POST B: Snus and the Swedish Experience


Above image: (General Original 2018)

Sweden has the lowest level of tobacco related mortality for men, and the third lowest overall in the EU (Shapiro 2018, 50) with 5 and 11% respectively of men and women smoking. This makes Sweden unusual; it’s one of the only countries in the world where women smoke more, and this trend has been widely attributed to the rise in popularity of Snus amongst men.

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Above image: (WHO 2012)

After dropping to its lowest consumption levels in 1967, Swedish moist snuff or Snus as it is referred to in Sweden, has been more popular with male nicotine users than traditional cigarettes since 1996. Made of dried ground tobacco, salt, water and  flavourings, it’s an oral product placed between the gum and upper lip.

Multiple sources cite increases in advertising in the 1960’s onwards, but primarily the development of new pasteurised products by the country’s primary Snus manufacturer Swedish Match (IARC 2007, chapter 1.1.2; Shapiro 2018, p. 48). This new process meant the product was air dried and free of chemicals similar products on the market had, and it proved an effective selling point to a market that was increasingly aware of the effects of smoking on the human body (Henningfield 2001).

Gender disparity suggests social and cultural factors were also at play, with male oriented marketing efforts and other societal notions influencing behaviours, a trend that also tends to ring true for cigarette smoking (WHO 2010).

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Above image: (Ramström 2018)

Nowadays, Swedish Match like many of its competitors openly represents it’s products as a harm reduction strategy (2018) targeting smokers who would like to quit. Studies on effective quitting methods tend to suggest that the use of Snus is in fact more effective than other products such as nicotine chewing gum and patches (Lund, McNeill & Scheffels 2010).


Above Image: (Camel Snus Ads 2011)

The above commercials from tobacco company Camel aired in 2011 and promoted Snus as a healthier alternative to cigarettes in the lead up to the government sponsored Great American Smokeout. While it might be less harmful overall, various studies including one facilitated by the International Agency for research on Cancer in 2007 conclude that Snus is still a group 1 carcinogen capable of causing oral, oesophageal and pancreatic cancers (IARC, chapter 5.5).

Whether Snus and other smokeless products are effective harm reduction strategies is a debated topic. Governments are reluctant to endorse these products due to commercial interests a company has in transferring nicotine addiction instead of allowing cessation to occur (Henningfield 2001). Some studies also suggest similar products in the United States may have contributed to escalated smoking rates among youths and young adults in the 1990’s by fostering nicotine addictions that were then translated into cigarette use.

Patterns of nicotine use are influenced by complex factors and the Swedish Phenomenon may be open to interpretation for a while yet. That being said, there can be no one-size-fits-all solution so while there is value in learning from individual case studies, it should not be taken as a recommendation for application in other contexts.



Camel Snus Ads, 2011, Camel, USA, viewed 30 November 2018, <>.

ENVIRON International Corporation 2013, Review of the Scientific Literature on Snus, ENVIRON International Corporation, Arlington, Virginia.

General Original, 2018, Swedish Match, viewed 30 November 2018, <>.

Henningfield, J. 2001, Swedish Match Company, Swedish Snus and Public Health: A Harm Reduction Experiment in Progress?, Pinney Associates, Maryland, USA, viewed 30 November 2018, <>.

Lund, K. McNeill, A. Scheffels, J. 2010, ‘The Use of Snus for Quitting Smoking Compared with Medicinal Products’, Nicotine & Tobacco Research, vol. 12, no. 8, pp. 817–822.

IARC, 2007, Smokeless Tobacco and Some Tobacco-specific N-Nitrosamines, NCBI, Lyon, France, viewed 29 November 2018, <>.

Ramström, L. 2018, Sweden’s pathway to Europe’s lowest level of tobacco-related mortality, Poster, World Conference on Tobacco or Health, South Africa.

Shapiro, H. 2018, No Fire, No Smoke: The Global State of Tobacco Harm Reduction, Knowledge-Action-Change, London.

Swedish Match, 2018, Our Standpoint, Swedish Match AB, Stockholm, viewed 30 November 2018, <>.

WHO, 2010, 10 Facts on Gender and Tobacco, World Health Organisation, Switzerland.

