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Nordic Country Tobacco Control

Astrid Nylenna, MD, Acting Head of Department, Department of Global Health, Norwegian Directorate of Health, Oslo, Norway;

Q: Norway has been very active in tobacco control and prevention with some success. To what do you attribute the success Norway has had and are there any lessons from other Scandinavian countries that might be useful, potential approaches for other developed countries?

A: The success in the reduction of cigarette smoking is hard to assign to one single act of regulation or a specific campaign because it is the combination of many simultaneous efforts over the years. The prevalence of daily smoking in Norway declined by more than half in the past 10 years and has reached 12% in 2016 for people 16-74 years old. For young people between 16-24 years of age, the reduction has been even steeper and only 3% were daily smokers in 2016. The mean age of daily smokers has increased, showing that the main reason for the reduction in daily smoking is a decline in recruitment. The use of smokeless tobacco, snus, has risen in the past decade, especially among young people.
The Norwegian tobacco control policy includes a national tobacco control strategy, high taxes, a ban on advertising, age limits (18 years), comprehensive smoking bans, ban on the display of tobacco products, pictorial warnings, ban of packs < 20, normative provision on children’s rights to a smoke-free environment, and tobacco-free schools. Tobacco advertising was banned already in 1973. Norway was the first country in the world to ratify the WHO Framework Convention on Tobacco Control (FCTC) in 2003. In July 2017 Norway introduced plain packaging and became the first country in the world to introduce standardized snus boxes without logo and colors. (For more information: HelsedirektoratetFolkehelseinstituttet (FHI, which translates to Norwegian Institute of Public Health)Tobacco Control Laws – Norway Summary)
Mass media campaigning is a key element in the present tobacco control strategy. Campaigns are informed by research literature, trends in tobacco use prevalence, dialogue with tobacco users, and trends in media use (especially social media). The decline in recruitment among young people indicates the need for emphasis on smoking cessation. The majority of daily smokers have a desire to quit, demonstrating a huge potential for helping people to quit smoking by promoting cessation tools and assistance. In the past five years, there have been mass media campaigns on a regular basis–including social media–offering cessation information.
One of the cessation tools being promoted is the free smart phone app “Slutta” (“Quit”) developed by the Norwegian Directorate of Health. It has been a huge success, downloaded 550,000 times since its launch in 2013. In a country of 5.5 million inhabitants and about 1 million tobacco users (both daily and occasional use of cigarettes and snus/snuff) the number of downloads is quite remarkable.
The Nordic countries collaborate and discuss tobacco issues. All the Nordic countries have strict tobacco laws and have seen a decline in daily smoking. One example is Finland, which has set a goal of becoming smoke free by 2040 (For more information: Valvira). Finland has also introduced rules on neighbor smoking. These rules include a ban on smoking on all common areas of housing cooperatives and also the possibility of these cooperatives to apply to the municipality to ban smoking on all separate balconies of private apartments, outdoor areas, and even inside the apartments.
Astrid Nylenna’s contact info is included in the author affiliations at the top of this page.
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