Smokeless tobacco is a tobacco product that is used by means other than smoking. Their use involves chewing, sniffing, or placing the product between gum and the cheek or lip. Smokeless tobacco products are produced in various forms, such as chewing tobacco, snuff, snus, and dissolvable tobacco products. Related non-combustible oral nicotine products, such as nicotine pouches, contain nicotine but may not contain tobacco leaf. Smokeless tobacco is particularly popular in South Asia, with this region accounting for about 80% of global smokeless tobacco consumption. All smokeless tobacco products contain nicotine and are therefore highly addictive. Quitting smokeless tobacco use is as challenging as smoking cessation.
Using smokeless tobacco can cause various harmful effects such as dental disease, oral cancer, oesophagus cancer, and pancreas cancer, coronary heart disease, as well as negative reproductive effects including stillbirth, premature birth and low birth weight. Smokeless tobacco poses a lower health risk than traditional combusted products. However it is not a healthy alternative to cigarette smoking. The level of risk varies between different types of products (e.g., low nitrosamine Swedish-type snus versus other smokeless tobacco with high nitrosamine levels) and producing regions. There is no safe level of smokeless tobacco use. Globally it contributes to 650 000 deaths each year.
Smokeless tobacco products typically contain over 3000 constituents, which includes multiple cancer-causing chemicals. Approximately 28 chemical constituents present in smokeless tobacco can cause cancer, among which nitrosamine is the most prominent. Smokeless tobacco consumption is widespread throughout the world. Once addicted to nicotine from smokeless tobacco use, many people, particularly young people, expand their tobacco use by smoking cigarettes. Males are more likely than females to use smokeless tobacco.
Types
Most smokeless tobacco use involves placing the product between the gum and the cheek or lip. Smokeless tobacco is a noncombustible tobacco product.
Types of smokeless tobacco include: Mixed routes of administration: Kuber, a smokeless tobacco product known for its highly addictive properties and its unique presentation disguised as a mouth freshener. Users commonly add it to tea or consume it directly by placing a pinch under the lower lip. Nasal administration: Snuff, a type of tobacco that is inhaled or "snuffed" into the nasal cavity. Traditionally, a specialized tool called a snuff spoon was used for this purpose. However, modern users may simply pinch the snuff between their thumb and forefinger or use pre-measured packets. Oral (buccal, sublabial, or sublingual): Chewing tobacco, a type of tobacco that is chewed Creamy snuff, a fluid tobacco mixture marketed as a dental hygiene aid, albeit used for recreation Dipping tobacco, a type of tobacco that is placed between the lower or upper lip and gums. This form of tobacco (Hindi: Khaini) is commonly used in Indian subcontinent. It is the second most common form of tobacco consumption in India, after cigarrette smoking. Dissolvable tobacco, a variation on chewing tobacco that completely dissolves in the mouth Gutka, a mixture of tobacco, areca nut, and various flavoring sold in South Asia Iqmik, an Alaskan tobacco product which also contains punk ash Naswar, an Afghan tobacco product similar to dipping tobacco Pituri, a nicotine-containing substance traditionally made from Australian tobacco plants, used by Indigenous Australians for chewing and placed between the lower lip and gums. They use it in high doses to induce stupor or trance. Snus, similar to dipping tobacco although the tobacco is placed under the upper lip and there is no need for spitting Tobacco chewing gum, a kind of chewing gum containing tobacco Toombak and shammah, preparations found in North Africa, East Africa, and the Arabian peninsula Topical: Topical tobacco paste, a paste applied to the skin and absorbed through the dermis
Since there are varied manufacturing methods, products can differ greatly in chemical arrangement and nicotine level. Smokeless tobacco products typically contain over 3000 constituents which play a part in their taste as well as scent.
Nicotine levels
Smokeless tobacco differs depending on the type of product, the types of tobacco used, and the amount of each tobacco type used within a product. Each variable results in different level of nicotine. Furthermore, nicotine is absorbed by the body to different degrees depending on the pH level of the product, which is known as the free nicotine or unionized nicotine level.