WHO, 2012, Global Report: Mortality Attributable to Tobacco, World Health Organisation, Switzerland.

POST B: Stoptober – a case study

In 2012 the English Department of Health designed a campaign called ‘Stoptober’, which focuses on the psychological principles underpinning tobacco use…


Studies reveal the effectiveness of mass media anti-smoking campaigns (Bala et al., 2008, 2012) and studies that compare different message types find that harm focused messages have a higher impact than those with an ‘anti-industry or how-to-quit-themes’ (Durkin et al., 2012). In 2012 the English Department of Health designed a campaign called ‘Stoptober’, which focuses on the psychological principles underpinning tobacco use, aiming to create a positive mass quitting trigger, an area which Durkin et al. (2012) shows there has been little research done on the effectiveness. The name itself, ‘Stoptober’, was designed to build engagement with the public through the association with other popular national events such as ‘Movember’ and to increase awareness on social media. The campaign was seen in a combination of traditional media such as TV, print, radio, online advertising and digital platforms such as Facebook and Twitter with the aim to create a social movement around a specific activity, stopping smoking for 28 days.

The main psychological principles which the campaign underpinned its components included:

The campaign used both top-down strategies, with advertising and public relations as well as bottom-up strategies, with its peer networking and support services. The results of the campaign show that more than 300,000 people took part in the campaign in 2012 and the overall estimate of past-month quitting was calculated to be 4.15%, being most cost-effective for the modal 35-44 year-old group, with an ICER (incremental cost-effectiveness ratio) of £414.26 (Brown et al., 2014). As a public health campaign, the cost-effectiveness of Stoptober compared favourably with other estimates concerning UK anti-tobacco campaigns. The effectiveness of the campaign is shown through its continuation since 2012 (Brown et al., 2014).

Some interesting strategies such as the motivational text messaging programme is a particularly effective strategy with teens, as revealed in the Swiss study ‘Efficacy of a text messaging (SMS) based smoking cessation intervention for adolescents and young adults’ (Haug et al., 2012). Unique to this study is the use of personalised messages that changes depending on the users’ personal traits over an extended period of 24 months.

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An example of personalised text messages to participants. (Haug et al., 2012)


The Stoptober campaign reveals the effectiveness of national campaigns based on psychological motivations through positive messages and social behavioural movements over the common fear strategies utilised in anti-smoking campaigns.


Bala M., Strzeszynski L., Cahill K. Can tobacco control programmes that include a mass media campaign help to reduce levels of smoking among adults. Cochrane Database Syst. Rev. 2012;(6) Art. No.: CD004704.

Brown, J., Kotz, D., Michie, S., Stapleton, J., Walmsley, M. & West, R. 2014, “How effective and cost-effective was the national mass media smoking cessation campaign ‘Stoptober’?”, Drug and alcohol dependence, vol. 135, pp. 52-58, <>.

Haug, S., Meyer, C., Dymalski, A., Lippke, S. & John, U. 2012, “Efficacy of a text messaging (SMS) based smoking cessation intervention for adolescents and young adults: Study protocol of a cluster randomised controlled trial”, BMC Public Health, vol. 12, pp. 51, <>.

Durkin S., Brennan E., Wakefield M. Mass media campaigns to promote smoking cessation among adults: an integrative review. Tob. Control. 2012;21:127–138, <>.

POST B: Thailand Takes on Tobacco

Being in Indonesia the past two weeks prior to our studio starting has allowed me to get a glimpse of the day to day life & culture of Indonesia & it’s people. This being my first time to Asia, really enabled culture shock to fester within me initially, & realise just how different it is here compared to my blessed, ordinary life back in Australia. Although seeing these drastic differences really left me so often wanting to know the answers to so many questions therefore making this research not so much of a task but more a curious exploration. I decided that I would take my research to a nearby neighbour rather than Indonesia, as I knew so much of our next two weeks of research & exploration would override my simple searches for information & answers. Hence the choice; Thailand.

