Karl Erik Lund

Norwegian Institute of Public Health · Department of Alcohol, Drugs & Tobacco

Background According to a recently published study, approximately half of those who currently smoke in Norway have little or no desire to quit despite a hostile regulatory and socio-cultural climate for smoking. On this background, we discuss some challenges that regulators will face in a further tightening of structural measures to curb smoking....

Even if smoking prevalence is declining in several western countries, continued smoking cessation is required to reduce tobacco-related harms and to achieve future goals of smoke-free societies or the tobacco endgame. But how many of the current smokers want to quit? Estimates vary and depend on the type of question asked. We investigate how a pool...

Introduction Use of snus (moist smokeless tobacco) is widespread in Scandinavia and increasingly popular in the U.S. Snus products vary in terms of product design, portion size and nicotine content. The aim of this study was to examine variations in the nicotine content in snus sold on the Norwegian market from 2005 to 2020. Methods We calculated...

Objective The tobacco industry plans to base their future earnings on the production of non-combustible nicotine products. These might replace or come in addition to the more harmful cigarettes that historically have dominated the nicotine market in the Nordic countries. The authorities in each country must decide whether the products should have m...

Background Similar to the debate around e-cigarettes, an increase in snus use among Norwegian adolescents has prompted debate on whether flavour options in snus should be limited. To this end, we compared use of flavoured snus among snus users with different smoking status. Methods Questions about flavoured snus use were included in an online omni...

Sammendrag Tobakksindustrien planlegger å basere sin framtidige inntjening på produksjon av forbrenningsfrie nikotinprodukter. Disse skal erstatte de langt farligere sigarettene. Myndighetene må avgjøre om produktene skal få markedsadgang og hvor strengt de eventuelt skal reguleres i forhold til sigaretter. Potensiell helsegevinst fra substitusjons...

Background: Most studies on perceived risks of smokeless tobacco products (SLT) have been conducted in the U.S., and the vast majority conclude that perceptions of the relative harmfulness of SLT versus cigarettes in the population are inconsistent with epidemiologically-based risk estimates, and typically conflated to that of cigarettes. We tested...

Data S1. Supporting info item

Aims: To examine how the relative size of six groups of male ever snus users (current and former users of snus who were current, former or never cigarette smokers) varied over time in Norway, and how these groups differ with regard to important measures of tobacco behaviour. Design: Repeated cross-sectional nationally representative surveys of t...

Background : Norway has achieved a noteworthy reduction in smoking prevalence over the past forty years. In 2015, 13% of Norwegians aged 13–74 smoked daily and a further 9% smoked occasionally. One of the objectives of the Norwegian 2013–16 national strategy for tobacco control is to achieve a reduction in the daily smoking prevalence to < 10% by 2...

Background: In Norway, low-nitrosamine smokeless tobacco (snus) is allowed to compete with cigarettes for market share. We aimed to study how the availability of snus influenced overall tobacco consumption, smoking initiation and smoking cessation. We discuss whether the Norwegian experience with snus can have any transfer value for e-cigarettes....

Objectives Providing lifetime smoking prevalence data and gender-specific cigarette consumption data for use in epidemiological studies of tobacco-induced cancer in Norway. Characterising smoking patterns in birth cohorts is essential for evaluating the impact of tobacco control interventions and predicting smoking-related mortality. Setting Norway...

Introduction: In Norway, snus use and cigarette smoking are at different developmental stages as described by the diffusion of innovation model. Concomitant with declining smoking rates, the use of snus is increasing. In light of these differences in use trends, we assumed that snus users and cigarette smokers would have different perceptions of t...

Norway has one of the most comprehensive infrastructures for tobacco control in the world and has launched several media campaigns recent years. Can yet another anti-smoking campaign, using fear appeal messages, have an immediate impact on smoking behavior, motivation to quit and health beliefs? A sample of smokers (N = 2543) completed a survey bef...

Purpose In Norway, snus (low nitrosamine smokeless tobacco) is allowed to compete with cigarettes for market share, and over the past decades the prevalence of snus users has increased as the prevalence of smokers has decreased. The author has aimed to sum up the findings from research that has tried to identify the role of snus in smoking cessatio...

