FAQs

A global campaign for a future free from cigarette smoking, built on a pragmatic, evidence-based approach to tobacco harm reduction. Sweden has all but eliminated smoking, and our purpose is to share how that was done with governments, health professionals and the public.

Fewer people smoking cigarettes, in every country. Where someone can stop using nicotine altogether, that is the best outcome and the first thing to recommend. Where they will not or cannot, they should have access to significantly less harmful alternatives rather than being left with cigarettes.

Smoke Free Sweden is led by Dr Delon Human, a physician and former Secretary General of the World Medical Association, and works with doctors, scientists and public health specialists around the world. Our reports carry the names of the experts who wrote them and list the sources behind every figure.

The principle that when someone will not give up nicotine, the priority is to get them off the most dangerous way of taking it. Almost all of the death and disease caused by tobacco comes from setting it alight and inhaling the smoke. Take the smoke away and most of the harm goes with it, even when the nicotine stays.

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It is the point at which fewer than 5% of adults smoke daily, as defined by the World Health Organization. Public health bodies and the EU both use that threshold. Sweden, at 5.3%, is closer to it than any other country in Europe.

Not on the national figure, but parts of the population have. Smoking among Swedish men is 4.9%, and among people born in Sweden it is 4.5%. The remaining gap is mainly with residents born outside the country, where the rate is higher; at 7.8% for those born elsewhere in Europe, it is still under a third of the EU average.

Link: The Safer Nicotine Revolution

Sweden ran the same tobacco control measures as everyone else and then did one more thing: it let smokers move to products that do not burn. Access, social acceptability and price all pushed the same way. Snus was already established, vapes arrived in 2015 and nicotine pouches in 2016, and parliament later agreed to tax nicotine products according to their risk, which put the excise on pouches at 8% of the cigarette rate. Smoking fell 54% in twelve years.

Link: The Swedish Experience

No. Snus gave Sweden a long head start, but the steepest falls are recent, and they follow the arrival of vapes and pouches rather than snus. The people who quit in the last decade are largely the people snus never reached, women above all. What Sweden shows is not the merit of one product; it is what happens when smokers have a range to choose from.

Sweden has 44% fewer tobacco-related deaths than the rest of the EU, 41% lower cancer incidence than the European average, and 36% fewer lung cancer deaths. Had the rest of the EU matched Swedish rates between 2000 and 2019, 2.9 million deaths would not have happened.

Link: No Smoke Less Harm

Because the harm is in the smoke, not the nicotine. Daily nicotine use in Sweden is 23.6%, level with the rest of the EU at 23.5%. The difference is that most Swedish nicotine users are not setting fire to anything. Sweden is as close as public health gets to a real-world test of that distinction: the same nicotine consumption, a fraction of the disease.

Link: No Smoke Less Harm

Around 355,000 lives a year in the EU alone, on Lars Ramström’s 2020 analysis, and more than 3.5 million over a decade. Our Lives Saved report works the same calculation through market by market.

No, and two other countries make the point. Japan had no history of oral nicotine and cut cigarette sales by roughly half after heated tobacco products reached the market in 2014 and 2015. New Zealand halved its smoking rate between 2018 and 2024, to 6.9%, after the government recognised vaping as a quitting tool and actively told smokers to use it. Different products, same principle.

Link: Quitting Strong: New Zealand

Four things. Separate smoked products from smoke-free ones in law and in tax. Treat harm reduction as part of tobacco control rather than a rival to it. Regulate each product according to the risk it carries. And correct the misinformation about nicotine that circulates among the public and among doctors.

Cigarettes should be the most expensive, most restricted and least convenient way to consume nicotine, and the alternatives should be cheaper and easier to obtain than cigarettes without being made attractive to people who do not smoke. Sweden does this with a tax scale set by risk, an age limit of 18, content and labelling standards and limits on how the products can be marketed.

A 1992 ban on oral tobacco, which Sweden negotiated an exemption from as a condition of joining in 1995. The ban was not the product of evidence that snus was comparable to cigarettes, and thirty years of Swedish data since have pointed the other way. Nicotine pouches contain no tobacco and sit outside that ban, which is why they, rather than snus, are what most European governments are now arguing about.

No. The EU set itself a tobacco-free generation by 2040, meaning fewer than 5% of the population. Sweden reaches that on smoking around seventeen years early. On the Commission’s own data, no other member state reaches it at all.

Link: Missing the Target

No, but they reduce lawful sales. Demand stays, and it is met by suppliers who do not check age, list ingredients or pay tax. Our country comparisons keep finding the same shape: prohibition in place, a large unregulated market alongside it, and a smoking rate several times Sweden’s.

Link: Tale of Two Nations: Mexico

Price is one of the three things that decides whether a smoker switches, so a tax that closes the gap with cigarettes removes the reason to bother. Sweden went the other way and set the rate on pouches at a fraction of the cigarette rate.

No. They are one of the reasons switching lasts. Sixty per cent of the Swedish women we surveyed named flavour as a reason they chose pouches over cigarettes. Ban flavours and the product that competes with cigarettes gets worse while the cigarette stays exactly as it was.

Link: Power in a Pouch

No. They are for adults who already smoke. Age limits that are enforced on a legal market are what keeps them away from children, and an illegal market has no age limit at all.

No, and the belief that it does is one of the biggest obstacles to progress. The NHS states that nicotine does not cause cancer, lung disease, heart disease or stroke, and has been used safely in medicines for years to help people stop smoking.

Link: No Smoke Less Harm

We are saying they are less harmful, which is a different claim. Nicotine is dependence-forming and none of these products is risk-free. On snus, where the record is longest, studies put the harm at about 5% of that of cigarettes and smoking-related mortality at 90 to 95% lower, with no established snus-related premature death. The comparison that matters for someone who smokes is not with abstinence, it is with the cigarette they would otherwise light.

Yes, and it remains the first thing to recommend. The question this campaign exists to answer is what to offer the very large number of people who have tried that and gone back to smoking.

It explains part of it but cannot account for the size of the gap. Sweden ran the standard measures, advertising bans, indoor smoking bans, tax rises, warning labels and education campaigns, and several EU countries ran them harder. Those countries have four to five times Sweden’s smoking rate. The timing points to what accounts for the rest: each acceleration in the Swedish decline follows a new alternative reaching the market.

Then compare it with a country that is both. Denmark has comparable income, a comparable health system and a similar culture, and more than twice Sweden’s smoking rate. The variable that differs is policy on smoke-free products.

Link: The Great Divide: Denmark

Sweden has the highest use of oral nicotine in Europe and the lowest smoking rate in Europe. If oral nicotine led people to cigarettes, that is the last pair of facts you would expect to find together, and they have held for decades rather than a couple of years.