Remaining smokers in Norway don’t really want to quit
Only one in three of those who still smoke in Norway want to quit once and for all. Those who insist on their smoking habits and rituals need to be given a real alternative, says researcher.
“The results of our study shows that it might be about time to better facilitate a transition from dangerous tobacco products to less harmful ones, such as e-cigarettes and snus (dry snuff)”, says tobacco researcher Karl Erik Lund at the Norwegian Institute of Public Health (NIPH).
He is one of the authors behind an article about willingness to quit among those who still smoke (link in Norwegian).
Around nine per cent of Norwegians aged 16-74 smoked daily in 2020 according to figures from Statistics Norway. Another eight per cent respond that they smoke every now and then.
More than 15 per cent of the world’s population uses tobacco, according to the World Health Organization.
Norway is famous for its high prices on alcohol and cigarettes, which is part of the country’s public health strategy. In fact, the price of alcohol and tobacco in Norway is 120 per cent above the European average.
The new article is based on a new survey with just over 800 respondents, and four indicators for interest in quiting: A wish to quit, a belief that it is possible to become smoke free, actual plans of quitting at some point, and previous attempts to quit smoking.
In total 31 per cent of the smokers in the survey showed a high or very high interest in quitting, while nearly half – 49 per cent – showed a low or no interested in abandoning cigarettes. The remaining 20 per cent showed medium interest. Among this group many are ambivalent, fluctuating between wanting to quit and wanting to continue.
Numbers from the Norwegian directorate of health and the Norwegian Cancer Society suggest that between 60 and 70 per cent of smokers wish to quit. These numbers however include those who are ambivalent.
Benefits outweigh disadvantages
According to the new survey, every fourth smoker has never tried to quit, despite all the measures and information about the health risks implied in continuing the habit. 80 per cent of those who smoke daily have tried to quit smoking before. Only 46 per cent of them envision an entirely smoke free future.
According to Lund, smoking habits are not just about being dependent on nicotine, it is also about identity, being social and joyous experiences. The fact that you smoke, what you smoke, how you smoke and who you chose to smoke with, is used to communicate who you are. This is not easy to give up.
A nicotine patch or chewing gum which perhaps helps with the physical addiction, doesn’t help with all of these other issues. A better replacement is needed.
“For many years now I’ve been studying alternatives such as switching to less harmful products, like snus and vaping. I find that the advantages of facilitating a transition to something less harmful far outweigh the disadvantages. But this is an area which involves a lot of emotions and opinions”, Lund says.
The health risks of vaping, such as passively inhaling nicotine, have been documented by the NIPH, and are one of the arguments against such a strategy. Norwegian authorities and the Norwegian Cancer Association are also worried about the potential effect on children and youngsters if more focus is put on e-cigarettes and snus.
Facts about the study and smoking in Norway
- Smoking is the most important cause of disease and early death which is preventable.
- The share of smokers in the Norwegian population has been considerably reduced over the past decades.
- Norway came fifth in The Tobacco Control Scale 2019 in Europe ranking, but performed very poorly in the categories treatment to quit smoking and use of public funds in order to reduce the use of tobacco.
- The reduction of smokers is due to the fact that fewer young people have started smoking during recent year, and that established smokers have indeed quit.
- There are now more former smokers in the Norwegian public than active smokers.
- Around 400 000 people smoke daily, another 400 000 smoke every now and then. These two groups are constituted by different people. Norway’s total population is just over 5,3 million.
- Smoking has over the past decades been placed in a negative symbolic light, and the users have gone through a social de-classificiation – so that smoking now is behaviour which is now carried out in an increasingly tobacco negative normative climate.
Minister of Health Bent Høie from the Conservative party received support from the Norwegian Cancer Society when he earlier this summer voiced a wish to increase the age limit on e-cigarettes to 25 years, as well as extending the existing ban on smoking indoors to also apply to cars where children are passengers, outdoor playgrounds, public transport stops and sports areas. It was also suggested that e-cigarettes should be prohibited from adding flavours, as it may lead to young people wanting to try them. Research on this area is however inconclusive.
E-cigarettes, like regular cigarettes, are allowed to be sold in Norway to people above the age of 18. They are however not allowed to contain nicotine – something which may change within a years’ time as new legislation is on the way.
“There are no signs suggesting an increase in use of e-cigarettes among youth in Norway”, researcher Lund says.
“And allowing cigarettes with tobacco and nicotine to be sold to people seven years before you may start using a less harmful product, does not make sense”, he says.
The Norwegian Cancer Society have established that getting people to quit smoking is the best strategy for reducing the number of lung cancer patients in Norway over the next few years. The Society therefore wish for more people to be offered help to quit smoking.
A pilot programme in Vestre Viken has shown that as long as the offer is good enough, smokers enroll. In this particular programme, participants’ expenses for medical products to aid the quitting process are covered.
According to Lund there are several offers to smokers to wish to quit, but without free medical products they are not much used.
“Today’s politics aim for a tobacco free society, without recreational use of nicotine products. This may perhaps be the best situation, but I don’t think we will ever get there. Nicotine has too many positive effects in the lives of those who continue using it, it is invigorating and stimulating. Harm reduction is far more realistic“, he says.