Sweden: Soon Europe's First 'Smoke-Free' Country

The Swedish Model

Based on current trends, Sweden will soon become a smoke-free society. Daily smoking prevalence in Sweden in 2024 had fallen to just 5.4% among individuals aged 16-84 compared to 12.8% in 2008.^[1] The World Health Organization (WHO) considers countries to be smoke-free when smoking prevalence is less than 5% of the population.^[4] As a result, Sweden is reaping the benefits.^[3]

A key to Sweden’s success has been its openness to allow the sale of smokeless alternatives to cigarettes that satisfy adult smokers’ desire for nicotine, and the government’s adoption of progressive Tobacco Harm Reduction policies that avoid excessively restricting these smokeless alternative products.

In Sweden, smokeless products are more accessible, affordable and socially acceptable than in many other countries, reflecting the country’s long-standing progressive approach to Tobacco Harm Reduction commonly referred to as The Swedish Model.

Nicotine pouches accelerating smoking decline among women

For decades, snus, a moist, pasteurised Oral Tobacco Product, has contributed to Sweden’s lower smoking rates and the reduced incidence of smoking-related disease and mortality, when compared to the rest of Europe. Men in Sweden were among the first demographic group to adopt snus broadly as their smoking rates declined, leading to Tobacco Harm Reduction from snus’ reduced risk as compared to cigarette smoking, while its use among women remained limited. Accordingly, between 2009 and 2015, smoking prevalence among women declined by just 16%, well below the 27% reduction observed among men^.[1]

Following the introduction of oral nicotine pouches in 2016, the smoking rate decline among females increased by nearly 200% compared with the previous six years.^[5] In 2024, only 5.8% of Swedish women aged 16-84 smoked, representing approximately a 39% drop since 2016.^[1] In parallel, the uptake of oral nicotine pouches has increased across adults: according to Sweden’s Public Health Agency, by 2024, daily usage of oral nicotine pouches among adults aged 16-84 had risen to 5.2%, up from 2.7% in 2022.^[1]

The earlier adoption of smokeless products instead of cigarettes among men in Sweden has also translated into substantial public health benefits. The data is particularly compelling when you look at the disease burden from smoking amongst men in Sweden compared to other EU countries. Lung cancer rates in Sweden are the lowest in Europe, Swedish men, in particular, have about 61% lower lung cancer incidence compared to the EU average.^[2] Overall, Sweden has 31% fewer total cancer deaths than the EU average, 41% fewer cancer cases and 44% lower tobaccorelated mortality.^[3]

THR Adoption

Sweden has combined access to smokeless products with traditional tobacco control measures to slash its smoking rates. By keeping snus legal for adults and allowing the introduction of newer, smokeless alternatives, Sweden is moving towards being a smoke-free society. Vaping was first introduced in 2015, and Oral Nicotine Pouches became available in 2016.

Swedish adult smokers have now access to a wide range of Smokeless Products – snus, Oral Nicotine Pouches, Vapour Products and Heated Tobacco Products – which are legal and available both online and in stores. 

In December 2024, the Swedish Parliament voted to formally enshrine tobacco harm reduction in public health policy^[6,7] cementing Sweden’s position as a global leader in the journey to build a Smokeless World. The focus shifted from reducing tobacco use to prioritising the reduction of tobacco related harm, with legislators acknowledging a spectrum of risk among nicotine products.^[8] Notably, authorities stated that combustibles carry greater health risks than smokefree products like snus. In line with this tobacco harm-reduction approach, Sweden implemented risk-proportionate taxation, in 2024 it raised excise duties on cigarettes and other combustible tobacco by 9% and simultaneously reduced the tax on snus by 20%. As a result, Smokeless Products are more affordable than cigarettes.^[9]

At the same time, Sweden introduced tight regulations on emerging nicotine products rather than banning them. In 2022 it adopted the Act on Tobacco‑Free Nicotine Products, establishing a regulatory framework for nicotine pouches and similar products.^[10] These controls (on product standards, marketing, age limits, etc.) ensure that such lower-risk profile alternatives are available to adult smokers while limiting youth access and maintaining minimum product safety standards.^[11]

There is also political support for maintaining access to a range of flavours and nicotine strengths. In 2022, the Swedish parliament voted against a proposal to ban vape flavours, with MPs citing concerns that it was counterproductive and would result in more people smoking cigarettes.^[12]

The culmination of these policies is that Sweden will shortly reach smoke-free status, 15 years ahead of the EU’s 2040 target, putting it far ahead of its European counterparts.