Who are Norway’s last daily smokers – and do they want to quit?

Daily smoking – a habit in decline

Over the past fifty years, daily cigarette smoking in Norway has transformed from a common and socially accepted activity to a less visible, heavily regulated and often socially unaccepted behaviour. In 1964, the year the landmark report on smoking and health was published by American health authorities – linking cigarette smoking with chronic bronchitis, emphysema, heart disease, and lung cancer – 58 per cent of men and 31 per cent of women smoked daily. By 2022, these numbers had dropped dramatically to 7 per cent among men and 6 per cent among women.

Reducing smoking is crucial for public health  

The strong decline in daily smoking is regarded as one of the greatest public health achievements in the 20^th century. However, this decline has not been evenly distributed across all social groups. In a recent study we examine how the proportion of daily smokers has changed in different socio-demographic and economic strata from 1978 to 2022. We then focus specifically on daily smokers to investigate changes in the composition of this group over time.  Finally, we shed light on smoking cessation behaviours and whether these have changed during the same period. Our analysis is informed by the theory of social diffusion processes, which states that new innovations spread through the social structure, starting with people of higher socio-economic status.

Some are left behind

We found that over the past decades, the decline in daily smoking has been smaller among men and women with shorter education, those outside the labour force, and people living alone, compared to other social groups. Perhaps most importantly, the decline has been much smaller among older age groups compared to younger ones. In fact, when we look at men and women who are both older and have shorter education, there has not been any substantial decline in smoking from 1978 to 2022 at all.

Stubborn habits

When examining various measures of smoking intensity and behaviours related to quitting among these daily smokers, we found little to no change over the years in the proportion who smoked more than 15 cigarettes per day, planned to quit, or had made a quit attempt. Similarly, the proportions interested in quitting or who believed that cigarettes were very harmful remained largely unchanged.

These findings align with results from other countries, which suggests that the decline in daily smoking is first and foremost driven by fewer young people starting to smoke, rather than by smokers quitting. In addition, the result showed that the decline, at least in relative terms, has been larger among those with long compared to short education – a pattern consistent with other countries that share a similar smoking history.

Running out of time

The harms from smoking become increasingly apparent after middle age, with updated estimates showing that two out of three daily smokers die from smoking- related diseases. Each additional year of smoking further increase the risk of death compared to non-smokers.

The results of his study suggest that broad, society-wide measures against smoking have limited effect on the current smoking patterns among the remaining daily smokers in Norway. More bluntly, if we do not manage to introduce effective measures to help specifically these groups to quit smoking or switch to using nicotine in a less harmful way, the alternative is that the last daily smokers simply die out.

The article is written by

Tord Finne Vedøy and Karl Erik Lund, Norwegian Institute of Public Health

on the request of PopNAD