Swedish Women and Nicotine Pouches: Lessons for the UK

Sweden’s approach to tobacco harm reduction—which incorporates alternatives like snus and nicotine pouches—has contributed to achieving one of the lowest smoking rates in the world and is on track to become the first developed nation to reach a smoking rate below 5%, often considered the threshold for a ‘smoke-free’ status.

But how did Sweden achieve this, and could elements of its approach help the UK, which already has some of the highest quit success rates in Europe, to reach its smokefree goals even faster?

The documentary How Sweden Quit Smoking, which premiered on January 19, 2025, explores this transformation.

Directed by Tomasz Agencki, the film examines how Sweden’s harm reduction approach contributed to its progress in reducing smoking rates, offering insights into alternative strategies.

It features insights from leading tobacco harm reduction experts, including Prof. Curt Enzell, the inventor of portion snus; Dr. Karl Fagerström, creator of the Fagerström Test for Cigarette Dependence; and Dr. Anders Milton, former Chair of the World Medical Association.

After watching the documentary, we wanted to explore one of its key themes: how Sweden’s shift away from cigarettes—particularly among women—was shaped by nicotine alternatives, and how the UK could incorporate these learnings to further strengthen its already successful approach.

For much of the 20th century, snus was overwhelmingly used by men, while women remained far more likely to smoke¹.

The introduction of portion snus—a pre-packaged, more convenient version of loose snus—offered a smokeless alternative to cigarettes, but it still contained tobacco and remained more popular among men.

The breakthrough for Swedish women came with nicotine pouches, offering a tobacco-free option in a cleaner, more discreet format.

Unlike snus, nicotine pouches do not contain tobacco leaves, relying instead on extracted nicotine, plant-based fillers, and flavourings. This made them a more attractive choice for women who had previously smoked but had not been drawn to traditional snus products.

This shift may have been influenced by changing consumer preferences and attitudes toward health and social settings.

As smokeless, odour-free nicotine products became more discreet and convenient, they provided an appealing alternative for those seeking to avoid the social downsides of smoking¹.

Nicotine pouches provide a level of convenience that cigarettes cannot.

They produce no smoke, no lingering odour, and require no designated smoking areas, making them easy to use in workplaces and social settings where smoking is restricted¹.

Their discreet design allows users to consume nicotine without disruption, contributing to their growing popularity among women seeking a smokeless alternative.

Flavour diversity may have contributed to the rising popularity of nicotine pouches, particularly among women.

While cigarettes have traditionally offered limited flavour options—and with menthol now banned across the EU—nicotine pouches provide a much broader range of flavours, allowing consumers to tailor their experience³.

The role of flavours in preventing relapse to smoking has been widely studied in relation to e-cigarettes, where more established data is available. Studies suggest that when smokers quit, their taste sensitivity can improve over time, which may influence their flavour preferences⁴.

Many former smokers report preferring non-tobacco flavours, as these do not remind them of smoking. Research suggests flavour variety may influence consumer choices, but regulatory policies on their availability vary by market⁵.

Sweden’s reduction in smoking rates has coincided with the continued availability of snus, a product deeply rooted in Swedish culture.

While Sweden did not actively embrace harm reduction as a policy, it fought to preserve the legality of snus—not for harm reduction reasons, but to protect a traditional product important to many Swedes.

This stance against prohibition, despite broader European bans, has coincided with lower smoking rates, particularly among women.

In contrast, the UK’s regulatory path regarding snus has been notably different.

Restrictions on the sale of snus were first introduced in 1989, and the UK later aligned with the EU-wide ban implemented in 1992 as part of broader tobacco control efforts.

This approach reflected prevailing public health strategies at the time, rather than a specific focus on harm reduction.

Sweden, however, secured an exemption from the ban based on the cultural significance of snus. While the UK has not revisited its stance on snus following Brexit, these differing regulatory paths highlight important context for ongoing discussions about nicotine alternatives and public health¹.

Sweden’s decline in smoking rates has coincided with the availability of alternative nicotine products, such as snus and nicotine pouches, alongside evolving consumer preferences and broader public health trends. Some industry experts suggest that reviewing regulatory approaches and taxation frameworks could help ensure that adult consumers have access to accurate information, supporting informed decision-making.

As Sweden approaches smoke-free status, the UK has an opportunity to build upon its strong progress. Understanding Sweden’s regulatory context and market trends may provide useful insights for policymakers as they consider strategies to further accelerate the UK’s journey towards a smokefree future.