A recent GSTHR briefing paper examined the historical trends in tobacco use in Norway, the impact of smoking on public health, regulatory measures introduced to curb tobacco consumption, and the role of snus in reducing smoking rates. And non-surprisngly, it reported a sharp drop in smoking rates, coinciding with a significant increase in the consumption of snus, the renowned smokeless tobacco product that has now become the most commonly used form of tobacco in the region.
According to Statistics Norway, the daily smoking rate among Norwegians aged 16-74 fell to just 7% in 2023, with smoking nearly disappearing among younger demographics. In contrast, the number of daily snus users more than tripled between 2005 and 2023, reaching 16%. Among men aged 25-34, 34% reported daily snus use, while 23% of women in the same age group also used snus regularly. By 2017, the number of daily snus users had surpassed the number of smokers.
However, despite this steady decline in cigarette consumption over the past five decades, smoking remains a major cause of premature death in Norway. A 2015 study attributed 20% of all deaths before the age of 70 to smoking, with approximately 6,300 annual fatalities linked to tobacco-related diseases. In 2009, smoking was responsible for an estimated 13% of deaths among Norwegians over the age of 35. While lung cancer mortality rates among men have declined since 2011, the same trend was not observed among women until 2018. Research indicates that over 80% of lung cancer cases in Norway could have been prevented if women had not smoked.
Tobacco has been used in Norway since the 16th century, though cigarette smoking did not become widespread until the early 20th century. The prevalence of daily smoking peaked in the late 1950s, reaching 65% among men, while for women, the highest recorded rate was 37% in 1970.
A bad reputation – despite its relative safety
Given that snus does not involve combustion, it significantly reduces exposure to harmful toxicants such as tobacco-specific nitrosamines, which are among the primary carcinogens found in tobacco smoke. However, in recent decades snus gained a bad reputation after being banned throughout the EU (since 1992), with the exception of Sweden and Norway, as the latter is not an EU member state.
In fact, a 2019 study examining risk perceptions of tobacco products in Norway over 16 years (2003–2018) found that many of the participants considered snus almost as harmful as cigarettes. Respondents rated the harm of eight products, including cigarettes and snus. Cigarettes were correctly rated the most harmful (6.5), while snus scored surprisingly high (5.14 equating to 79.3%), despite its prevalence.
Norway’s tobacco control efforts
Meanwhile, Norway has been at the forefront of tobacco control since the mid-1960s when the Norwegian parliament first explored ways to address smoking-related health issues. This led to the introduction of the Norwegian Tobacco Act in 1975, marking the country’s early commitment to strict tobacco regulations. The Act required health warnings on tobacco products, set a minimum purchasing age of 16, and positioned Norway as one of the first nations to ban tobacco advertising.
Further restrictions followed in 1988, prohibiting smoking in public spaces and workplaces. A year later, the import and sale of novel tobacco and nicotine products were banned, though snus was exempt from these regulations. Smoking in bars, restaurants, and cafes was progressively restricted before Norway enacted a nationwide smoking ban in 2004, becoming the second country after Ireland to do so.
By 2010, Norway had introduced measures to prevent the display of tobacco products at points of sale, and in 2018, it became the first country to implement plain packaging rules for snus. These regulations applied to all tobacco products, requiring standardized packaging without brand logos or distinctive colors. While a concerning measure included in a 2023 public health report proposed banning the online sales of snus.
Despite the legality of snus, other reduced-risk nicotine products remain restricted in Norway. Current regulations prohibit the manufacture and sale of new tobacco and nicotine products unless they receive approval from the Norwegian Directorate of Health. As a result, applications for nicotine pouches and heated tobacco products have yet to be approved, effectively banning them.
The driving factors of snus use
Several factors have contributed to the increasing preference for snus over cigarettes. The growing awareness of smoking-related health risks, combined with Norway’s stringent tobacco regulations, created an environment where an alternative nicotine product could thrive. The introduction of low-nitrosamine snus in the late 1990s made the product even more appealing to those seeking a less harmful nicotine source.
The modern evolution of snus, particularly the shift from loose snus to portioned pouches, has also played a role in its popularity. These pouches eliminate the need for spitting, are more convenient to use, and are available in various flavors, making them attractive to consumers—including those who may not have previously used tobacco.
Additionally, snus provides a comparable nicotine experience to cigarettes without the harmful byproducts of combustion. Its affordability further enhances its appeal, as snus is significantly cheaper than cigarettes, especially following a 25% tax reduction in 2021 to curb cross-border purchases from Sweden.
What is Norway getting right and what it is it getting wrong?
Despite the evident role of snus in reducing smoking rates, Norwegian health authorities continue to discourage its use. Government policies unfortunately do not distinguish between snus and combustible tobacco, treating both under the same regulatory framework. Moreover, efforts such as plain packaging regulations and the goal of preventing increased snus use among young people could be sending the wrong message about the realtive safety of the product.
Norway’s proactive tobacco control policies have contributed significantly to the decline in cigarette smoking. While the government has not explicitly endorsed snus as a harm reduction tool, consumer preferences have driven the transition away from smoking toward this alternative nicotine product. Just like in Sweden, snus has played a crucial role in reducing smoking rates, particularly among younger Norwegians, demonstrating how the availability of a lower-risk tobacco product can help replace cigarette use.
Winner of The Global Smoke-Free Race: Sweden, Reduces Tax on Snus by 20%