Background:
Tobacco use patterns in Sweden have undergone dramatic changes during the last 50 years resulting in tobacco-related mortality in men being the lowest in all European Union countries. The objective of this study is to describe this development and analyse the incentives and impediments that have influenced the course of the changes.

Methods:
Timelines of tobacco use prevalence and tobacco control measures including tax policies were retrieved from various official sources of statistics. Details of initiation and cessation practices were retrieved from large national surveys in Sweden. These pieces of evidence were combined to analyse the development of tobacco use in Sweden from the 1970s to today.

Results:
The major feature of the Swedish development is the transition from cigarettes to snus (the Swedish kind of low-toxicity oral tobacco) as dominating tobacco product among men, and this has been shown to be a major reason behind the record-low tobacco-related mortality. In 1976 the prevalence of daily use was 46% for smoking and 9% for snus use, in 2016 the figures were 8% respectively 18%. The transition started in the late 1960s. The main incentive came from the scientific reports that had created a wide awareness of the health risks of smoking (RCP 1962, US SG 1964). Snus was a nearby alternative and transition to snus was further encouraged by a beneficial price difference. Up till the early 2000s the transition was gaining momentum in spite of shrinking price benefits. In 2006 there was a sudden “chock increase” of tax on snus but not on cigarettes. As a result the next following years showed a drop in snus use and an absence of continued drop in smoking.

Conclusions:
Tobacco control policies should encourage transition from cigarettes to low-toxicity alternatives.