Messages from research: Tobacco, drug use, gambling

Conducting scientific research is to participate in a conversation about how things are and what they could and should be. This last issue of Nordic Studies on Alcohol and Drugs from 2021 is a thick collection of contributions with a weighty series of messages. In altogether five reports, conclusions are drawn on tobacco use and how we can understand it as an object of regulation in the Nordic countries today.

The point of departure for the study by Salokannel and Ollila on the legal regulation of snus and the movement of snus across national borders is that the use of snus and snus-like nicotine products in the Nordic countries is increasing in particular among young people (Salokannel & Ollila, 2021). The study evaluates how the regulatory means live up to the public health framework, where the use of snus is considered harmful, especially to young people. European Union (EU) law, national tobacco control legislation, case law of the Court of Justice of the European Union (CJEU), and relevant public health studies are analysed. The normative assumption is that EU and national legislation should protect young people from new tobacco and nicotine products, but the authors argue that Sweden’s exemption from the EU ban on snus sales actively impacts adolescents’ health in the neighbouring countries. The message is that the legal boundaries of this exemption do not work, and do not protect the young people in jurisdictions that have chosen to protect their youth according to other types of principles.

Kjeld et al. (2021) map young tobacco users in Denmark on the basis of self-reported data from 2,307 students at 46 Danish schools in 2017. While all of the well-known risk factors are associated with the use of any tobacco product, the authors stress that one particular factor – the social determinant of use – carries a special signification. Students with friends who smoked, binge drank, and had low well-being at home had notably higher odds for smoking cigarettes and using alternative tobacco products compared to the other tobacco use patterns. Alternative tobacco products are on the rise in comparison with cigarettes, but if one comes across both, the likelihood of use increases significantly. The authors suggest that these findings may help targeting the youngest adolescents at risk of using tobacco products.

A way of protecting young people from tobacco use is to strictly control their possibilities of coming into contact with tobacco products. A study by Feltmann et al. (2021) investigates the rate of cigarette sales and ID checks when pseudo-underage mystery shoppers attempted to purchase cigarettes in the Stockholm region. In over a fourth of the purchase attempts, cigarettes were sold although the pseudo-underage mystery shopper did not provide a valid ID. In 82.6% of the attempts, the shopper was asked to provide identification, and cigarettes were sold in 9.7% of these cases (even if they did not have ID to show). The message from the study is twofold: first, it describes a reality in which cigarettes could potentially be rather frequently sold to underage adolescents by outlets within Stockholm County; and second, the system does not work, and more control and awareness regarding this matter is necessary.

In their contribution, Lund and Vedøy (2021) develop a conceptual framework for how societies can reason around snus and novel nicotine products from a public health perspective. What is reasonable and what benefits society the most? The aim is to present a framework that can assist the health authorities to draw up regulations where the benefits outweigh the harms. We know that the tobacco industry plans to base their future earnings on the production of non-combustible nicotine products. Authorities in different jurisdictions must decide whether the products should have market access and how strictly they should be regulated. In their conceptual framework, Lund and Vedøy emphasise that health gains from substitution must be weighed against the health loss from additional use. They conclude that the net effect on public health will appear as an overall result of the number of people with positive and negative user patterns, respectively, in combination with the magnitude of the change in health status these people will experience.

This conceptual framework breaks a large and complex question into smaller pieces and requires the authorities to disclose and explain the evidence and reasoning behind regulations of novel nicotine products. A critical reader may ask where the authorities will take the resources to separate and weigh in universalist statements of things being generally and epidemiologically speaking “bad”, on the one hand, and their harm-reduction and life-quality-enhancing characteristics on the other. Still, if some sort of acknowledgement of the complexity of the questions is achieved, a more nuanced view on tobacco use as a social question may be accomplished.

Halkjelsvik (2021) contributes to the literature on behavioural economics by investigating the discounting of future rewards of substance use. The study shows that in comparison with non-smokers, smokers’ relative valuations of future gains are lower. The data support an association between gain discounting and smoking. However, the study suggests that a robust link between gain discounting and smoking status does not reflect a general devaluation of future outcomes among smokers.

Policy change in focus

The Norwegian study by Fjær and Dyregrov (2021) stresses the value of integrating into service development the experiences of those who have suffered a drug-related bereavement. The interview study points out that many of the services sought by the bereaved are already in place and described in national guidelines for follow-up strategies after sudden unexpected deaths. Drug-related deaths, however, have not been included as a task for the services and are not explicitly mentioned in these guidelines. The authors suggest a normative aim for the Norwegian society: that the scope of research and policy-making on drug problems and drug-related deaths should be broadened to include families and social networks in order to make the group more visible and to strengthen their influence on policy.

Last but not least, a book review by Nikkinen (2021) and a discussion piece by Järvinen-Tassopoulos et al. (2021) both emphasise the need for a great shift in gambling policies. In the review of Rebecca Cassidy’s book Vicious games: Gambling and capitalism, the absurdities and threats of the gambling industry are unveiled. Järvinen-Tassopoulus and colleagues plug into this perspective by referring to the great exceptional case of Finland’s placing of electronic gambling machines (EGMs) in supermarkets, kiosks, and petrol stations. This is discussed as a matter of serious concern.