Challenges in legitimizing further measures against smoking in jurisdictions with robust infrastructure for tobacco control: how far can the authorities allow themselves to go?

Background: According to a recently published study, approximately half of those who currently smoke in Norway have little or no desire to quit despite a hostile regulatory and socio-cultural climate for smoking. On this background, we discuss some challenges that regulators will face in a further tightening of structural measures to curb smoking.

Main Body: Central to our discussion is the research literature concerned with the concept of state-paternalism in tobacco control-the line between an ethically justified interference with the freedom of those who smoke and an exaggerated infringement disproportionate to the same people's right to live as they choose.

How do Smokers in a Snus-Prevalent Society Consider E-cigarettes, Snus, and Nicotine Replacement Therapy Products as Relevant Replacements for Cigarettes in the Event They Should Stop Smoking?

Introduction: Around 50 percent of the tobacco in Norway is consumed in the form of snus, a smokeless oral tobacco. We examined Norwegian smokers' openness, and thereby the potential reach, to use e-cigarettes, nicotine replacement therapy products (NRT), and snus in the event of quitting smoking, in a society where snus use is common.

Methods: Using data from an online survey of 4073 smokers from 2019 to 2021, we calculated predicted probabilities of smokers' being open, undecided, and not open to use e-cigarettes, snus, and NRT in the event they should quit smoking.

Indexing Quit-Smoking Interest among Norwegian Smokers 2019-2021.

Even if smoking prevalence is declining in several western countries, continued smoking cessation is required to reduce tobacco-related harms and to achieve future goals of smoke-free societies or the tobacco endgame. But how many of the current smokers want to quit? Estimates vary and depend on the type of question asked. We investigate how a pooled sample of Norwegian smokers ( = 1321) is distributed over four indicators of interest in quitting: (i) degree of desire to quit, (ii) prediction of future smoking status, (iii) reported plan for quitting smoking, and (iv) statements on previous attempts to quit.

The impact of the COVID-19 epidemic on where tobacco users purchased cigarettes and snus in different Norwegian regions.

With the spread of COVID-19, the Norwegian government introduced restrictions on cross-border travel starting March 2020. Purchase of tobacco when travelling, especially from Sweden and duty-free shops, has comprised a substantial part of Norwegian tobacco consumption for many years. We investigated whether COVID-19-related travel restrictions and recommendations led to changes in tobacco purchases from Norway, Sweden, duty-free, other countries, possible illicit sources and web shops.

Beliefs about harms of cigarette smoking among Norwegian adults born from 1899 to 1969. Do variations across education, smoking status and sex mirror the decline in smoking?

Background And Aim: Smoking is one of the most important causes of socioeconomic disparities in morbidity and mortality. The aim of this study was to examine if beliefs about harms of smoking differed across gender, smoking status and education among Norwegian adults born between 1899 and 1969.

Methods: Using data from a nationally representative survey of smoking habits and a multinomial logit/negative binomial two-stage hurdle model design, we examined (first hurdle) the associations between birth cohort, gender, education and smoking status and four beliefs about cigarette smoking: i) smoking is not harmful, ii) do not know if smoking is harmful, iii) any number of cigarettes per day (CPD) is harmful and iv) smoking more than a given nonzero number of CPD is harmful, and (second hurdle) the predicted number of CPD that could be smoked without causing harm (from outcome iv).

A conceptual framework for assessing the public health effects from snus and novel non-combustible nicotine products.

Objective: The tobacco industry plans to base their future earnings on the production of non-combustible nicotine products. These might replace or come in addition to the more harmful cigarettes that historically have dominated the nicotine market in the Nordic countries. The authorities in each country must decide whether the products should have market access and, in that case, how strictly they should be regulated.

Nicotine Content in Swedish-Type Snus Sold in Norway From 2005 to 2020.

Introduction: Use of snus (moist smokeless tobacco) is widespread in Scandinavia and increasingly popular in the U.S. Snus products vary in terms of product design, portion size, and nicotine content.

The greater use of flavoured snus among ever-smokers versus never-smokers in Norway.

Background: Similar to the debate around e-cigarettes, an increase in snus use among Norwegian adolescents has prompted debate on whether flavour options in snus should be limited. To this end, we compared use of flavoured snus among snus users with different smoking status.

Methods: Questions about flavoured snus use were included in an online omnibus study conducted from 2015 to 2019 (N = 65,445) that included 16,295 ever snus users (aged 15+).

Relative Risk Perceptions between Snus and Cigarettes in a Snus-Prevalent Society-An Observational Study over a 16 Year Period.

Most studies on perceived risks of smokeless tobacco products (SLT) have been conducted in the U.S., and the vast majority conclude that perceptions of the relative harmfulness of SLT versus cigarettes in the population are inconsistent with epidemiologically-based risk estimates, and typically conflated to that of cigarettes.

Do never smokers make up an increasing share of snus users as cigarette smoking declines? Changes in smoking status among male snus users in Norway 2003-15.

Aims: To examine how the relative size of six groups of male ever snus users (current and former users of snus who were current, former or never cigarette smokers) varied over time in Norway, and how these groups differ with regard to important measures of tobacco behaviour.

Design: Repeated cross-sectional nationally representative surveys of tobacco use. The association between survey year and the six categories of ever snus use was examined using cross-tabulation and multinomial logistic regression.

