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.
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.