World Health Organization
Shaping Narratives, Driving Action: The 2nd WHO Symposium on Meaningful Engagement of People Living with NCDs, Mental Health, and Neurological Conditions
Meaningful Engagement of People with Lived Experiences
12 Nov 2024
WHO Regional Office for Europe | 29 May 2024
“There is a lot of talk about Sweden becoming smoke-free, but this is a narrative that has been created by the tobacco industry,” warns Helen Stjerna, leader of the Swedish non-profit foundation, A Non-Smoking Generation. The organization has been working for 45 years to reduce the number of young people in the country who start using tobacco.
“Our laws against marketing tobacco products were really effective up until 2016, when the Swedish tobacco industry launched white snus,” she explains. “All of a sudden, they were allowed to market white snus, or snuff, as tobacco-free. They would even hand out nicotine pouches for free outside school playgrounds. They were sponsoring events, and music festivals, and social media was flooded with influencer marketing.”
For the last 35 years, shops in Sweden have not been allowed to advertise tobacco. By 1993 the country had banned workplace smoking, which was followed by minimum age limits for buying tobacco, and then laws introducing smoke-free restaurants in 2005 and smoke-free outdoor seating in 2019. This meant fewer young people taking up smoking. Now, Helen says, the industry can circumvent all these tobacco laws.
“White snus is a Swedish innovation,” she says. “It is essentially flavoured nicotine. Removing the brown tobacco leaves from the new products means the industry can avoid not only the tobacco laws, but also the rules on tobacco taxation. This is key in terms of making products that young people can afford.”
Helen goes on to describe how the so-called tobacco-free label also serves a dual purpose for the industry, as it makes the new products appear harmless.
“Nicotine is a harmful poison that lowers your cognitive abilities, making it harder to concentrate and harder to sleep. It's likely that white snus is even more dangerous than the traditional brown snus but, since there are no studies on white snus, we don't know. Children can “click here” on social media and order as many as six free pouches, which is enough to get them addicted. So many kids get in touch with us and say, ‘I was given this free sample and now I cannot stop; I cannot do my homework without it.’”
Many studies show that a cigarette smoker who tries to switch to snus is more likely to become a dual user, rather than to quit smoking. People use snus in the many indoor and outdoor areas where the law would otherwise prevent them from smoking, Helen points out. She stresses that “rather than helping people to quit, these products are designed to facilitate nicotine addiction and encourage traditional smoking”.
Despite a recent law in 2022, which banned advertising nicotine products on television and radio in Sweden, Helen says the tobacco industry still buys influence across social media and aggressively markets white snus, particularly at girls and young women.
“They push the idea that white snus is something fresh, with candy-like flavours. It’s no longer this disgusting brown snus that runs down your teeth and stains them brown. The industry saw an opportunity here since snus was already part of our cultural tradition.”
However, while in the past it was almost exclusively older men who used brown snus in Sweden, the introduction of white snus has resulted in a wider range of people taking up the habit.
“It was originally designed to manipulate young women, but, in the last few years, we have seen a lot of boys taking it up or switching from brown snus to white snus. The tobacco industry has successfully manipulated the narrative around white snus, promoting it as safe to use or even as a healthier alternative to traditional cigarettes.”
Helen highlights how white snus use is also now spreading from Sweden to every country around the world. “These products have enormous amounts of nicotine in them, which, in the majority of cases, is produced from tobacco leaves,” she points out. “This is not smoking cessation. This is nicotine and tobacco introduction.”
To try to protect children, A Non-Smoking Generation is campaigning for tougher laws to ensure that time spent in Swedish schools is free from all products containing nicotine.
“Snus use is spreading like an epidemic in schools here because students who are 18 can go and buy it and then sell it on to their younger friends who use it during school hours,” she says. “There are no laws to prevent this and it’s a huge problem in Sweden right now.”
Helen is hoping the law will soon be changed to ban nicotine products from being used during the school day, including on school property and outside the school gates. She believes this is fundamentally necessary although it’s not a magic bullet and there is much work needed to explain to children and young people how the purpose of the law is to protect all those minors that have not yet started using white snus and other nicotine products.
“From my point of view, I talk to many young people who say, ‘I want to stop but it's really hard because everyone uses it.’ So, it’s very important to help all these young people that want to stop using snus but can’t if all the friends use it during school time.”
“None of them ever intended to be a smoker or a snus user,” she emphasizes. “They were just going to try it for a while and then stop anytime they wanted. At least that's what they thought. It’s a shock how easy it is to get addicted and how hard it is to stop.”
So how does Helen’s organization go about convincing young people to change their habits or to avoid taking up the white snus in the first place?
Firstly, during lectures, young people need to be able to relate to and identify with the person standing on the stage talking to them, she says. Then, they’ve found the most effective solution is to talk about sustainability issues connected to the tobacco industry. These include issues of child labour, industry processes that involve massive deforestation, and all the poison that ends up in nature.
“We explain how tobacco and nicotine products are produced. Then we add to that the waste products that are thrown away. We highlight the cigarette butts and the nicotine pouches, as well as the lithium batteries and the plastic from disposable e-cigarettes that end up polluting our waters, the air, and the ground. So, what do you want to do? Do you want to support an industry that uses child labour and destroys the environment?”
She has noticed that young people are often very angry when they are given this information. At the end of these talks, they bring up their cigarette packs and snus tins and throw them in the bin. Because, in the end, nobody wants to feel tricked.
Figures show nine out of ten adult tobacco users started as teenagers or even earlier, and this means the industry must relentlessly target children in order to maintain their customer base. Helen is quick to point out that, if we can protect our youth from falling prey to their tactics, it won’t be long before we have a tobacco-free generation.