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Snus: New Form of Smokeless Tobacco Courts Controversy

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A type of smokeless tobacco popular in Sweden called snus is growing in popularity in the United States. While most recognize that it is a safer alternative to cigarettes or older forms of smokeless tobacco, others are concerned that it will attract young people, becoming a steppingstone to cigarettes, says a researcher who spoke this week at the Smokeless Tobacco Summit in Austin, TX.

There is also concern that smokers may use snus in places where they can’t smoke, which will encourage them to keep smoking instead of quitting, says Lois Biener, PhD, Adjunct Professor, Department of Psychology at the University Of Massachusetts – Boston and Senior Research Fellow at the Center for Survey Research, University Of Massachusetts – Boston.

Snus (pronounced snoos) was first introduced in several U.S. test markets in 2006, and has been available nationwide since 2009. It is sold under several brands including Marlboro Snus and Camel Snus. The product is different from other types of smokeless tobacco in several important ways, Dr. Biener says. Snus is manufactured using a process that makes it lower in carcinogens called tobacco-specific nitrosamines. Snus also doesn’t stimulate saliva the way that snuff does and thus doesn’t require spitting. A person using snus puts a small pouch filled with the product between the lip and the gum.

Dr. Biener’s research has shown that the primary group of snus users in the United States is male smokers. “There is very little trial of the product among females and virtually no trial of it among nonsmokers,” she says.

Because snus comes in sweet and fruity flavors, public health officials are concerned that it is catching on with teens. The 2010 Monitoring the Future survey found that the use of smokeless tobacco (including snus) has started to increase significantly after years of declines. The survey found that 13 percent of 10th grade boys and 15.7 percent of 12th grade boys reported using smokeless tobacco in the previous 30 days.

Mixed Findings on Health Effects

Snus has been long been used in Sweden, where its health effects have been studied. “In Sweden, where cigarette smoking among men is low and snus use is high, we see lower levels of lung cancer among men compared with the rest of Europe and the United States,” Dr. Biener said.

One study of the health effects of snus, published in The Lancet in 2007, studied 125,000 Swedish male construction workers who had never smoked, and followed them for 12 to 26 years. The study found that snus use was associated with a slight increased risk of pancreatic cancer, but was not associated with any increased risk of oral cancer or lung cancer; cigarette smoking was significantly associated with all three.

Another study in the same issue of the journal found there was little difference in life expectancy between smokers who quit all tobacco and those who switched to snus. The researchers of that study concluded that snus could produce a net benefit to health if used by hard-core smokers. That study bolstered the argument that switching smokers to snus could reduce the harm caused by cigarettes.

Dr. Biener is conducting interviews with a representative sample of adults in Dallas/Fort Worth and Indianapolis, two early test markets for the product. There is currently no solid data on what proportion of the individuals who try Snus go on to use it regularly, and Dr. Biener hopes to answer this question. She also wants to find out whether regular snus users change their smoking patterns.

Dr. Biener and her colleagues are also looking at the level of nicotine in various snus products. “It’s likely that snus and cigarettes have comparable levels of nicotine and are comparably addictive, although the mode of delivery of the nicotine is different,” she said.

Another concern of snus critics is that using the product along with cigarettes might lead to higher levels of nicotine addiction and make it harder for people to quit smoking, a theory that she says has yet to be studied.

“People have a right to accurate information about these products,” Dr. Biener said. “It’s important that health agencies are upfront about the different level of risk and harm in different tobacco products, so that people don’t end up thinking, ‘One is just as bad as another so I might as well continue to smoke.’ Until there is more information on how people are using snus and what the impact is on their smoking, we can’t make a recommendation about its use.”

10 Responses to this article

  1. Cat Williams / November 16, 2013 at 1:15 pm

    It is a crime that snus has not been more widely available in the USA, and shows the power of the cigarette lobby on our laws.

  2. Cat Williams / November 16, 2013 at 1:12 pm

    I switched over to the e-cig to quit smoking, then found out about snus, and primarily use General snus (it’s the only real Swedish snus sold in my area in the USA). I think snus is amazing, the easiest, least hassle free tobacco to use. I have not felt like smoking since I started using snus, and I am the healthier for it, now four months smoke-free. It’s also much cheaper than cigs. I wish I had known about years ago. I smoked off & on for 17 years, and did not think there was a healthier alternative. I got tired of quitting and re-starting smoking, and the snus gives me confidence I will not smoke. I will have to quit tobacco at some point, but I will be craving snus and not cigarettes. It is a crime that it

