What
is smokeless tobacco? Smokeless tobacco is tobacco that is not burned. It is also
known as chewing tobacco, oral tobacco, spit or spitting tobacco, dip, chew,
and snuff. Most people chew or suck (dip) the tobacco in their mouth and spit
out the tobacco juices that build up, although “spitless” smokeless tobacco has
also been developed. Nicotine in the tobacco is absorbed through the lining of the
mouth.
There are two main types of
smokeless tobacco: Chewing tobacco,
which is available as loose leaves, plugs (bricks), or twists of rope. A piece
of tobacco is placed between the cheek and lower lip, typically toward the back
of the mouth. It is either chewed or held in place. Saliva is spit or
swallowed. Snuff, which is finely cut or powdered tobacco. It may be sold in
different scents and flavors. It is packaged moist or dry; most American snuff
is moist. It is available loose, in dissolvable lozenges or strips, or in small
pouches similar to tea bags. The user places a pinch or pouch of moist snuff
between the cheek and gums or behind the upper or lower lip. Another name for
moist snuff is snus (pronounced “snoose”). Some people inhale dry snuff into
the nose.
Does
smokeless tobacco cause cancer or other diseases? Yes.
Smokeless tobacco causes oral cancer, esophageal cancer, and pancreatic cancer
(1). Using smokeless
tobacco may also cause heart disease, gum disease, and oral lesions other than cancer, such as leukoplakia (precancerous white patches in the mouth) (1).
Can
a user get addicted to smokeless tobacco?
Yes. All tobacco products, including
smokeless tobacco, contain nicotine, which is addictive (1). Users of smokeless
tobacco and users of cigarettes have comparable levels of nicotine in the
blood. In users of smokeless tobacco, nicotine is absorbed through the mouth
tissues directly into the blood, where it goes to the brain. Even after the
tobacco is removed from the mouth, nicotine continues to be absorbed into the
bloodstream. Also, the nicotine stays in the blood longer for users of
smokeless tobacco than for smokers (2). The
level of nicotine in the blood depends on the amount of nicotine in the
smokeless tobacco product, the tobacco cut size, the product’s pH (a measure of
its acidity or basicity), and other factors (3).
Is
using smokeless tobacco less hazardous than smoking cigarettes? Because
all tobacco products are harmful and cause cancer, the use of all of these
products should be strongly discouraged. There is no safe level of tobacco use.
People who use any type of tobacco product should be urged to quit. As long ago
as 1986, the advisory committee to the Surgeon General concluded that the use
of smokeless tobacco “is not a safe substitute for smoking cigarettes. It can
cause cancer and a number of noncancerous oral conditions and can lead to
nicotine addiction and dependence” (4). Furthermore, a panel of experts
convened by the National Institutes of Health (NIH) in 2006 stated that the
“range of risks, including nicotine addiction, from smokeless tobacco products
may vary extensively because of differing levels of nicotine, carcinogens, and
other toxins in different products” (5).
Should
smokeless tobacco be used to help a person quit smoking? No.
There is no scientific evidence that using smokeless tobacco can help a person
quit smoking (6). Because all tobacco products are harmful and cause
cancer, the use of all tobacco products is strongly discouraged. There is no
safe level of tobacco use. People who use any type of tobacco product should be
urged to quit.
How
can I get help quitting smokeless tobacco?
NCI offers free information about
quitting smokeless tobacco: Call National Cancer Institute’s Smoking Quitline at 1–877–448–7848.
Talk with a smoking cessation counselor about quitting smokeless tobacco within
the United States, Monday through Friday, 8:00 a.m. to 8:00 p.m., Eastern Time. Use LiveHelp online chat.
You can have a confidential online text chat with an NCI smoking cessation
counselor Monday through Friday, 8:00 a.m. to 11:00 p.m., Eastern Time. Call QuitLine Iowa at 1-800-784-8669 to talk
with a smoking cessation counselor about quitting. Use
the www.quitlineiowa.org website for
information on quitting or contacting someone for help quitting. The National Institute of Dental and
Craniofacial Research, the NIH agency that supports dental, oral, and
craniofacial research, offers a guide for quitting called Smokeless
Tobacco: A Guide for Quitting and other information
about smokeless tobacco. For other
resources, you may be interested in the NCI fact sheet Where To Get
Help When You Decide To Quit Smoking.
Selected
References
1.
International Agency for Research on
Cancer. Smokeless Tobacco and Some Tobacco-SpecificN-Nitrosamines.
Lyon, France: World Health Organization International Agency for Research on
Cancer; 2007. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans
Volume 89.
2.
National Cancer Institute. Smokeless
Tobacco or Health: An International Perspective. Bethesda, MD: National
Cancer Institute; 1992. Smoking and Tobacco Control Monograph 2.
3.
Richter P, Hodge K, Stanfill S,
Zhang L, Watson C. Surveillance of moist snuff: total nicotine, moisture, pH,
un-ionized nicotine, and tobacco-specific nitrosamines. Nicotine and
Tobacco Research 2008; 10(11):1645–1652.
4.
U.S. Department of Health and Human
Services. The Health Consequences of Using Smokeless Tobacco: A Report
of the Advisory Committee to the Surgeon General. Bethesda, MD: U.S.
Department of Health and Human Services, 1986.
5.
NIH State-of-the-Science Panel.
National Institutes of Health State-of-the-Science conference statement:
tobacco use: prevention, cessation, and control. Annals of Internal
Medicine 2006; 145(11):839–844.
6.
The Clinical Practice Guideline
Treating Tobacco Use and Dependence 2008 Update Panel, Liaisons, and Staff. A
clinical practice guideline for treating tobacco use and dependence: 2008
update. A U.S. Public Health Service report. American Journal of
Preventive Medicine 2008; 35(2):158–176.