Blurring the Lines: What Sweden’s Smoke-free Success Teaches

Molly Ogbodum

Globally, the global conversation around tobacco control is undergoing a major shift, with discussions moving away from treating all nicotine use as a single, uniform risk. Sweden is leading the way globally with a clear real-world example of this shift by successfully lowering its smoking prevalence to 5.4 per cent and getting closer to the internationally recognized 5 per cent smoke-free threshold. Between 2012 and 2024, the country’s smoking rate declined by more than 54 per cent, much faster than its other EU contemporaries. 

This milestone by Sweden demonstrates that an approach centered on recognizing and distinguishing between different nicotine delivery systems yield rapid results. Sweden’s success was not a matter of product availability, but rather the result of a willingness to recognize risk differences, speak plainly about scientific evidence, and prioritize realistic public health outcomes.

Central to understanding Tobacco Harm Reduction (THR) is debunking the myth that all nicotine products carry the exact same dangers. The scientific reality relies heavily on risk differentiation. The primary health hazard in tobacco uses stems from the toxic substances produced by burning tobacco. Nicotine is not the primary cause of smoking-related illnesses; the real danger is the smoke generated by burning. 

A landmark report by the Royal College of Physicians, titled ‘Nicotine Without Smoke’, concluded that the health hazards associated with long-term e-cigarette use are unlikely to exceed 5 per cent of those smoking traditional tobacco. Independent reviews by Public Health England have corroborated these findings, establishing that while non-combustible, reduced-risk alternatives are not entirely risk-free, they are less risky and safer than smoking traditional cigarettes.

Yet, a significant misconception persists where public discussions treat all nicotine delivery systems as an identical threat tobacco product. When public awareness campaigns refuse to distinguish between traditional tobacco products and reduced-risk alternatives, they inadvertently deny adult smokers a realistic exit from combustible tobacco. This information gap is particularly evident in Nigeria, where smoking prevalence remains a significant challenge. 

While alternative products like nicotine pouches and vaping devices are increasingly accessible in the marketplace, they circulate without standardized public health guidance or accurate information for the consumer due to the complete absence of formal public education. This creates an environment where adult smokers looking to quit traditional cigarettes and tobacco products are left to rely on unsafe information or myths just to understand their choices.

Public health outcomes are fundamentally shaped by how evidence is interpreted and communicated to the public. The potential risk for Nigeria is failing to engage with the changing nature of this global scientific debate altogether. In over a decade, success seen in advanced smoke-free nations occurred because alternative nicotine products were made accessible, affordable, and socially acceptable based on clearly communicated evidence with Sweden as a core case study. 

Moving Paving the way forward will requiredemands a strong focus on education and the dissemination of accurate information. The middle ground of tobacco control – where evidence-based harm reduction occurs – is where the most significant gains in population health are achieved. By prioritizing THR awareness, we can dismantle long-standing myths and ensure that adult smokers are provided with the clear, accurate and correct information necessary to transition away from the most harmful forms of tobacco use

Ogbodum is a Public Health Advocate