How has the availability of snus influenced cigarette smoking in Norway?

Background: In Norway, low-nitrosamine smokeless tobacco (snus) is allowed to compete with cigarettes for market share. We aimed to study how the availability of snus influenced overall tobacco consumption, smoking initiation and smoking cessation. We discuss whether the Norwegian experience with snus can have any transfer value for e-cigarettes.

Lifetime smoking habits among Norwegian men and women born between 1890 and 1994: a cohort analysis using cross-sectional data.

Objectives: Providing lifetime smoking prevalence data and gender-specific cigarette consumption data for use in epidemiological studies of tobacco-induced cancer in Norway. Characterising smoking patterns in birth cohorts is essential for evaluating the impact of tobacco control interventions and predicting smoking-related mortality.

Setting: Norway.

Contrasting smokers' and snus users' perceptions of personal tobacco behavior in norway.

Introduction: In Norway, snus use and cigarette smoking are at different developmental stages as described by the diffusion of innovation model. Concomitant with declining smoking rates, the use of snus is increasing. In light of these differences in use trends, we assumed that snus users and cigarette smokers would have different perceptions of their personal tobacco use.

Fear appeals in advanced tobacco control environments: the impact of a national mass media campaign in Norway.

Norway has one of the most comprehensive infrastructures for tobacco control in the world and has launched several media campaigns recent years. Can yet another anti-smoking campaign, using fear appeal messages, have an immediate impact on smoking behavior, motivation to quit and health beliefs? A sample of smokers (N = 2543) completed a survey before and after a 7-week national media campaign. Individual exposure to campaign (unaided recall) was used as predictor of change.

The relationship between snus use and smoking cognitions.

We examined whether use of snus influenced cognitions in terms of smoking expectancies and smoking prototype perceptions in a direction that could promote smoking initiation, thus highlighting potential causal mechanisms between the use of snus and smoking behavior. A telephone-based longitudinal survey among Norwegian adolescents was conducted with two points of measurement during a 1-year period in 2006-2007. The respondents were divided into four groups: Group 1: snus initiators during the period (N = 54), Group 2: regular snus users (N = 160), Group 3: non-users of snus and cigarettes (N = 376), and Group 4: regular smokers (N = 306).

Patterns of dual use of snus and cigarettes in a mature snus market.

Introduction: We examine the prevalence of dual use of snus and cigarettes among Norwegian men by categorizing dual use into four categories according to the frequency of use of each product, considering the order of uptake of both products, and examining reasons for additional snus use. We compare dual users and exclusive cigarette smokers with respect to their smoking intensity, plans for quitting smoking, and future smoking identity.

Methods: We used a data pool of six cross-sectional, national representative surveys conducted annually in the period 2005-2010 containing a total of 3,524 males aged 16-74.

Association between willingness to use snus to quit smoking and perception of relative risk between snus and cigarettes.

Introduction: Smokers are often incorrect in their assessment of the relative risk of snus and cigarettes. We have studied how perception of risks of snus compared with cigarettes was associated with the willingness of trying snus as a quit-smoking method.

Methods: Fourteen thousand seven hundred and forty-four Norwegian men aged 20-50 years were selected at random from a national representative web panel and sent a questionnaire by e-mail.

Hardcore smokers in Norway 1996-2009.

Introduction: The aim of this study was to investigate changes in the relative proportion of hardcore smokers (HCS) in Norway for the years 1996-2009.

Methods: Data were derived from Statistics Norway's annually cross-sectional representative samples of the adult population. The total sample size of smokers each year was between 250 and 500.

Post-ban self-reports on economic impact of smoke-free bars and restaurants are biased by pre-ban attitudes. A longitudinal study among employees.

Introduction: Objective sales data have indicated that the Norwegian indoor smoke-free regime implemented in June 2004 did not affect the hospitality business negatively. This paper investigates whether self-reports on the economic impact of the smoking ban from employees in the hospitality sector gave similar results, and whether post-ban self-reports on the economic impact of the ban were influenced by pre-ban attitudes towards smoke-free policies.

Methods: A random sample of 516 employees in bars and restaurants stated their attitudes towards smoke-free policies shortly before the ban became effective.

The use of snus for quitting smoking compared with medicinal products.

Introduction: Given there are few experimental studies comparing the effects of snus and medicinal products for quitting smoking, self-reports from smokers who have used different methods for quitting smoking can be informative.

Methods: Fourteen thousand seven hundred and forty-four Norwegian men aged between 20 and 50 years were selected at random from a national representative web panel and sent a questionnaire by E-mail. Of the 7,170 (48.

[Tobacco purchase among underaged].

Background: A previous Norwegian study showed that underaged smokers usually buy cigarettes for themselves. The Norwegian Medical Association has recently suggested that the minimum legal age for purchase of tobacco should be raised from 18 to 20 years. This study presents new data on underaged who buy cigarettes and snus for themselves; i.

Use and barriers to use of screening and brief interventions for alcohol problems among Norwegian general practitioners.

Aims: To investigate the use and the obstacles to use of screening and brief interventions (SBI) for alcohol misuse among Norwegian general practitioners (GP).

Methods: A questionnaire with 68 questions about the use and barriers to use of SBI in general practice was mailed to 2000 randomly selected Norwegian GPs.

Results: The survey response rate was 45%.