The use of snus is increasing in Norway. In this study we examined differences between adolescents who were exclusive snus users, and adolescent non-users, smokers and dual users of snus and cigarettes on a number of psychosocial factors, categorized as risk variables and protective variables associated with involvement in health compromising behav...

We examined whether use of snus influenced cognitions in terms of smoking expectancies and smoking prototype perceptions in a direction that could promote smoking initiation, thus highlighting potential causal mechanisms between the use of snus and smoking behavior. A telephone-based longitudinal survey among Norwegian adolescents was conducted wit...

Introduction: We examine the prevalence of dual use of snus and cigarettes among Norwegian men by categorizing dual use into four categories according to the frequency of use of each product, considering the order of uptake of both products, and examining reasons for additional snus use. We compare dual users and exclusive cigarette smokers with re...

Smokers are often incorrect in their assessment of the relative risk of snus and cigarettes. We have studied how perception of risks of snus compared with cigarettes was associated with the willingness of trying snus as a quit-smoking method. Fourteen thousand seven hundred and forty-four Norwegian men aged 20-50 years were selected at random from...

Snus is considerably less hazardous to health than cigarettes. Recent data from Scandinavia have indicated that many smokers use snus as a method for quitting smoking. Data from five repeated cross-sectional surveys of Norwegian men and women aged 16-74 were pooled (N = 6 262). Respondents were asked about current and former smoking and snus use. F...

The aim of this study was to investigate changes in the relative proportion of hardcore smokers (HCS) in Norway for the years 1996-2009. Data were derived from Statistics Norway's annually cross-sectional representative samples of the adult population. The total sample size of smokers each year was between 250 and 500. The outcome measure was HCS,...

Objective sales data have indicated that the Norwegian indoor smoke-free regime implemented in June 2004 did not affect the hospitality business negatively. This paper investigates whether self-reports on the economic impact of the smoking ban from employees in the hospitality sector gave similar results, and whether post-ban self-reports on the ec...

In the debate about laws regulating smoking in restaurants and pubs, there has been some controversy as to whether smoke-free laws would reduce revenues in the hospitality industry. Norway presents an interesting case for three reasons. First, it was among the first countries to implement smoke-free laws, so it is possible to assess the long-term e...

Swedish studies have shown that experience of using snus is associated with an increased probability of being a former smoker. We examined whether this result is also found in Norway.   Seven cross-sectional data sets collected during the period 2003-08. Norway. A total of 10, 441 ever (current or former) smokers. Quit ratios for smoking were compa...

Given there are few experimental studies comparing the effects of snus and medicinal products for quitting smoking, self-reports from smokers who have used different methods for quitting smoking can be informative. Fourteen thousand seven hundred and forty-four Norwegian men aged between 20 and 50 years were selected at random from a national repre...

A previous Norwegian study showed that underaged smokers usually buy cigarettes for themselves. The Norwegian Medical Association has recently suggested that the minimum legal age for purchase of tobacco should be raised from 18 to 20 years. This study presents new data on underaged who buy cigarettes and snus for themselves; i.e. number of buyers...

To investigate the use and the obstacles to use of screening and brief interventions (SBI) for alcohol misuse among Norwegian general practitioners (GP). A questionnaire with 68 questions about the use and barriers to use of SBI in general practice was mailed to 2000 randomly selected Norwegian GPs. The survey response rate was 45%. There was a muc...

strong> SAMMENDRAG Mens tobakksmotstanden i Norge i første halvdel av det 20. århundre mest var tuftet på moral med utgangspunkt i et religiøst paradigme, kom det i løpet av perioden 1955-61 undersøkelser som ga det tobakksforebyggende arbeidet et sekulært vitenskapsbasert fundament. Den medisinske profesjon var imidlertid noe forbeholden til at...

After 100 years of mass consumption of cigarettes, the smoking epidemic is on the verge of a historic decline in Norway. The article shows the number of smokers and tobacco consumption among men and women from 1927 to 2007. The total consumption of tobacco was estimated by adding up registered and unregistered sales. Data were collected from the Di...

NORSK SAMMENDRAG: SIRUS har i samarbeid med HEMIL-senteret ved Universitetet i Bergen evaluert den statlige innsatsen mot tobakksskadene fra 2003 til 2007, på oppdrag fra Helsedirektoratet. I denne perioden intensiverte myndighetene sitt arbeid mot tobakkskader. For det første satset man mer på massemediakampanjer med sterkere virkemidler enn tidli...