Southeast asian country, Thailand is very well known by Australians for its tropical beaches, beautiful temples & bustling night life. Hidden behind the flashing lights & the azure waters is the problem of tobacco. In hindsight, not so hidden really with many tourists taking the opportunity to please their smoking habits with the extremely low prices of tobacco, with packs sitting between $2.30-$4.00 AUD as compared to $20-$30 AUD back home. This tempting habit not only being taken up by tourists but also locals with ‘more than 50,000 children (10-14 years old) & 10,736,000 adults (15+ years old) continue to use tobacco each day’ (Tobacco Atlas, 2016) sitting in a population of estimated 64,000,000 people.


Figure 1: Beautiful Thailand
Humphrey Muleba, 2018, Maya Bay, Phi Phi Island, Unsplash, viewed 29th November 2018, <;.

These sort of stats calculate to 41.4% of the male population in Thailand using tobacco every day leading to a rate of 22.88% of male deaths in Thailand caused by tobacco & an average life expectancy of a Thai male being 75.3 (Tobacco Atlas 2016). Although stats sit much lower in the Thai female population, this does not dim the light of the problem of tobacco use & the need for a strive towards a cleaner & tobacco-less future.

Fortunately precautions are being taken towards a smoke free future for Thailand, after becoming a ‘party to the WHO Framework convention on Tobacco Control on February 27, 2005’ (Tobacco Control Laws, 2017). Taking part in this framework has pushed Thailand to have a current policy which protects public places from second hand smoke & minimise the areas where smokers can partake in the habit. Such areas include ‘healthcare facilities, educational facilities, universities, government facilities, indoor offices, restaurants, pubs, bars & public transport’ (Tobacco Atlas, 2016). Although this is a great movement towards cleaner public places, Thailand is yet to enforce smoke free other indoor places & contribute funding for smoke free enforcement.

Past smoke free area management, Thailand has also started to offer a ‘national quit-line & also cost covered cessation services’ (Tobacco Atlas, 2017). Packaging has also had implementation of smoke prevention imagery such as ‘85% of the pack being covered with graphic warnings’ (Tobacco Atlas, 2017) of the dangers of tobacco use on the body & close by others. Media campaigns are also being run to the whole population via television & radio utilising ‘target audience research & media planning’ (Tobacco Atlas, 2017). Bans have also been enforced to not allow direct & indirect forms of interdisciplinary advertising for tobacco use, with direct bans being ‘national tv, radio, magazines, newspapers, billboards, the internet etc. (Tobacco Atlas, 2017). Finally Thailand has also paired with the WHO benchmark of having ‘70% excise tax on the retail price’ (Tobacco Atlas, 2017) of tobacco at the point of sale.

Thailand Cigarette Warnings
Figure 2: Thailand Tobacco Packaging
Asian Correspondent 2014, Thailand OKs bigger warnings on cigarette packs, Asian Correspondent, viewed 29th November 2018, <;.

All of these contributing movements, changes & factors standardised by WHO Framework convention on Tobacco Control are pushing Thailand & the Thailand Government towards enforcing & implementing a cleaner & more positive future for the health of the Thai population.

Tobacco Atlas, 2018, Thailand, American Cancer Society, Inc. and Vital Strategies, viewed 29th November 2018, <;.

Tobacco Control Laws, 2017, Legislation by Country, Campaign for Tobacco-Free Kids, Washington, viewed 29th November 2018, <;.

WHO Framework convention on Tobacco Control, 2018, About the WHO Framework convention on Tobacco Control, WHO, viewed 29th November 2018, <;.

Humphrey Muleba, 2018, Maya Bay, Phi Phi Island, Unsplash, viewed 29th November 2018, <;.

Asian Correspondent 2014, Thailand OKs bigger warnings on cigarette packs, Asian Correspondent, viewed 29th November 2018, <;.

