title: The incentives created by a harm reduction approach to smoking cessation: Snus and smoking in Sweden and Finland.
abstract: BACKGROUND
  Tobacco harm reduction involves advocating the use of a less harmful alternative to smoking for those users who are unwilling or unable to quit. The net effect of such an approach is unclear as it may create opposing incentives. Although some smokers may substitute toward this less harmful alternative, it may reduce the incentive to quit by undermining public health efforts and may act as a gateway to smoking. This research paper aims to answer the question: Does the availability of a less harmful alternative to smoking lead to cessation? To explore the opposing incentives created by a harm reduction approach to smoking cessation, I focus on the role of snus, a popular smokeless tobacco product in Scandinavia that is widely used in Sweden.
  
  
  METHODS
  This paper exploits a quasi-natural experiment to examine the net effect resulting from these opposing incentives. While two Scandinavian countries, Sweden and Finland, joined the European Union (EU) in 1995, Finland was subject to a pre-existing EU ban on oral tobacco products while Sweden received an exemption. A difference in differences framework is used to estimate the change in the smoking rate in Finland due to the implementation of the ban. A secondary analysis uses Finnish smoking data to test for a structural break in trend.
  
  
  RESULTS
  In the post-ban period, smoking was 3.47 percentage points higher in Finland relative to what it would have been in the absence of the ban.
  
  
  CONCLUSIONS
  The availability of snus, a less harmful alternative to smoking, appears to have had a positive impact (reduction) on the smoking rate. Offering acceptable alternatives to cigarettes is critical in reducing smoking prevalence.
authors.affiliation: Center for Healthcare Economics and Policy, 1101 K Street, NW, Suite B100, Washington, DC 20005, USA. Electronic address: Jen.Maki@FTIconsulting.com.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Maki
mesh_terms: D005260:Female; D005387:Finland / Q000453:epidemiology; D040261:Harm Reduction; D006801:Humans; D008297:Male; D009042:Motivation; D012907:Smoking / Q000453:epidemiology* / Q000639:trends; D016540:Smoking Cessation / Q000379:methods* / Q000706:statistics & numerical data*; D013548:Sweden / Q000453:epidemiology; D014030:Tobacco, Smokeless / Q000706:statistics & numerical data* / Q000600:supply & distribution*
keywords: Harm reduction; Incentives; Smoking cessation