After 16 years of exemptions from the ban on indoor smoking in other places of work, Norway became the second country after Ireland to implement a smoke-free regime in pubs and restaurants. This paper evaluates the economic impact on the hospitality sector in a northern region with a cold climate. The data consists of bi-monthly observations of rev...

Different prevalences of cigarette smoking and use of snus between University students and non-students, may supply us with information about the diffusion stage of the epidemic. User characteristics and involvement in other risk behaviour influences their status as diffusion agents. 1 655 students at the University of Oslo responded to a postal qu...

Norwegian authorities encouraged the county authorities in 2002 to restrict smoking in high schools. By 2004, 10 county councils had made resolutions in favour of smoke-free schoolyards. We have examined the extent to which schools in these counties comply with county regulations. We have also studied smoking habits for students from schools with d...

NORSK SAMMENDRAG: Rapporten bygger på spørreskjemaundersøkelser om bruk av rusmidler og tobakk blant unge voksne mellom 21 og 30 år. SIRUS har foretatt slike undersøkelser i 1998, 2002 og 2006, og ett utvalg med personer fra hele landet og ett utvalg fra Oslo er blitt spurt. SIRUS-forskerne Marte Ødegård Lund, Astrid Skretting og Karl Erik Lund stå...

This cross-sectional study assessed changes between 1999 and 2003 in attitudes among Swedish general practitioners (GPs) toward smoking cessation activities and also assessed the effect of a nationwide quitline on GPs' smoking cessation activities. A random sample of 621 Swedish GPs answered a questionnaire mailed to their home addresses in spring...

The aims of the present study were to investigate the awareness among dentists and dental hygienists of evidence-based reports and guidelines on tobacco cessation activities and the impact these publications had on clinical practice. A questionnaire was mailed to dental hygienists and dentists in Stockholm County, Sweden, and the results were compa...

This study discusses whether adolescent occasional smokers form a distinct subgroup in comparison with daily smokers, in terms of smoking motivation, confidence in ability to quit and social and cultural characteristics. In a sample of 2484 adolescents aged 16–19, 22 per cent (n=552) were daily smokers and 20 per cent (n=495) were occasional smoker...

The purpose of the present study was to explore the predictive power of four predictors (level of household education, rules for indoor smoking, awareness of health risks of ETS, and attitudes towards ETS) in accounting for level of children's exposure to environmental tobacco smoking (ETS) as reported by parents. The data derive from two nationwid...

The Government wants a plan of action for equality in health, and smoking is the leading preventable cause of poor health and early death. Data were obtained from the national databank on smoking behaviour at the Directorate for Health and Social Affairs. Analyses to explore social gradients in terms of smoking status, intensity of consumption, pro...

We wanted to investigate variations among socioeconomic groups with regard to smoking cessation, attempts at quitting, intention to quit, future smoking identity and knowledge about help available for smoking cessation. Data were drawn from the Directorate for Health and Social Affairs' population-based smoking surveys. A total of 5125 subjects age...

To determine dentists' and dental hygienists' intervention activity towards patients who smoke or use snus (oral moist snuff), and to establish which factors impede interventions and cause variations in approach. A questionnaire was mailed to a sample of 1500 dentists (response rate: 68%) and all dental hygienists in the country (522 in all; respon...

Studies indicate that shortage of cessation counsellors may be a major barrier for tobacco prevention among physicians. Telephone helplines (quitlines) may be an option. The effectiveness of the Swedish quitline and factors related to abstinence from smoking 12 months after the first contact were assessed. Subjects included 694 smokers calling a re...

The Norwegian Cancer Society has led a comprehensive information campaign since 1995 with the aim of reducing young children's ETS (environmental tobacco smoke) exposure in their homes. The aims of the present study were to assess changes in parents' reporting of child exposure to ETS, attitudes towards ETS, and awareness regarding the potential ha...

The ministers of education and health have called upon county councils to use their right of ownership to make upper secondary schools smoke-free. The aim of this study was to ascertain changes in the proportion of smoke-free school grounds occurring between 1998 and 2003, to ascertain the number of schools that are planning a ban on smoking on sch...

