Points of interest


ITS’ comments to the report SOU 2015:6 on proposals for legislation to implement the EU Directive on Tobacco Products.


Mortality attributable to tobacco among men in Sweden and other European countries: an analysis of data in a WHO report.


Death by regulation: the EU ban on low-risk oral tobacco

Clive Bates makes strong arguments for lifting the EU-ban on smokeless tobacco.

Read more >


Swedish tobacco experts in double seats

Doctors help to lobby against snus – and for Pfizer’s drugs

Read more (eng) >

Read more (Swe) >


Cut out the smoke, reduce the risks


Poster presentations

Dual use after uptake of snus among daily smokers:
How does it influence the conditions for subsequent cessation of smoking?

Lars M. Ramström, ITS, Tom Wikmans. FSI.

Poster presented at 13th Annual Meeting of the SRNT Europe inAntalya,Turkey: September 8 -11, 2011

Although dual use of cigarettes and snus is a small part of tobacco use, there have been concerns that it would represent a major public health problem by delaying or weakening cessation efforts and/or increasing nicotine load and related nicotine dependence. The findings of this study do not support these concerns. They do rather suggest that, for smokers who take up snus use, dual use would usually be a transitional phase serving as a stepping-stone towards quitting smoking or quitting all tobacco use. The likelihood of a smoke-free endpoint is further strengthened by the effectiveness of Swedish snus as a cessation aid.

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Revisiting Harm Reduction – An Update of Pros and Cons

Lars M. Ramström, ITS, Tom Wikmans. FSI.

Poster presented at European Conference on Tobacco and Health (ECToH) inAmsterdamtheNetherlands: March 28 -30, 2011

The data presented in this poster suggest the following answers to five frequently asked questions.

  • Primary Snus-use does not serve as a gateway to smoking, rather as a resistance against smoking.
  • Initiation of Snus-use among smokers will lead to cessation of smoking rather than to dual use.
  • Switching from daily smoking to daily Snus-use will weaken rather than strengthen nicotine dependence.
  • Smokers who take up Snus-use are more likely to make quit-smoking-attempts.
  • Evidence from Sweden demonstrates that Snus can be an effective smoking cessation aid and has been a major contributory factor behind the record low prevalence of smoking in Sweden.

In summary:
Harm reduction strategies where cigarettes are replaced by snus could play an important role in the efforts to achieve a tobacco-free society.

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The Swedish experience of minimizing smoking a possibly challenging example for large scale smoking cessation in the Asia Pacific region.

Lars M. Ramström, ITS, Tom Wikmans. FSI.

Poster presented at Asia Pacific Conference on Tobacco and Health (APACT) inSydney,AustraliaOctober 6–9, 2010

The Swedish experience

  • Snus has not increased the total initiation of tobacco use in Sweden
  • Snus is both the most preferred and most effective quitting aid in Sweden
  • Snus has increased the cessation rate in Sweden

International experience

  • Snus is both the most preferred and most effective quitting aid in Norway
  • Snus has increased the cessation rate in Norway

Snus as a non medical quitting aid in other regions

All evidence points out the effectiveness and relative harmlessness of Swedish Snus as a non medical quitting-aid. This would justify a policy that not just allows the sale of this non medical quitting-aid but actively encourages the use of it where other quitting aids have failed to be effective.

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Changing tobacco habits in Sweden: Influence of environmental and psychological factors related to smoking and use of smokeless tobacco (“snus”).

Lars M. Ramström, ITS, Tom Wikmans. FSI.

Poster presented at SRNT’s 14th Annual Meeting inPortland,USAFebruary 27-March 1, 2008

The survey data from the study presented in this poster illustrate some important features of the interaction factors that influence the development of an individual’s tobacco use behaviour. Two interaction factors appear to play a particularly central role, namely; proximity to tobacco users, and attitude to smoking and snus use as an acceptable or unacceptable phenomenon in the society.

Among Swedish men;

  • the proportion finding snus use acceptable is larger than the proportion finding smoking acceptable.
  • the proportion finding smoking acceptable is larger among those with, than among those without proximity to smokers, irrespective of the type of own tobacco use.
  • onset of primary smoking is promoted by proximity during adolescence to smokers, but not by proximity during adolescence to snus users.
  • desire to quit smoking is higher among those with a negative attitude to smoking than among those with a positive attitude to smoking. The corresponding pattern applies to snus users.
  • never smokers have a strong resistance against considering trying to smoke, but the resistance is weaker than average among those with a positive attitude. The corresponding pattern applies to snus users.
  • a majority of smokers have experience of feeling uncomfortable in their role as smoker, while less than half of the snus users have a corresponding experience.
  • both among smokers and snus users those who have experience of feeling uncomfortable have stronger desire to quit than those without such experience.

The findings can help assessing the consequences of a continued development such as the one that has taken place inSwedenwith increasing snus use and decreasing smoking. A continued such development would decrease overall proximity to smokers and thereby increase non- acceptance of smoking, a factor that appears to promote cessation of smoking. The inherent increase of proximity to snus users does not appear to promote onset of smoking. The combination of all these interactions may therefore accelerate a downward trend in smoking with subsequent public health benefits.

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Perception of health status among different groups of tobacco users in Sweden

Lars M. Ramström, ITS, Tom Wikmans. FSI.

Poster presented at the 1st Asian Regional SRNT Conference inBangkok28-31 October 2008

The findings presented in this poster are based on self-reported data. However, self-reported perceptions can lead to real consequences. These self-reported perceptions can be seen as markers of real conditions. Therefore, we may assume that the findings reflect reality. Consequently, we can conclude that our findings suggest that:

  • Daily smoking does impair health in people’s daily life.
  • Daily snus use does not noticeably impair health in daily life
  • Switching from smoking to snus use yields a viable improvement of health.

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Swedish adults’ understanding of the health risks of long term use of nicotine replacement products and of using Swedish snus compared to smoking

Lars M. Ramström, ITS, Tom Wikmans. FSI.

Poster presented at the 10th European SRNT Europe Conference inRome23-26 September 2008

The overall picture indicates low awareness of the scientific evidence, even lower regarding Snus than regarding NRT. Reported uncertainty is high regarding NRT, while the beliefs about Snus are more definite (although Inconsistent).

  • Regarding NRT the proportion of Inconsistent answers is higher in 2004/2006 than in 1996.
  • Regarding Snus the proportion of Inconsistent answers is lower in 2004/2006 than in 1996.
  • Both regarding NRT and Snus, the proportion of Inconsistent answers is:
  • lower among men than among women.
  • lower in high income groups than in low income groups.
  • lower among academics than among others.
  • Regarding Snus but not NRT the proportion of inconsistent answers is lower among young people than among old.

Information on the scientific evidence regarding NRT and Snus has not reached out to the general public inSweden. The observed influence of education level suggests that further large scale educational efforts would be potentially effective to fulfil the need for increased awareness of actual facts and rectify prevailing misinterpretations.

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