Sweden’s use of the oral tobacco product snus has led it towards becoming the world’s first “smoke-free” country (defined as an overall smoking rate below 5 percent). But modern nicotine pouches are accelerating this progress—with women leading the way, highlights a new report.
Like snus, these pouches are placed under the lip to deliver nicotine. But unlike snus, they contain no tobacco, but rather a powdered mix of plant fibers and flavorings to go with the active ingredient.
The report, titled “Power in a Pouch,” was published by Smoke Free Sweden, a campaign from the Health Diplomats network. It details how nicotine pouches have become Sweden’s most popular smoking cessation aid—and are ranked by consumers there as the most successful, surpassing NRT, vapes and even snus.
Pouches are at the lowest end of the nicotine products continuum of risk. And they’re proving particularly valuable to women who smoke, who have historically been less likely than men to switch to snus. The smoking-cessation rate among women has increased almost 200 percent since nicotine pouches were introduced to Sweden in 2016, the report notes.
“Unless policy missteps block access, pouches will very likely be the final driver that helps Sweden become the first smoke-free country in the world.”
A national survey conducted in April-May 2025 found that among people who formerly smoked, 28 percent of women and 26 percent of men were using pouches. In contrast, while 23 percent of the men were using tobacco snus, just 7 percent of women were.
“Nicotine pouches have helped close gender gaps, enhance cessation success, and make quitting socially and practically accessible for nearly all demographics,” Dr. Delon Human, a physician and former World Health Organization adviser who co-authored the report, told Filter.
“Unless policy missteps block access, they will very likely be the final driver that helps Sweden become the first smoke-free country in the world,” he said.
The report, which was also co-authored by Filter contributor Dr. Marewa Glover, noted that Swedish women’s daily smoking rate dropped from 11.2 percent in 2015 to 5.7 percent in 2024, and is now falling faster than men’s.
Why have pouches been so much more of a game-changer for Swedish women than snus?
Because of this adjustment in the gender dynamic, Dr Human explained, the overall rate now looks set to drop below 5 percent this year. “Without pouches, the decline would likely have stalled, particularly amongst women,” he said.
But why have pouches been so much more of a game-changer for Swedish women than snus?
“It is a lot better for you than smoking, which is the most central aspect for me,” Carrissa During, who lives in Sweden and switched from smoking to pouches, told Filter.
That’s true of other safer nicotine options, too. But During added that pouches come in many flavors, and “don’t make your mouth feel disgusting like cigarettes and snus,” which minimized her anxiety for “having a bad breath.”
Snus had never appealed to her, she continued, because she worried it might stain her teeth. “I also find vapes do not give as much freedom or discretion as nicotine pouches do; in most places you still have to use it outside, as you do with cigarettes, which is why it’s not my preferred safer nicotine product.”
During’s sentiments correspond with survey statistics in the report; 60 percent of women who use pouches named the wider variety of flavors as one of the most appealing things about them versus snus, while 41 percent saw pouches as safer.
When it came to their “biggest turn-off” about snus, 26 percent named the smell or flavor of tobacco; 25 percent said it was “less aesthetically appealing;” and 21 percent cited the concern about potential staining of teeth.
Dr. Human also commented that image-wise, snus was still seen as “male-associated,” with “historical ties to blue-collar and military culture.”
These and other factors seem to position availability of pouches as an element of the gender-specific tobacco harm reduction that some advocates have been calling for.
“I honestly don’t see myself going back to smoking, unless pouches were no longer available.”
Filippa Althoff said pouches became desirable to her when Sweden banned smoking in outdoor areas.
“My friends and I were used to sitting and smoking while drinking, but now we had to move away from the bar,” Althoff told Filter. “That shift, combined with the rise in pouch popularity, led me to gradually shift over to pouches.”
Althoff, who’s in her 20s, said there was a very noticeable culture shift among women in her generation—that younger women were skipping the smoking stage of peer pressure altogether, and moving straight to pouches.
Like During, Althoff also named convenience and discretion as big benefits of pouches. “I honestly don’t see myself going back to smoking, unless pouches were no longer available,” she said.
In a warning to policymakers, the report noted that 16 percent of Swedish women using pouches express the same sentiment: They might go back to cigarettes if pouches were banned.
The EU has a smoking rate of 24 percent—almost five times higher than Sweden’s. “The difference,” Dr. Human said, “lies in Sweden’s bold, evidence-based embrace of harm reduction.”
Pouch bans are a reality in both Germany and Belgium. Dr. Human called this “deeply concerning,” particularly “when viewed through the lens of Sweden’s success.”
“Germany and Belgium should urgently reconsider their position on nicotine pouches,” he said, with a focus on flavor safeguards, risk-proportionate regulation, consumer education and access.
“If the goal is truly to reduce smoking-related harm and save lives, then following Sweden’s example, not rejecting it, is the scientifically sound, humane and effective path forward,” Dr Human said.
It might not be the path other countries take, however. Sweden is a member of the European Union, and the EU Commission is currently considering raising taxes on safer nicotine products—including pouches, which would make them less accessible to many. In July, Sweden’s finance minister, Elisabeth Svantesson, called the proposal “completely unacceptable to the Swedish government.”
The EU as a whole has a smoking rate of 24 percent—almost five times higher than Sweden’s. “The difference,” Dr. Human said, “lies in Sweden’s bold, evidence-based embrace of harm reduction, particularly through nicotine pouches.”
Photograph (cropped) by Global State of Tobacco Harm Reduction via Flickr/Creative Commons 2.0
