Sweden has one of the best tobacco control programmes in the world and was the only country in Europe to achieve the year 2000 World Health Organisation target of reducing the number of smokers in its population to below 20%. Recognising the impact of marketing to specific target groups, Sweden pays more attention to smoking among women compared to any other European country. Until recently, Sweden was the only country where more women than men smoked.

Among all women in Sweden, the poorest are most likely to smoke. More effective support methods are being developed to reach lower income women and those groups which are resistant to change.

How many women smoke or use tobacco?

• Around a fifth of women in Sweden are daily cigarette smokers; 19% women vs. 16% men, which is lower compared to the 25% female average in the western WHO-Europe Region.
• Men are much more likely to use oral snuff or ‘snus’; 20% men vs. 1-2% women. The argument over the idea that snus alone has caused the decrease in smoking prevalence is simplistic and should be avoided. In fact, only the minority of smokers who quit smoking did so by using snus.
• Following a successful national campaign, smoking during pregnancy fell by two-thirds between 1983 and 2002. Today, pregnant women are less likely to smoke, though high smoking rates are still seen among those pregnant women with a lower socioeconomic status.
• In the last 20 years, smoking among women has fallen by almost 30%.
• There has been a downtrend since the peak smoking rate of 32% in the 1970s.
• Smoking rates are higher among poorer and less educated women in Sweden and those whom are socially isolated. In fact, the poorest women are almost twice as likely to smoke as the most affluent.
• Smoking is now most common among middle-aged women, rather than among younger adults.
• Compared to men, women are more likely to choose ‘low tar’ cigarettes which provide no additional health benefit. In the mid-1990s, approximately three-quarters of women who smoked regular cigarettes switched to ‘low tar’.

Smoking among young women

• Regular weekly smoking among Swedish girls usually starts around age 14-15.
• By age 16, almost a third of girls are considered smokers where 30% smoke at least occasionally and 13% are smoking every day or almost every day.
• At 16 years of age, daily smoking is more common among girls than boys; 10% girls vs. 5% boys. These smokers are likely to be as nicotine dependent as adults.
• National campaigns have focussed on girls and young women. For example, between 1996 and 2000, Miss Sweden contestants were involved in tobacco-free educational campaigns for young girls in co-operation with women’s magazines. The strategies continue today with the publication of women-focused tobacco information in women’s magazines and health promotion activities aimed to alert women to tobacco industry marketing tactics.

Health risks

• Every year around 2,284 women in Sweden die as a direct result of smoking. That’s equivalent to 43 deaths every week.
• In 1998, 49% of female deaths were due to coronary heart disease where 33% of these deaths were heart attacks.
• In 2001, 1,347 women died of lung cancer. The main cause of lung cancer is smoking.
• The death rate from lung cancer among Swedish women continues to increase, and is now more than double the rate reported in the early 1980s.

Tobacco control

• Sweden has both an action plan on tobacco, and a national coordinating body.
• The Swedish experience has demonstrated the value of offering women-centred programmes in the context of comprehensive policy.
• New national policy from 2002 includes commitments to further tobacco control, increase health promotion, restrict youth access to tobacco products and boost smokefree standards in restaurants.
• The cost of smoking is just above European Union average. A pack ‘costs’ around 27-28 minutes of average labour.
• Tobacco prices increased by nearly half during 1996-97, but cuts to the amount of tax in 1998 resulted in a substantial fall in cigarette prices during 1999 and 2000.
• Direct advertising is completely banned in Sweden, except at point of sale; where only the use of images of people is forbidden. Indirect advertising was banned in 2003.
• Workplaces, transport and most public places are smokefree. A new law was passed in 2004 where restaurants and bars must be smokefree by June 1, 2005 with the option of building a separately ventilated designated smoking room.
• Swedish policy is uniquely ‘gender sensitive’, recognising the need to address tobacco use among women in all aspects of tobacco control.
• Smoking costs the Swedish Health Care System and society 26 billion Swedish Kronor or 2.8 billion Euros each year. This amount includes the expense of medical treatment and lost production among other factors.

Education and support to quit

• Support to quit smoking is widely available through pharmacies, health centres, workplaces and a national Quitline.
• After one year, 39% Quitline of clients are smokefree. The Quitline is most popular among women where 75% of the callers are female.
• The successful smoking in pregnancy campaign has trained nearly all midwives and child health nurses in a specific smoking cessation counselling technique. Follow-up by a child health nurse has cut the relapse rate to less than 20% eight months after the baby is born.
• Nicotine replacement therapy (NRT) was first developed in Sweden. Most forms are available without prescription.

12 July 2004

For more information

• The Tobacco Control Programme of the National Institute of Public Health – Sweden http://www.fhi.se/fakta/tobak.asp
• Tobacco information www.tobaksfakta.org, includes information on women and smoking and the report titled “Progress & Challenge Tobacco Control (Swedish Style)”
• Swedish Cancer Society www.cancerfonden.se
• Swedish Council for Information on Alcohol and Other Drugs (CAN) www.can.se
• “Women and Smoking: a Report of the Surgeon General”
  US Dept of Health and Human Services. 2001
• “Women and the Tobacco Epidemic” WHO Geneva: World Health Organisation. 2001