Guest Blog: Smokeless Tobacco, Not A Safe Alternative

Most of us agree that tobacco use is the most preventable cause of illness and death in the U.S. While the percentage of people smoking has declined, smokeless tobacco use is on the rise. There are 9 million users in the US alone! Not only are tobacco companies expanding their product lines to include more smokeless products, they are promoting many of these products as safer alternatives to smoking when smoking is prohibited.  According to a 2011 FTC report, the total amount of smokeless tobacco sold by manufacturers increased from 2006 to 2008 in which 120 million pounds were sold. Moist snuff continued to garner most of the market with $2.38 billion or 86.2% of sales.

We are seeing an alarming rise in youth use of smokeless tobacco.  Many of the newest smokeless products do not require users to spit, and others dissolve like mints; these products include snus—a spitless snuff packaged in a small teabag-like sachet—and dissolvable strips, sticks and lozenges. Young people find these products appealing because they can be used at school or other places without being detected. However, they still lead to nicotine addiction, and most youth who use them also smoke or will smoke cigarettes. Also, more adults are now dual consumers, using both cigarettes and smokeless tobacco. Researchers at the University of Oklahoma found that among smokeless users, 4 out of 10 females and 3 out 10 males also smoked cigarettes.

While, in general, smokeless tobacco does not contribute to the multitude of cancers that smoking does, we do know that it causes oral cancer, other mouth and gum disease and has a negative effect on reproductive health. Just two weeks ago, scientists reported a link of a specific nitrosamine compound called (S)-NNN in smokeless tobacco products to an increased risk for oral and esophageal cancer. "This is the first example of a strong oral-cavity carcinogen that's in smokeless tobacco," said study author Stephen Hecht, from the University of Minnesota. "Our results are very important in regard to the growing use of smokeless tobacco in the world, especially among younger people who think it is a safer form of tobacco than cigarettes." In the study, lab rats were given two types of low-dose NNN for 17 months, thought to be similar to a human consuming a half-tin of smokeless tobacco a day for 30 years. Since these findings were in animals and not yet published in a journal, they are considered preliminary, but very worrisome for all smokeless users! Combined use of smokeless and cigarettes may actually increase exposure to harmful chemicals. A 2002 study showed an increased risk of stomach cancer. Another study in 2006 reported a higher risk of heart attack among dual users than those using only one product. 

There are many who wrongly believe that switching to smokeless tobacco will help them quit smoking. In fact, it might make quitting more difficult. We have not shown that any of the medications that help smokers quit smoking actually help smokeless users quit. Most meds, however, do help symptoms of nicotine withdrawal from smokeless tobacco and with hard work to change their behavioral patterns and support, smokeless users can successfully quit! Some find that with the assistance of their doctors, combinations of medications may be more helpful.

Not only is smokeless tobacco Not a safe alternative - those that might try using it as quit aide or when smoking is prohibited may end up addicted to both and have a harder time quitting.

We must all resist the attraction of newly introduced products or long-standing products now promoted as safer or more environmentally friendly alternatives. We need to tackle tobacco use head-on and try to quit with proven tools and assistance.

Ann Wendling, M.D., M.P.H.

Medical Director, Tobacco Cessation

Healthways, Inc.


Federal Trade Commission Smokeless Tobacco Report for 2007-2008,” Tech. Rep., Federal Trade Commission, Washington, DC. 2011.

“Smokeless Tobacco Facts,” Centers for Disease Control and Prevention, Office on Smoking and Health, Atlanta, GA.

"Preventing Tobacco Use Among Youth and Young Adults: A Report of the Surgeon General," USDHHS, CDC, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, Atlanta, GA. 2012.

N. Mushtaq, M. B. Williams, L. A. Beebe, “Concurrent Use of Cigarettes and Smokeless Tobacco among US Males and Females,” Journal of Environmental and Public Health, vol. 2012, Article ID 984561, 2012.

American Chemical Society, news release, Aug. 22, 2012, Philadelphia, PA.

A. Chao, M. J. Thun, S. J. Henley, E. J. Jacobs, M. L. McCullough, and E. E. Calle, “Cigarette smoking, use of other tobacco products and stomach cancer mortality in US adults:  the cancer prevention study II,” International Journal of Cancer, vol. 101, no. 4, pp. 380–389, 2002.

K. K. Teo, S. Ounpuu, S. Hawken et al., “Tobacco use and risk of myocardial infarction in 52 countries in the INTERHEART study: a case-control study,” The Lancet, vol. 368, no. 9536, pp.647–658, 2006.