl_253_en.pdf (accessed 16 January 2020).
3. "Overview - Public Health - European Commission", Public Health - European Commission, 2020 https://ec.europa.eu/health/tobacco/overview_en [Accessed 16 January 2020].
4."Spotlight On Science - Winter 2020", U.S. Food And Drug Administration, 2020 https://www.fda.gov/tobacco-products/ctp-newsroom/spotlight-science-winter-2020 [Accessed 16 January 2020].
5.Skademinimering« är ett omdiskuterat alternativ för dem som inte kan sluta röka, (Harm reduction is a well-debated alternative for those who cannot quit smoking) Stefan Willers, Läkartidningen, http://www.lakartidningen.se/Klinik-och-vetenskap/Klinisk-oversikt/2018/10/Skademinimering-ar-ett-omdiskuterat-alternativ-for-dem-som-inte-kan-sluta-roka/
EU for Snus is an advocacy group campaigning to give everyone access to nicotine replacement products with an onus on the right to enjoy smokeless tobacco products such as snus. EU for Snus’ Facebook group has several thousand members from about 100 countries, including all countries in the EU. The members are adult men and women, almost all of whom have stopped smoking with the help of snus. You can find out more about EU for Snus on their Facebook page.
ETHRA founder partner, the New Nicotine Alliance in the UK, is calling on European Harm Reduction Advocates to prepare for worrying developments in the new year.
In an article just before Christmas, they urged vapers, especially, to “prepare for battle” in the coming year. The European Union is currently gathering evidence for a review of the Tobacco Products Directive and meetings have already been planned to discuss how misinformation emanating from the US can be used to close down the sensible regulations Europe has enjoyed since 2014.
As the NNA put it: “The war on harm reduction in the EU is starting again. Much sooner than you realise, minds will be closed, and positions taken. By the time any of us are asked for comment on this, policy proposals will already have been made. We are expecting the first significant discussions to start in the European Parliament as soon as the end of January 2020.”
It is important that all partners take this threat seriously. Harm reduction in Europe is under imminent threat and we will have to mobilise consumers as we did for the last iteration of the TPD. Five years ago, it took a lot of pressure from vapers to educate the EU as to how important vaping products were and to head off counterproductive regulations which would affect the choices of European smokers wishing to quit.
2020 will see major threats to the sensible regulations that we fought so hard for under TPD2, but it would appear that the EU wishes to erase them and introduce the same damaging proposals that they were forced to abandon before.
We must all resist this by reminding the EU that the most important voice on this subject in Europe is that of those of us who have derived tangible and life-changing benefits from harm reduction. ETHRA is committed to galvanising the consumer voice in our region and will be asking for your help in a major campaign in 2020 to remind the EU why they prohibit reduced risk products at their peril. They would prefer we stay silent and be rule-takers, we must make them realise that we will not sit idly by as they dismantle what we know is working.
We cannot just let ill-informed bureaucrats play games with our lives, please be prepared to mobilise all European consumers in 2020.
Notes:
New Nicotine Alliance UK is a registered charity which raises awareness about tobacco harm reduction. The Board of NNA and Associates include ex-smokers, most of whom have succeeded in giving up smoking through the use of other nicotine delivery systems. NNA can be contacted here.
ETHRA is pleased to welcome some promising news from Norway.
The Norwegian government has declared that it will lift its ban on e-cigarettes with nicotine and replace it with an authorisation system as it belatedly moves to implement the EU’s Tobacco Products Directive (TPD). Manufacturers of e-cigarettes and new tobacco products will have to apply for authorisation at least six months before they intend to put their product on the market, as the TPD requires. The government is also planning to allow e-cigarettes and refill containers to be advertised at the point of sale and be presented online neutrally, unlike cigarettes.
The Norwegian Directorate of Health, which will evaluate the applications, will look at “whether the product will contribute to tobacco harm reduction;” whether it appeals to youngsters; whether it will lead to the initiation and re-normalisation of tobacco use; and whether it’s addictive, according to draft rules sent to notify the European Commission at the end of November.
The directorate will then decide whether the e-cigarette or novel tobacco product is defined as a nicotine or smokeless tobacco product, or a tobacco product for smoking, and which regulations should apply to it. This measure goes beyond the scope of the TPD.
“Legalising vaping in Norway is a welcoming development and we congratulate our government for aligning with the EU’s TPD,”, says Trond Meier, of Norsk Dampselskap/Norwegian Union of Vapers, a consumer-led association which advocates for vaping in Norway, “however, there is still much negative publicity around vaping in the media and many details still to become clear so our welcome must be cautious for now. There is still more work for us and our ETHRA partners to do.”.
André Bendigtsen, of Nikan, the tobacco harm reduction consumer group, adds: “We understand that these proposals will be implemented during 2020 and we would suggest that the government includes consumers of reduced risk products in the process at every stage.”, André continues, “these products offer a lifeline to many former smokers and can lead to better outcomes for the public’s health in Norway in the future. Consumers are ready and available to offer our experience and knowledge to regulators in order to maximise the many benefits of safer nicotine use.”.
Notes
Nikan has written about the new proposals on their website here and welcome being contacted here: This email address is being protected from spambots. You need JavaScript enabled to view it.
Norsk Dampselskap / Norwegian Union of Vapers can be contacted at This email address is being protected from spambots. You need JavaScript enabled to view it. and their website is here.
Norsk Dampselskap was established on 6 November 2011 and has over 4,000 members.
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