Smokeless tobacco products
Smokeless tobacco products
Chewing tobacco and other forms of smokeless tobacco are more harmful and addictive than you might think.
Chewing tobacco and other smokeless tobacco products are often promoted as safer than cigarettes because they aren’t linked to lung cancer.
However, these products have some of the same risks as cigarettes. And smokeless tobacco has other risks as well. There are no harmless tobacco products.
What is smokeless tobacco?
Smokeless tobacco products consist of tobacco that’s chewed, sucked or sniffed, rather than smoked. Nicotine is absorbed through the tissues of the mouth and in some cases swallowed.
Many types of smokeless tobacco products are used around the world. In the U.S., the most popular include chewing tobacco, snuff, snus and dissolvable tobacco products.
Chewing tobacco is sold as loose leaves, braided leaves (called a twist) and compressed leaves (called a plug). It may be flavored. Chewing tobacco is placed between the cheek and gum. The saliva that builds up in the mouth is either spit out or swallowed. Chewing tobacco is also called chew, spitting tobacco or spit.
Snuff is finely ground tobacco that may be dry or moist. It’s packaged in tins or pouches. It may be flavored. A pinch of snuff is placed along the gumline, either behind the lip or between the gum and cheek. Using snuff is also called dipping. Dry snuff can be snorted.
Snus (pronounced snoos) is a type of moist snuff that originated in Sweden. It’s sold loose or in pouches. Snus is pasteurized to kill bacteria that can produce cancer-causing chemicals. Some evidence suggests that snus users aren’t at as great a risk as cigarette users are for mouth cancer, heart disease, stroke, lung cancer and other lung problems.
Dissolvable tobacco products are powdered tobacco pressed into shapes, such as tablets, sticks or strips. Some contain sweeteners or flavoring and may look like candy. The pressed tobacco is chewed or held in the mouth until it dissolves. These products are not the same as the nicotine lozenges used to help people quit smoking.
Health risks of smokeless tobacco
Smokeless tobacco products might expose people to lower levels of harmful chemicals than tobacco smoke, but that doesn’t mean these products are a safe alternative to smoking.
Smokeless tobacco contains nicotine, which can lead to addiction, and dozens of chemicals that can cause cancer.
Health problems related to smokeless tobacco include the following:
- Addiction. Nicotine is the chemical that makes tobacco addictive. Research suggests that people who use smokeless tobacco get as much or more nicotine into their bodies as people who smoke cigarettes. Just as with smoking, withdrawal from smokeless tobacco can cause intense cravings, irritability and depressed mood.
- Cancer. The use of chewing tobacco and other smokeless tobacco products increases the risk of cancer of the mouth, throat and pancreas. Smokeless tobacco also increases the risk of developing small white patches in your mouth called leukoplakia (loo-koh-PLAY-key-uh). These patches are precancerous — meaning that they have the potential to turn into cancer.
- Heart disease. Some forms of smokeless tobacco increase your heart rate and blood pressure. Long-term use of smokeless tobacco increases your risk of dying of heart disease and stroke.
- Dental disease. The sugar and irritants in smokeless tobacco products can cause cavities, abrasion of teeth, teeth staining, bad breath, gum disease, receding gums, bone loss around roots and tooth loss.
- Pregnancy risk. Using smokeless tobacco during pregnancy increases the risk of stillbirth, low birth weight and heart rate variability in infants.
- Poisoning risk. The candy-like appearance and flavors of some smokeless tobacco products make them attractive to children. Eating these products can cause nicotine poisoning. Nicotine poisoning in children may cause nausea, vomiting, weakness, convulsions, unresponsiveness, trouble breathing and even death.
Manufacturers may imply that smokeless tobacco will help you quit smoking, but this hasn’t been proved. Because of the health risks, smokeless tobacco products aren’t a good alternative to quit smoking.
If you use chewing tobacco or other forms of smokeless tobacco, consider options to help you quit. Your doctor can be a great resource and can help you create a quit plan.