There are no studies of the relative significance in Norway of registered sales, tax-free import, border trade or smuggling of tobacco. The estimated registered sales of tobacco are based on data from the Norwegian customs and excise authorities. The border trade and tax-free import estimates were based on nation-wide, representative surveys of dai...

To assess tobacco prevention in Swedish dental care and to identify barriers. Also, to investigate whether dentists and dental hygienists were familiar with recently published review of smoking cessation methods. A questionnaire was mailed to all 353 dental hygienists and 528 dentists in Stockholm County. The overall response rate was 61% for the d...

Aims: Studies indicate that doctors may be reluctant to discuss smoking with their patients. Knowledge about how this problem might be solved is limited. The aim of this study was to identify barriers for engaging in tobacco prevention in general practice. Methods: An anonymous questionnaire was mailed to 3,167 randomly selected general practitione...

After small-scale trials, BE smokeFREE, a tobacco education programme covering the three years of lower secondary school was offered to all Norwegian schools in 1997. We have studied the effects of the programme, comparing them with results from the pilot project (1994-97). A representative sample of 3,691 students filled in a questionnaire on thei...

Studies indicate that doctors may be reluctant to discuss smoking with their patients. Knowledge about how this problem might be solved is limited. The aim of this study was to identify barriers for engaging in tobacco prevention in general practice. An anonymous questionnaire was mailed to 3,167 randomly selected general practitioners (GPs) in Swe...

A Norwegian official report, NOU 2000: 16, Tort liability for the Norwegian tobacco industry, concludes that Norwegian law and judicial practice allows lawsuits against the tobacco industry for damages. A crucial claim in such suits would be that the industry withheld information on health risks and addiction and instead used advertising messages t...

To assess attitudes towards environmental tobacco smoke (ETS) and health-risk awareness regarding the potential hazards of ETS for children among parents of young children in the Nordic countries. Also to investigate to what extent these factors are related to ETS exposure of the children. A cross-sectional community-based survey using an anonymous...

This study examined trends in the prevalence of smoking and snuff use among Norwegian adolescents in lower secondary school (ages 13-15 years) from a national survey conducted every 5 years between 1975 and 1995. Pupils completed a brief written questionnaire on tobacco use and related information. Local school administrators coordinated data colle...

Objective: To assess praxis and identify the most common barriers for engaging in tobacco prevention in general practice in the Nordic countries. Material and methods: All 167 practicing general practitioners in Iceland received a questionnaire at home assessing praxis and barriers for systematic involvement in tobacco prevention. Results: The...

Almost seven out of ten parents who smoke state that they have never received information on passive smoking from health personnel when they bring their children in for routine medical examination. We examined what GPs, doctors and nurses at mother-and-child clinics and midwives reported. A self-administered questionnaire focusing on practice as re...

Health personnel make only moderate efforts at motivating parents to establish a smoke-free indoor environment for babies and infants. It is only when children show symptoms of exposure to tobacco smoke that they routinely raise the question of passive smoking during consultations with the parents. We wanted to find out why so many neglect to raise...

The Ministry of Health and Social Affairs has defined "smoke-free schools" and "role models" as priority objectives in a document describing the national strategy to prevent the harmful effects of tobacco. We have investigated smoking policies in upper secondary schools, and to what extent policies support these objectives. Heads of Schools or Coun...

Five thousand parents of children born in 1992 in Denmark, Finland, Iceland, Norway and Sweden were asked about their smoking behaviour while indoors with their children. The prevalence of daily smoking was 20% among fathers, 15% among married or cohabiting mothers and 47% among single mothers. Both parents reported smoking daily in 7% of the house...

The objective of this study was to assess whether attitudes to environmental tobacco smoke and knowledge and beliefs about its potential hazard for children affect whether parents who smoke avoid exposing their children. The study was initiated by the Nordic Cancer Union.

In 1993, a joint Nordic effort to reduce the prevalence of smoking in the vicinity of children was initiated by the Nordic Cancer Union. The Union established a three-year intervention and evaluation project, headed by the information departments of the five Nordic cancer societies. The objectives of the project are (i) to assess the magnitude of e...

The introduction in 1996 of a ban on the sale of tobacco to persons under the age of 18 in Norway does not seem to have reduced the extent of smoking among minors. One reason may be that Norway's 20,000 tobacconists have not respected the age limit. A representative sample of households was randomly selected from a database containing all telephone...