B. Japan’s Commitment for Future Smoke-free Japan

Tobacco smoking kills an estimated 129,000 Japanese in Japan every year based on 2007 data, and more than half of them die because of second-hand tobacco smoke (FCTC 2018).  Additionally, there are significant different in the life expectancy between the smoker and non-smoker elder people, whether men or women (see figure 1). As the numbers keep dropping, this concern carries a big attention to the WHO FCTC and the Japanese Governor to make sure that Japan will improve the health populations in the future.

table 1Figure 1 Japanese people who born between 1935 -1945 (Sakata et al. 2012)< >

Japan’s health policies relating to tobacco are vague and minimal. Furthermore, Japanese law does unclear motive whether they are committed to ban smoking in public area. One of the Japanese tobacco law in The Health Promotion Act stated, ‘Article 25 of the Health Promotion Act is non-binding and asks managers of certain enumerated public places, and “other facilities used by numerous people” to “try to take whatever steps are necessary to prevent passive smoking exposure” (The Health Promotion Act 2002, s. 103).’ Additionally, in a review site about Japanese tobacco control law also stated that, ‘At the national level, the language of the laws are not obligatory in nature and do not require managers or employers to ban or restrict smoking in workplaces, but rather “to endeavor” or “to try” to take measures “as necessary” (, 2018).’ Thus, these two statement showing that Japanese tobacco laws does not align with the FCTC Art. 8 Guidelines that indicate certain places in Japan to be smoke-free (Guidelines on Protection from Exposure to Tobacco Smoke 2007).

There is no other way for Japan but to take slow step by step as the Japanese learn to change for their own health benefits. Starting from Tokyo, Japan Governor, Yoichi Masuzoe, was in an uproar to achieve his goal of smoke-free Tokyo that plan to be held before the Olympic games in 2020 (FCTC 2018); also a starter to accomplish Japan Art.8 of the Convention to World Health Organization Framework Convention on Tobacco Control (WHO FCTC). The announcement came out of the country and brought people from outside to use this opportunity to support Japan. Phillip Morris, the British American Tobacco company is collaborated with Japan Tobacco company to raise up the smokeless heated-tobacco device, named IQOS (Phillip Morris International n.d.). With certain temperatures settings, the device will not burn the cigarette but heat them to avoid the release of smoke; instead a nicotine containing vapor will release. IQOS has been released in Japan not long after the smoke-free statement in 2014.

However, there is always a negative and unsolved problem after seemingly to be solved. The device is a ‘safer’ smoking device, means it will just slow down the risk of tobacco related diseased and not completely solved it. And while the use of the device is very expansive, more people are still going with the old way. A lot of remaining things that has to be carried by Japan government, like the health warnings on tobacco packaging and advertising who had been a struggle for them to overcome with the tobacco companies and relevant departments of government (The Japan Times 2017, para. 5).



B. Here to harm or here to help?

Hon Lik

Hon Lik, Captured by Wang Zhao, n.d.

The use of electronic cigarettes, better known as “vaping”, mimics the look and feel of smoking through heating up chemicals in a cartridge which is then inhaled by the user (Fairchild, A. et al, 2014). These devices were designed by 52 year old pharmacist, inventor and smoker, Hon Lik from Beijing, China in 2003 (CASAA, 2016) after his father who was a heavy smoker died of lung cancer. Hon Lik wanted to minimise the use of tobacco by creating a tobacco-less product which still gave the user a nicotine hit. Hon Lik’s invention was the seed which sprouted a billion dollar industry, which now sees tobacco companies owning all of the top e-cigarette brands (Greenhalgh, E., & Scollo, M. 2016). 

Now… without a critical eye as of yet, and assuming the intentions were pure, the e-cigarette initiative was a transdisciplinary design which created conversation around alternatives to tobacco smoking. But with heavy investment now made by the tobacco industry, are we merely consuming the harmful collateral of marketing extraordinaries, giving more money to tobacco tycoons (Cheney, M. et al, 2015)?

Hon Lik graduated from a Traditional Chinese Medicine college, where he majored in Pharmarcy. Post graduation, Lik spent over ten years working in plant agriculture, while developing a system which used food additives as solvents vaporised by ultrasound to help combat his smoking habits (Blu UK,2016). Lik’s initial design used a transdisciplinary approach to create a well informed product with good intentions. This bottom-up approach started from one individuals experimentation into dealing with tobacco issues.


Tobacco Fields, Keith Taylor, 2013

Once patenting the product, the commercial use become fanatical before enough research was conducted to know if this design was a solution to an issue, or if it became part of the issue itself. In 2015, an estimated 35 million people were recorded as regular users of vapour products and the market was estimated to be worth 7.1 billion US dollars (Greenhalgh, E., & Scollo, M. 2016). 

