The Swedish Miracle Confirmed

Investigators from Umeå University and the Karolinska Institute in Sweden have just published a study of tobacco use among the population (40, 50 and 60 year-olds) of Västerbotten County in Northern Sweden over the period 1990 to 2007 (abstract here). The results confirm the findings from earlier published reports (here, here and here), that snus use has been a major influence in low smoking and high cessation rates among Swedish men, and more recently among Swedish women.

This table, adapted from the publication, lists the prevalence (%) of men who used snus, cigarettes, or both products during each period of the study.

Prevalence (%) of Tobacco Use Among Men in Västerbotten County, 1990-2007
	1990-95	1996-2001	2002-07
40 Year Olds
Snus	19	26	28
Cigarettes	20	12	7
Both	8	6	6
50 Year Olds
Snus	12	20	24
Cigarettes	21	16	11
Both	6	6	6
60 Year Olds
Snus	11	14	18
Cigarettes	17	14	13
Both	3	3	4

It clearly shows the transition from cigarettes to snus. Men of all ages made the switch, but the findings are most impressive for 40 year olds: snus use rose from 19% in 1990-95 to 28% in 2002-07, while smoking dropped from 20% to 7%.

Women also made the switch. In 1990-95, 31% of 40 year old women smoked, and only 2% used snus. By 2002-07, 12% smoked and 12% used snus.

The following table, also adapted from the publication, shows that many men used snus to quit smoking.

Percentage of Men Former Smokers Who Were Current Snus Users
	1990-95	1996-2001	2002-07
40 Year Olds	41	49	60
50 Year Olds	26	37	44
60 Year Olds	23	26	31

Once again, the switch was most impressive among 40 year olds. In 1990-95, 41% of former smokers were using snus. By 2002-07 that figure was 60%. Although the percentages were smaller among women former smokers, they were still impressive. In 2002-07, 30% of 40 year old former smokers were using snus -- 16% among 50 year olds, and 7% among 60 year olds.

The study also looked at tobacco use among participants 10 years after they enrolled in the study (Baseline). Here is a breakdown of those results.

Tobacco Use Among Men After 10 Years
	Baseline Tobacco-Free	Baseline Snus	Baseline Cigarettes	Baseline Both
Follow-Up Tobacco
Tobacco-Free	93%	20%	29%	12%
Snus	4	74	13	45
Cigarettes	2	1	51	7
Both	Under 1	5	7	34

Note: Stable use in bold

The important message here is that only 51% of smokers were still lighting up after 10 years, while 29% were tobacco-free, and 13% were using snus. Dual use was even more unstable, with 45% using snus at follow-up. Once again, these findings are similar to previously published research (here).

These results clearly show that snus use has played an important role in low smoking rates. Despite this, the researchers who produced the data argue to the contrary. They write, “If this was a randomized trial it would definitely refute the argument that snus use reduces smoking prevalence…our data is not in support of the claim of smoking reduction of snus…on a population level, snus has played a small role in the decision process to quit smoking.”

The researchers’ anti-tobacco sentiments are clearly at odds with the evidence. Their data simply proves, once again, the reality of the Swedish Miracle. Their jarring analysis underscores the disconnect between the fact-based science of tobacco harm reduction and the obfuscating politics of tobacco prohibitionism.