Wednesday, September 24, 2014

The Swedish Snus Experience Isn’t Finnished

Despite the wealth of evidence demonstrating that snus has helped thousands of Swedish men and women avoid the ravages of smoking, the European Union continues to enforce an irrational ban on snus beyond Sweden’s border. 

I have documented that smoking deaths in Sweden are significantly lower than in all other EU countries (here and here).  A new study clearly demonstrates the differences in smoking rates when snus is available and when it is banned (abstract here).

Snus has been popular in Sweden for 200 years, but it was also used in neighboring Norway and Finland.  In 1995, Sweden and Finland joined the EU.  Sweden applied for and received a waiver on the EU’s existing snus prohibition, thereby allowing Swedes to continue producing and selling within the country.  In contrast, Finland accepted the ban, denying its snus consumers a legal source.  Norway never joined the EU, so snus remained available.

Dr. Jennifer Maki, an economist with the Center for Healthcare Economics and Policy, compared the smoking rates in these three countries before and after 1995.  Maki's figure above shows the rates among men in Sweden and Finland.  Clearly, a decline in smoking levels off in Finland after 1995, while the decline in Sweden continues, despite the fact that it was far lower over the entire period.  As Maki writes, “…in the post-ban period, smoking increased in Finland by 3.47 percentage points relative to Sweden…this estimate can be interpreted as an increase in the smoking rate [in Finland], relative to what it would have been, in the absence of the ban.”

The comparison of Finland and Norway, seen in Maki's chart on the left, also shows the effects of snus use on smoking.  According to Maki, “the smoking rate [decline] in Norway is similar to that in Finland prior to 1995, after which point the rates diverge. Using Norway in place of Sweden as a control produces a result similar to, but not as drastic as, [the Swedish comparison].”

Maki’s conclusions illustrate the impact of snus in Sweden, the impact of the snus ban in Finland, and the utter failure of EU policy:

“The smoking rate among Swedish males is remarkable [sic] low, and continues to decline; given Sweden’s low smoking rate pre-1995, the ability to achieve further reductions post-1995 is notable… The findings presented in this paper provide support for the viability of a harm reduction approach to smoking cessation and suggest that the Swedish Experience could be replicated elsewhere… It may have been underway in Finland prior to the implementation of the ban.  These results are not only meaningful within Finland, but may be applicable to the entire EU.”

Note: I am especially proud of Jennifer’s contribution.  She contacted me when she was a doctoral student at North Carolina State University; I provided materials on tobacco harm reduction, reviewed and critiqued early versions of her thesis and helped her search for Swedish and Finnish datasets.  Her mentor, Professor Barry Goodwin, sponsored my guest lecture at NC State, and I hosted a visit by Jennifer to the University of Louisville so that she could present her work.   

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