The tobacco industry is heavily investing in this product which shows a projected increase in popularity, highlighting the possibility of reliance and addiction (Cheney, M. et al, 2015). There is definitely a path that can be taken with this design to help combat the tobacco issues we have, however with the more momentum this fad gains, the more open it is to being morally and ethically questioned. 

Research such as the one conducted by (Caponnetto P, et al. 2014) shows that we can definitely adapt Hon Lik’s design to help combat the issue and see preferential changes, however we must develop this product to make it a healthier alternative. We must remain aware of the companies and industries that are supporting the evolution of such products to assure that the general population are making educated and informed decisions rather than buying in to new-age marketing tactics. 

Is Vaping Healthier?, WIRED, Youtube, 2016



  1. blu UK. (2016). Hon Lik: The Man Who Invented Vaping. [online] Available at:–the-man-who-invented-vaping/hon-lik-man-invented-vaping-2.html?countryselect=true (Accessed 27 Nov. 2018)
  2. Caponnetto P, Campagna D, Cibella F, Morjaria JB, Caruso M, Russo C, et al. (2014) Correction: EffiCiency and Safety of an eLectronic cigAreTte (ECLAT) as Tobacco Cigarettes Substitute: A Prospective 12-Month Randomized Control Design Study. PLoS ONE 9(1):
  3. CASAA. (2016). Historical Timeline of Electronic Cigarettes. [online] Available at: (Accessed 27 Nov. 2018)
  4. Cheney, M., Gowin, M., & Wann, T. F. (2015). Marketing practices of vapor store owners. American journal of public health, 105(6), e16-21. 
  5. Electronic Nicotine Delivery Systems and Electronic Non-Nicotine Delivery Systems (ENDS/ENNDS). (2016). In: Conference of the Parties to the WHO Framework Convention on Tobacco Control. [online] Delhi, India: WHO Framework Convention, pp.1-7. Available at: (Accessed 27 Nov. 2018)
  6. Fairchild, A., Bayer, R. and Colgrove, J. (2014). The Renormalization of Smoking? E-Cigarettes and the Tobacco “Endgame”. New England Journal of Medicine, 370(4), pp.293-295
  7. Greenhalgh, E., & Scollo, M. (2016) InDepth 18B: Electronic cigarettes (e-cigarettes). In Scollo, MM and Winstanley, MH [editors]. Tobacco in Australia: Facts and issues. Melbourne: Cancer Council Victoria; 2016. Available from:
  8. NSW Health. (2018). Ban the use of e-cigarettes in smoke-free public places – Tobacco and Smoking. [online] Available at: (Accessed 27 Nov. 2018)
  9. Taylor, K. (2013). Tobacco Fields. [image] Available at: (Accessed 27 Nov. 2018)
  10. WIRED (2016). Is Vaping Healthier than Smoking?. Available at: (Accessed 27 Nov. 2018)
  11. Zhao, W. (2016). Hon Lik enjoying a vape. [image] Available at: (Accessed 27 Nov. 2018)

B. Singapore: Anti-Tobacco Movement

Hefty fines if caught smoking. Captured by Josepha Na, 28/11/18.

Singapore is one of the first countries in the world that has adopted a tobacco control initiative on a nationwide scale. The challenge was that smoke environments expose the public to secondhand smoke. Removing this exposure would effectively minimise the health effects caused by tobacco smoke. 2012 Design initiative, Blue Ribbon, is a symbol of the anti-tobacco movement by the Health Promotion Board (HPB). Its effectiveness on minimising the exposure of secondhand smoke upon the public, through smoke-free areas, has been acknowledged and recognised by the World Health Organisation (WHO) in 2012.

This initiative contains a bottom-up approach. Through de-normalising smoking, with smoke-free environments, it sends the message that this is a default lifestyle. Citizens themselves have to promote this lifestyle “to build such smoke-free environments,” said Dr Amy Khor, Minister of State for Health. Evidently, Singapore has always had one of the lowest prevalence of smoking in the world, with men at 24.2% and women at 3.5%. (Shafey, 2003).

smoking timeline
Popspoken’s, Sheryl Teo, Infographic timeline on Singapore’s Tobacco regulations. <>

Through this timeline we can see that it was not a simple and quick process.  In 1986 the government launched a long term, comprehensive national programme with the theme: “Towards a Nation of Non-Smokers.” (Assunta, 2004) and even till today new initiatives have been created to combat new challenges and enforce further control on tobacco.

