Smoking initiation in Norway among young people is below 2% and regular smokers approximately 9% of its population

In Norway, people consume nicotine in other forms, mainly the oral tobacco product called snus, which has taken the place of cigarettes in the nicotine market and has been for decades the most popular method to quit smoking.

This was said by Dr. Karl E. Lund, at the 5th Scientific Summit of Tobacco Harm Reduction in Athens, Greece (September 21-22, 2022) that was attended by over 200 participants from 41 countries.

He was speaking during a panel discussion after a presentation under the topic, ‘Current Challenges that Governments Face in Smoking Control—The Case of New Zealand’.

Dr. Lund said smoking initiation among young people in Norway is below 2% and regular smokers are approximately 9% of the population.

Panel discussion

“So, the main challenge that Norwegian government faces in tobacco control might appear quite different from those in countries where smoking remains more prevalent.”

He added that since snus has served as a very effective harm reduction alternative to cigarettes, the Norwegian authorities have recognized the fact that snus has played a role in reducing  smoking prevalence — the risk differences between snus and cigarettes have been communicated and the product has lower taxation than cigarettes.

The Summit recognised that there is a growing trend today to adopt Harm Reduction Strategies as a complementary strategy to smoking cessation and smoking prevention.  It is also to evaluate Tobacco Harm Reduction as another pillar of public health strategies.

While the end goal remains a “smoke free world”, THR advocates believe that governments should adopt a pragmatic public health perspective for smokers who fail to quit.

The challenges that governments face currently in smoking control were discussed in the panel discussion that included Vassilis Kontozamanis, previous Minister of Health of the Greek Republic.

The other panellists included SCOHRE founding members David T. Sweanor J.D. (Canada), Dr. Lund (Norway), Sharifa Ezat Wan Puteh (Malaysia) and Michael G. Toumbis (Cyprus).

Moderator Prof. Sweanor emphasized that smoking control is a global issue and needs to be seen from a global perspective — and had asked the panellists to share their views about the importance of integrating harm reduction strategies into the smoking control efforts in their countries, the ways they use to decrease smoking prevalence and the results they have seen until now.

Thus Dr. Lund continued to say Norway’s upcoming strategy plan goes a step further, including measures to minimize all kinds of nicotine use, — “meaning that the fight against smoking has become more a fight against nicotine”.

“So, the tobacco harm reduction debate in Norway is about to be replaced by a debate where the authorities seek justification for restricting use of recreational nicotine products.

“It is very interesting to observe and monitor the several arguments in this debate,” Dr. Lund said.

Dr. Sharifa Ezat Wan Puteh contended that in Malaysia, smoking is an issue of high importance since it is very prevalent.

“About 40% of males 15-years-olds and above in the country smoke and tobacco use is the leading cause of cancer, contributing to 22% of total cancer-related deaths,”’she explained.

Although the tobacco prevalence shows a gradual decrease during the last two decades, Dr. Wan Puteh said “it seems to fall short of Malaysia’s goal of 15% decrease until 2025”.

“One of the reasons that Malaysia faces such a huge problem of smoking is that the country still remains the world’s largest market for illicit cigarettes.”

According to the results of a recent study conducted by Nielsen on illicit cigarettes, she noted, 57.7% of cigarette consumption in the country was illicit.

“In an attempt to solve the problem, Malaysia’s Ministry of Health has proposed a generational tobacco ban, which, if passed, will come into effect from 2025, when those born in 2007 turn 18.

“According to this ban, anyone born after Jan 1, 2007, will face a high fine if caught buying tobacco and vape products,” she said, adding that there is a huge support for this generation smoking ban among smokers, vapers and non-smokers/vapers.

Unfortunately, Dr. Wan Puteh said, “most people believe that, without implementing other harm reduction measures, this ban will only increase black market sales without decreasing smoking prevalence.”

In his contribution, Dr. Michael Toumbis of Cyprus, said there is no objection that harm reduction strategies have a role in tobacco control strategies, saying tobacco harm reduction can be used as a complementary strategy.

“But our first priority in Cyprus is the full implementation and use of WHO – FCTC (Framework Convention on Tobacco Control). Unfortunately, the main problem with harm reduction is that we don’t have one product, but we need to implement rules for thousands of novel products.

“The most impressive example of harm reduction is coming from Sweden and Norway with snus. Their harm reduction strategy has shown really impressive results for tobacco control, but these countries have only one product to control.”

He indicated that the first and most important step in using harm reduction is to have control and knowledge of what you offer as an alternative, and it is not so easy to regulate and control so many harm reduction products.

Speaking about the situation in Greece, Vassilis Kontozamanis underlined that the country has managed to accomplish a paradigm shift to its healthcare system.

“The country’s strategy is to put the public health forward and not just to manage the everyday healthcare system problems,” he said.

“The ‘anti-smoking’ law that was effectively installed a few years back underlined the government’s will to fight the effects of smoking, he said, adding that almost the whole population complied with the new legislation which was very impressive.

“Of course, we cannot ban everything at once, we must do it step by step, apply smoking control policies and harm reduction policies.

“This is why we passed a legislation that provides some differentiation to potentially less harmful tobacco products,” he said, emphasizing that Greece created experts’ committees that evaluate all new, innovative products, as well as surveillance services to make sure that everything is run according to the law.

“Harm reduction products can be important tools for smoking control strategies, but we have to make sure that they are safe, through sufficient and well-established monitoring mechanisms; also, of course, to install a regulatory framework to protect the youth from smoking initiation.

“Eventually, we would all like to live in a smokeless world, but at this moment we must take care of all those who are smokers and do not want or cannot abandon the use of nicotine, and for doing that we need regulations, surveillance and further observational comparative studies, “ he concluded.

At the end of the discussion, all panellists agreed that good scientific research and good policies could benefit all countries, and that it is the duty of researchers to inform consumers about the alternatives that are available.

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