Resources developed for smoking cessation may help you stop using smokeless tobacco. The following interventions have been found most effective in research about quitting chewing tobacco and other smokeless products:
- Behavioral interventions — such as telephone services, self-help materials and counseling — can provide you with support and help you develop coping skills.
- Nicotine replacement therapy using the patch, gum or lozenges can help reduce cravings for tobacco products.
- Medication. Two non-nicotine prescription medications are approved to help reduce nicotine withdrawal symptoms.
In the U.S. you can call the National Cancer Institute’s telephone quit line: Call 877-44U-QUIT (877-448-7848). Or you can find your state’s quit line by calling 800-QUIT-NOW (800-784-8669).
March 19, 2021
- Smokeless tobacco fact sheets. Centers for Disease Control and Prevention. https://www.cdc.gov/tobacco/data_statistics/fact_sheets/smokeless/index.htm. Accessed Jan. 28, 2021.
- Health risks of smokeless tobacco. American Cancer Society. https://www.cancer.org/healthy/stay-away-from-tobacco/health-risks-of-tobacco/smokeless-tobacco.html. AccessedJan. 29, 2021.
- Seidenberg AB, et al. Characteristics of ‘American snus’ and Swedish snus products for sale in Massachusetts, USA. Nicotine & Tobacco Research. 2018; doi:10.1093/ntr/ntw334.
- Kleigman RM, et al., eds. Substance abuse. In: Nelson Textbook of Pediatrics. 21st ed. Elsevier; 2020. https://www.clinicalkey.com. Accessed Jan. 28, 2021.
- Rostron BL, et al. Nicotine and toxicant exposure among U.S. smokeless tobacco users: Results from 1999 to 2012 National Health and Nutrition Examination Survey data. Cancer Epidemiology, Biomarkers & Prevention. 2015; doi:10.1158/1055-9965.EPI-15-0376.
- Smoking, smokeless tobacco. American Dental Association. http://www.mouthhealthy.org/en/az-topics/s/smokeless-tobacco. Accessed Jan. 28, 2021.
- Glover M, et al. Potential effects of using non-combustible tobacco and nicotine products during pregnancy: A systematic review. Harm Reduction Journal. 2020; doi:10.1186/s12954-020-00359-2.
- Gupta R, et al. Risk of coronary heart disease among smokeless tobacco users: Results of systematic review and meta-analysis of global data. Nicotine & Tobacco Research. 2019; doi:10.1093/ntr/nty002.
- Dangers of smokeless tobacco. American Academy of Pediatrics. https://www.healthychildren.org/English/health-issues/conditions/tobacco/Pages/Dangers-of-Chew.aspx. Accessed Jan. 28, 2021.
- Ebbert JO, et al. Interventions for smokeless tobacco use cessation. Cochrane Database of Systematic Reviews. 2015; doi:10.1002/14651858.CD004306.pub5.
- Speak to an expert. National Cancer Institute. https://smokefree.gov/tools-tips/get-extra-help/speak-to-an-expert. Accessed Jan. 28, 2021.
- Connolly GN, et al. Unintentional child poisonings through ingestion of conventional and novel tobacco products. Pediatrics. 2010; doi:10.1542/peds.2009-2835.
- Smokeless tobacco products, including dip, snuff, snus, and chewing tobacco. U.S. Food and Drug Administration. https://www.fda.gov/tobacco-products/products-ingredients-components/smokeless-tobacco-products-including-dip-snuff-snus-and-chewing-tobacco. Accessed Jan. 28, 2021.
- Nethan ST, et al. Behavioral interventions for smokeless tobacco cessation. Nicotine & Tobacco Research. 2020; doi:10.1093/ntr/ntz107.
- AskMayoExpert. Tobacco-related oral issues (adult). Mayo Clinic; 2019.
- Quitting smoking or smokeless tobacco. American Cancer Society. https://www.cancer.org/healthy/stay-away-from-tobacco/guide-quitting-smoking/quitting-smoking-or-smokeless-tobacco.html. Accessed Jan. 29, 2021.
- Rigotti NA. Patterns of tobacco use. https://www.uptodate.com/contents/search. Accessed Jan. 29, 2021.