  3. Avatar of teatiller
    teatiller / August 20, 2013 at 1:22 am

    First of all, Nicotine is about the same level of toxin as caffeine. If Mother Nature had put nicotine in coffee, and put caffeine in tobacco, we would be extremely worried about “caffeine addiction”. Second of all, there is a huge difference between Swedish made Snus and American made snus. The American made stuff can’t really even be considered snus, because only God (and the American tobacco companies) know what’s in it and how it’s made. Stay away from the Camel snus and Marlboro snus. Swedish snus is sold widely in the US only through the General brand (there are many more brands sold over seas.) Swedish snus has been studied to death in Sweden, statistics and scientific studies of the Swedish people show that snus ain’t that bad. Go to swedishmatch.com to find out more facts on Swedish snus that are not mentioned in this article. (and an ingredient list of what is in their products, unlike American tobacco)

  4. Avatar of Justin Azevedo
    Justin Azevedo / June 28, 2011 at 2:12 pm

    I really have to agree with this article. I used Camel Winterchill SNUS to quit smoking. Today is my 17th day without a smoke. I was doing both for about 2 weeks before that, slowing moving my habit over, but 17 days completely smoke free. I smoked for 26 years, 2 packs a day.
    The differences are HUGE people, not small. My veins don’t stick out of my hands and arms like they used to. My eyesight is so much better. I had an enlarged heart from hypertension (from smoking), and all that anxiety and tension is gone, I am so relaxed now. I don’t wake up at night with irregular heartbeats anymore. The list goes on and on. We need to get as many smokers like me informed as possible. I tried the gum, pills, patch, nasal spray, and nothing worked. The SNUS worked the first time and was really actually easy in comparison. I was going to quit using SNUS in a few weeks or months, but I actually like it and as an adult may make the decision to keep using it for a while.

  5. Avatar of Swedish Ex-smoker
    Swedish Ex-smoker / May 18, 2011 at 4:41 am

    “But snus is still a product which delivers a very, very addictive drug.” So? Addiction is not a health issue.

    Addiction might be annoying, but it doesn’t do any harm.

    Well-informed adults should be allowed to decide whether or not to use products that are addictive, such as coffee, chili, gyms, snus – or even cigarettes.

    While tobacco usage in Sweden is about the average in the Western world, tobacco related cancer rates are very low. Thanks to snus 50% of Swedish tobacco users don’t smoke! Even pancreatic cancer rates in Sweden are among the lowest in Europe, only Cyprus has lower rates.

    Swedish snus is the best way to quit smoking, it’s effective and the health benefits are undisputable.

  6. Avatar of Martin Drautzburg
    Martin Drautzburg / May 17, 2011 at 3:26 am

    Snus is not a safe alternative to smoking, just like driving with a seatbelt is not a safe alternative to driving without one.

    In the EU we are far from “urging smokers to use Snus”. We are not even allowing them to make an “informed decision”. Snus is banned in the EU.

    It is hard to believe that the Snus ban has anything to do with public health. I understand why people raise an eyebrow on articles like this one, because it gives the impression than Snus is a problem, where really the Snus ban is a much bigger problem.

  7. Avatar of THOMT
    THOMT / May 16, 2011 at 6:05 pm

    Ethically, health professionals are required to provide information that is accurate, up-to-date, and peer-reviewed. This may include information about Snus. However, under the precepts of the Hippocratic Oath, health professionals are also ethically bound to “do no harm”. All tobacco products are harmful in one way or another, albeit not equally so. It is, therefore, our obligation to state the known harmful nature of any product, any comparative differences of one product from another, then let the person we are providing information to make an informed decision for themselves. Urging current smokers to use Snus instead of smoking does not seem to meet the burden of doing no harm.

  8. Avatar of Elaine Keller
    Elaine Keller / May 14, 2011 at 10:38 am

    The best advice that Dr. Beiner provided was that health organizations should stop misleading the public into believing that all tobacco products are equally harmful. That keeps smokers smoking instead of switching. If we already know that snus is safer than smoking, what is the wisdom in waiting for more information about how people are using it? While smokers are waiting for you to collect this information, more damage is being done to their lungs, cardiovascular system and DNA. If they aren’t switching, maybe it’s because health organizations have done such a good job of misleading them. How about telling the truth and urging smokers who can’t quit to switch?

  9. maxwood / May 13, 2011 at 4:57 pm

    Persons “concerned that it will attract young people, becoming a steppingstone to cigarettes” might be reassured if actions were taken to promote the e-cigarette (with or without nicotine in cartridge) as destination INSTEAD OF cigarettes.

  10. Sandra Streifel / May 15, 2011 at 11:02 am

    Ah, another person(?) to tell us the e-cigarette is the answer to every nicotine problem. But snus is still a product which delivers a very, very addictive drug. This article had a lot of information about snus–I thought it was just Scandinavian chewing tobacco. The Lancet info was surprising; I’ll bet the companies that own Camel and Marlboro brands will be happy with this trend–thanks for the info Dr. Blener. I don’t expect any tobacco company money went to your research or that smokeless tobacco conference–or did it?

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