Of the tobacco consumed by young people between the ages of 13 and 17 in Norway, 75% is bought by minors. The Ministry of Health has requested the tobacconist's trade association to improve the enforcement of the 18-year age limit for the purchase of tobacco. After identifying 122 scientific articles through searches in Medline and Sociological Abs...

Of the tobacco consumed by young people between the ages of 13 and 17 in Norway, 75 % is bought by minors. The Ministry of Health has requested the tobacconist's trade association to improve the enforcement of the 18-year age limit for the purchase of tobacco. After identifying 122 scientific articles through searches in Medline and Sociological Ab...

To assess similarities and differences in the Nordic countries regarding ETS (environmental tobacco smoke) exposure in young children. A population-based cross-sectional study comprising a randomly selected sample of 5,500 households which included a child born in 1992. Data were collected using a mailed anonymous questionnaire. While the prevalenc...

A comparative analysis of smoking habits, based on data from three different sources, shows that the present level of tobacco consumption in Norway is at a mid-Nordic level, but lower in a European perspective. There has been a 25% decline in per capita consumption of tobacco since the mid-1970s, and the decrease has been most pronounced during the...

To assess to what extent Nordic parents strive to protect their children from environmental tobacco smoke (ETS) at home. A cross-sectional study using an anonymous questionnaire. A stratified, random sample of 5500 households containing a child born during 1992, including 1500 households in Denmark and 1000 households in each of the countries of Fi...

A comparative analysis of smoking habits, based on data from three different sources, shows that the present level of tobacco consumption in Norway is at a mid-Nordic level, but lower in a European perspective. There has been a 25% decline in per capita consumption of tobacco since the mid-1970s, and the decrease has been most pronounced during the...

In Norway, tobacco-chewing, either of plug-tobacco or tobacco consumed as moist snuff, were the predominant type of tobacco consumption right up to the 1930’s. Among smokers the pipe was much more common than the cigarette, but was displaced by cigarettes after World War II and is now together with the use of chewing tobacco a curiosity on the mark...

Primitive tobacco advertising was seen from the middle of the 19th century in the western world, while the more spectacular advertising, run as mass-communication, appeared in the ‘roaring twenties’ (1,2,3,4,5). During World War I, an extensive system was developed to spread propaganda, and the tobacco industry was among the first to utilize the id...

The theme of this paper is whether smoking is in the process of becoming socially unacceptable in Norway.

This article describes smoking habits among Norwegian men and women born between 1890 and 1974. In order to follow the smoking habits in groups which included the same persons throughout the observation period, the proportion of smokers in five-year birth cohorts of men and women was tabulated by age or calendar year of birth. The percentage of smo...

The aims of the present study were to provide lifetime smoking data for epidemiological studies of tobacco-induced cancer in Norway, and to sort out the influence of age, gender, and period on the population's smoking habits in this century. We used annual surveys of smoking habits from 1954 to 1992, and individual lifetime smoking histories collec...

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/Open Objective: To assess praxis and identify the most common barriers for engaging in tobacco prevention in general practice in the Nordic countries. Material and methods: All 167 practicing general practitioners in Iceland received a questionnaire at home...

NORSK SAMMENDRAG: Rapporten bygger på en spørreundersøkelse med 1655 studenter ved Universitetet i Oslo om bruk av alkohol og andre rusmidler, røyking og pengespill. Resultatene fra 2006 er sammenlignet med tall fra en tilsvarende undersøkelse i 1997. Rapporten er utarbeidet av Ellen M. Tefre, Arvid Amundsen, Sturla Nordlund og Karl Erik Lund ved S...

Hvis målet er å utjevne sosiale forskjeller i helsestatus, bør framtidens tobakksforebyggende politikk ta i bruk skadereduksjon som en strategi. Visjonen om et tobakksfritt samfunn bør ikke stå i veien for å redusere tobakksrelaterte sykdommer med en pragmatisk innstilling til skadereduserende nikotinprodukter som f.eks. snus, konkluderer forskning...

ENGLISH SUMMARY: Harm reduction means that cigarette smokers who are either unable or unwilling to stop using nicotine products are encouraged to switch to nicotine products with much lower health risk. Harm reduction has previously been debated in various forms in the area of tobacco when filter cigarettes were introduced in the 1960s, and when so...