Sweden’s unusually low smoking prevalence has long attracted international attention. Much of the discussion has focused on the country’s long history of snus use, particularly among men. But Sweden’s nicotine market is changing. Tobacco-free nicotine pouches have grown rapidly, and their uptake among women raises a new question: could a product category with broader appeal help narrow a smoking gap that traditional snus did not fully close?
The evidence does not establish that nicotine pouches are responsible for Sweden’s declining female smoking rate. Smoking behaviour is shaped by many factors, and Sweden’s progress reflects decades of tobacco control, changing social norms and access to different alternatives to cigarettes. Nevertheless, the simultaneous decline in female smoking and growth of pouch use among women deserves closer examination.
Sweden’s Long Harm-Reduction Experience
According to Sweden’s Public Health Agency, 5.4% of people aged 16–84 reported smoking daily in 2024. Sweden also has a long-established culture of oral nicotine use, historically dominated by tobacco-containing snus.
This history is particularly relevant when looking at differences between men and women. In 2024, 22% of Swedish men reported daily snus use compared with 10% of women. Traditional snus therefore appears to have had considerably greater uptake among men.
Snus is not risk-free, and nicotine use is inappropriate for children, people who do not currently use nicotine and during pregnancy. However, its lack of combustion distinguishes it from cigarettes. This distinction is central to tobacco harm reduction because much of the severe disease burden associated with smoking results from repeated exposure to toxic substances generated when tobacco is burned.
Sweden’s experience suggests that the availability and acceptability of non-combustible alternatives may be relevant to understanding smoking behaviour. It also demonstrates why population averages can hide important differences between groups.
Nicotine Pouches Are Changing the Oral Nicotine Market
Nicotine pouches have introduced a different type of oral nicotine product. Unlike traditional snus, they do not contain tobacco leaf and are available in a range of formats, flavours and strengths.
Official Swedish data show that daily nicotine-pouch use reached 5% of the population in 2024. Uptake has been particularly notable among younger women. Among women aged 16–29, daily pouch use increased from 10% in 2022 to 15% in 2024.
Commercial data point to a wider transformation of the market. A 2026 cross-sectional study analysing more than 19 million online purchases in Sweden and Norway found that nicotine pouches overtook traditional snus in volume share in 2025. In Sweden, their share increased from 5% in 2018 to 55% in 2025. The analysis also found that female consumers began purchasing more nicotine pouches than traditional snus in 2022.
These findings do not tell us whether those consumers previously smoked, used snus or had never used nicotine. They do, however, indicate that nicotine pouches are reaching women to a greater extent than the traditional snus market historically did.
Female Smoking Has Declined Alongside Pouch Uptake
During the period in which nicotine pouches have become more established, smoking among Swedish women has also continued to decline. One analysis estimates that female daily smoking fell from 11.2% in 2015 to 5.7% in 2024. Official Public Health Agency data similarly show the country’s broader long-term decline in daily smoking.
The overlap is noteworthy, but it should not be mistaken for proof of causation.
The available population and market data cannot determine how much of the decline in female smoking, if any, can be attributed specifically to nicotine pouches. Some pouch users may previously have smoked, while others may have switched from snus, use multiple nicotine products or begun using nicotine without a history of smoking.
Longitudinal evidence tracking individual transitions would provide a stronger basis for determining the role pouches play in smoking displacement.
What the current evidence does show is that Sweden now has a non-combustible oral nicotine category attracting considerably greater uptake among women at a time when female smoking has continued to fall. That relationship warrants investigation rather than assumption in either direction.
Acceptability Matters in Harm Reduction
The Swedish experience also raises a broader question about consumer choice. Lower-risk alternatives can only contribute to reducing smoking if adults who smoke are willing to use them instead of cigarettes.
Different products will not necessarily appeal equally to different consumers. Taste, format, discretion, nicotine delivery, price and social acceptability can influence whether an alternative is attractive enough to replace smoking.
This may help explain why nicotine pouches deserve attention in Sweden’s evolving harm-reduction landscape. Their importance is not necessarily that they replace snus. It may be that they broaden the range of smoke-free alternatives available to consumers who did not find traditional oral tobacco products acceptable.
At the same time, greater consumer appeal creates its own regulatory responsibilities. Increasing pouch use among younger adults, including young women, reinforces the importance of monitoring initiation among people who did not previously use nicotine.
What This Means for Regulation
For GINN, Sweden’s experience illustrates why harm-reduction policy needs to consider both relative risk and patterns of actual use.
Strong age restrictions, responsible marketing, appropriate nicotine and product standards, accurate labelling and effective enforcement remain essential. Surveillance should distinguish between complete switching from cigarettes, dual use, movement between non-combustible products and nicotine initiation among previous non-users.
Risk communication also needs balance. Nicotine pouches should not be presented as harmless, but neither should the absence of combustion be ignored when communicating relative risk to adults who smoke.
Most importantly, policymakers should avoid assuming that one alternative will work equally well for every smoker. Sweden’s earlier experience with snus suggests substantial differences in product uptake between men and women. The growth of nicotine pouches provides an opportunity to study whether expanding the range of acceptable non-combustible alternatives can help reach groups that previous products reached less effectively.
Closing the Evidence Gap
Sweden is approaching smoking prevalence levels that few European countries have achieved. Understanding how it reached this point requires looking beyond any single policy or product.
Traditional snus, tobacco-control measures, changing social attitudes and other factors have all formed part of Sweden’s distinctive environment. Nicotine pouches are now another part of that picture, and their comparatively strong uptake among women makes them particularly relevant to the country’s remaining smoking gender gap.
The emerging pattern is promising enough to investigate, but not strong enough to declare causation.
The next step should therefore be better evidence: longitudinal research examining who adopts nicotine pouches, what products they previously used and whether pouch uptake results in complete displacement of cigarettes over time.
If nicotine pouches are helping some women move away from smoking, that would carry important implications for harm-reduction policy beyond Sweden. Establishing that contribution requires following the evidence carefully as Sweden’s nicotine market continues to evolve.
