In the USA, Choi et al 22 found that youth perceived snus products as attractive, thought the packages were more modern than cigarette packages and found them cleverly designed to attract attention. While research about cigarette packaging has increased over the latest decade, only a few studies have explored how consumers perceive snus packaging and product design. 19 Similarly, studies of flavoured cigarettes has indicated that these products often are perceived as less harmful and as more attractive than regular cigarettes, in particular among young women. It has also been indicated by experimental research that cigarette packaging developed to appeal particularly to young women, for example, packages looking like lipstick boxes, are perceived as appealing and as less harmful than more standard cigarette packages, because of their smaller size and likeness to cosmetics. 16 This conclusion has been largely supported by recent evaluation results from Australia, 17 18 where legislation mandating standardised packaging of tobacco was implemented in 2012. 14 15 A systematic review of research on cigarette packaging has indicated that such processes can be counteracted by standardising cigarette pack appearance. 11 Research has demonstrated how light-coloured or white packages are perceived as less harmful than darker packages, 12 13 and how notions of relative harm can be strengthened by variant descriptor names denoting colour. Through the use of colour, fonts, images and trademarks, packages can project a brand image that says something about the user of the product and about product qualities. In countries with comprehensive restrictions on advertising, tobacco packaging is the most prominent form of marketing. 10 Snus packages, traditionally dark-coloured and round boxes that resemble an ice hockey puck, are today available in a wide variety of colours and designs. For example, Swedish Match, the market-leading snus-producing company in Scandinavia, increased its brand portfolio from 22 variants in 2002 to 180 variants 6 years later. 9 During the period of increase in snus use in Norway, a range of new snus brands and products have been introduced to the market, including a wide variety of products with flavour additives such as mint, fruit or chocolate and with different shapes and colours of snus sachets. Both products are sold in regular shops, and no form of advertising is allowed, including point of sale advertising ban. 7 8 Similar to cigarettes, the minimum age for purchasing snus in Norway is 18 and warning labels are mandatory, although for snus a smaller sized, non-graphic version, with a more moderated textual content, is used. 6 Consequently, the public health effects from adolescent use could be quite different from that of adult use, as switching to snus implies a substantial harm reduction for individual smokers while initiation of snus use implies an increased risk of harm for non-tobacco users. While the majority of adult snus users in Norway are former smokers, the majority of young users started without prior smoking. 2 3 Massive marketing of snus in the USA, including new products from companies also producing cigarettes, such as Camel and Marlboro snus, 4 5 has however given rise to some concern that snus use may be escalating also outside Scandinavia. In other countries where snus is marketed, like the USA, the prevalence of snus use is low. Norway is not a member of the EU, and snus is legally sold and used. 1 The only country with a similar level of snus use is Sweden, that was granted an exemption from the ban on sale of snus in the European Union (EU) as a condition of their membership treaty. In comparison, the prevalence of daily and occasional smoking in this age segment was 3% and 13% respectively. Daily use was slightly more prevalent among males (21%) than females (17%). In 2016, 25% of 16-24 year olds were daily or occasional snus users. Since then, snus use has increased dramatically, particularly among youth. In Norway, snus sales were low until around 1990, when the traditional moist snuff was reintroduced as a new, drier product packed in small sachets. Snus (a traditional Swedish-type oral moist snuff) has a long product history and use tradition among men in Scandinavia.

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