Singapore has taken numerous progressive steps in Tobacco Control. Largely the government has impacted this movement through accepting it as legislation across the nation (Barraclough, 2003). This is also largely a part of its success. Being recognised by WHO, for Blue Ribbon, is a huge indicator that this legislation has been successful. HPB’s health ambassadors play a large role in advocating for these smoke free environments. They go door to door distributing blue ribbons and quit kits. This involvement is a positive enforcement upon the community. The peer support given by the higher ups is definitely a positive act that will impact citizens.

In being recognised by the World Health Organisation and evidently having one of the world’s lowest prevalence rates of smoking, Singapore’s government has made effective and successful measures from the past 4 decades to ensure tobacco in the country is under control.




B. Malaysia’s “Tak Nak (Don’t want)” campaign.

In 2004 Malaysia rolled out its bold Tak Nak campaign in an effort to cause a public health intervention to the national tobacco problem. They sought to use a counter advertising campaign across all available media to denormalise and deglamourize the national view of smoking. This efforts primary goals were to dissuade a new generation from smoking, reduce the amount of young people taking up smoking and to prompt people who already smoke to quit and seek help during the quitting process from available resources. The program was funded by the government aiming to mitigate future impact on both the public health and economy of the country, the spending allowed advertising on TV, radio, billboards, cinemas as well as print and social media.

Data from the ITC project showed that the success of the campaign lay predominantly in awareness with “The majority (72%) of smokers feel that campaigns make smoking less socially desirable and almost half (43%) of smokers and quitters said that campaigns made them more likely to quit or stay quit.” (ITC National report Malaysia, 2012). We can also see other data supporting the success of  the campaign where “Based on a Global Youth Tobacco Survey, smoking prevalence among Malaysians aged 13 to 15 is on a decline, from 20.2 per cent in 2003 to 18.2 percent in 2009 and 14.8 per cent in 2016.” (Arumgam, 2018).

The campaign was utilising a cognitive behavioural model to target the smokers at multiple stages of the behavioural change, this can be seen in the diagram below sourced from Dr Omar’s media dialogue for the ITC.

Untitled Extract Pages.jpg
Dr Maizurah Omar representation of Tak Nak Cognitive behavioural model <>

You can clearly see that the campaign was designed to take into account smokers in all stages of the quitting process from those in the precontemplative stage, those who don’t know that smoking is a problem, to those in the maintenance stage, individuals who have quit and are trying to continue and consolidate good habits. The campaign spanned the process from its use of counter advertising and infomercials which teach those who may not know the ill effects of smoking. It then offered material which helped people to form plans of action with which to excecute their quitting journey to make the first step less intimidating. The other element of the Tak Nak initiative was the MQuit program which offered support to those who are in the process of quitting.

Criticism of the project was limited, researchers found that the impact of the campaign tapered off over time which is common among fear based advertising as the viewer becomes desensitised over numerous exposures (Hong etal. 2013). The authors also believed that the campaigns use of fear worked initially but to truly have a successful campaign you need to tie the information into the social narrative of a place and the Tak Nak campaign failed to change the place of tabacco smoking in Malaysian society.


Arumgam, T. 2018. No smoking campaigns having impact on the young. Viewed 26th November 2018. <>

Hong, Y.H., Soh, P., Khan, N., Abdullah, M.M., & Heng Teh, B. 2013. Effectiveness of Anti-Smoking Advertising: The Roles of Message and Media. International Journal of Business and Management. 8. 10.5539/ijbm.v8n19p55.

The International Tobacco Control Policy Evaluation Project 2012, ITC Malaysia National Report, March 2012. Viewed 26th November 2018. <>

Omar, M. 2007. Tak Nak Anti-Tabacco Media Campaign in Malaysia. ITC Project files. Viewed 26th November 2018. <>