Below are some measured nicotine levels of various smokeless tobacco products from 2006 and 2007 and their corresponding free nicotine levels as calculated by the Henderson–Hasselbalch equation.
Product Nicotine (mg/g) Free Nicotine (mg/g) Free Nicotine (% of total nicotine) pH Type Form Year Ariva 3.90 0.70 17.95 7.36 dissolvable, dry pieces 2007 Stonewall Natural 8.19 1.17 14.23 7.24 dissolvable, dry pieces 2007 Beech-nut Chewing Tobacco 7.07 0.02 0.35 5.56 loose leaf loose 2006 Hawken Wintergreen 2.92 0.01 0.22 5.37 loose leaf cut 2007 Lancaster Premium Chewing Tobacco 8.01 0.01 0.11 5.05 loose leaf loose 2007 Levi Garrett Chewing Tobacco 5.34 0.06 1.19 6.10 loose leaf loose 2006 Red Man Chewing Tobacco 8.58 0.08 0.88 5.97 loose leaf loose 2006 Red Man Golden Chewing Tobacco 7.70 0.06 0.72 5.88 loose leaf loose 2006 Stoker Chew Apple Chewing Tobacco 3.77 0.01 0.22 5.37 loose leaf loose 2007 Taylor's Pride 6.43 0.06 0.90 5.98 plug one cut 2006 Catch Dry Eucalyptus 15.93 1.39 8.72 7.00 snuff, dry pouch 2006 Catch Dry Licorice 16.70 0.68 4.09 6.65 snuff, dry pouch 2006 Skoal Dry 11.91 2.39 20.08 7.42 snuff, dry pouch 2007 Taboka 16.73 0.36 2.14 6.36 snuff, dry pouch 2007 Taboka Green 13.01 0.48 3.66 6.60 snuff, dry pouch 2007 Bruton Scotch Snuff 17.49 0.49 2.80 6.48 snuff, dry powder 2006 Dental Sweet Snuff 11.14 0.13 1.19 6.10 snuff, dry powder 2006 Levi Garrett Snuff 16.60 0.07 0.42 5.65 snuff, dry powder 2007 Railroad Mills Plain Scotch Snuff 23.13 0.48 2.09 6.35 snuff, dry powder 2007 Red Seal Sweet Snuff 15.08 0.40 2.62 6.45 snuff, dry powder 2007 Camel Frost 13.25 4.70 35.46 7.76 snuff, moist pouch 2006 Camel Frost 14.10 4.71 33.39 7.72 snuff, moist pouch 2007 Camel Original 13.87 4.70 33.90 7.73 snuff, moist pouch 2006 Camel Original 13.49 6.20 45.98 7.95 snuff, moist pouch 2007 Camel Spice 13.16 6.65 50.58 8.03 snuff, moist pouch 2006 Camel Spice 13.16 6.65 50.58 8.03 snuff, moist pouch 2007 Cooper Long Cut Wintergreen 7.97 1.09 13.68 7.22 snuff, moist long cut 2007 Copenhagen 12.68 3.21 25.31 7.55 snuff, moist fine cut 2006 Copenhagen Long Cut 13.91 5.38 38.69 7.82 snuff, moist long cut 2006 Copenhagen Pouches 11.21 6.81 60.77 8.21 snuff, moist fine cut 2006 General Loose 7.15 1.87 26.19 7.57 snuff, moist coarse 2006 General Original Portion 8.46 5.10 60.22 8.20 snuff, moist pouch 2006 General White Portion 7.92 4.81 60.77 8.21 snuff, moist pouch 2006 Grizzly Long Cut Wintergreen 10.29 6.59 64.01 8.27 snuff, moist long cut 2006 Grizzly Long Cut Wintergreen 11.20 5.86 52.30 8.06 snuff, moist long cut 2007 Husky Fine Cut Natural 12.86 4.77 37.06 7.79 snuff, moist fine cut 2007 Kayak Long Cut Wintergreen 11.88 2.26 18.99 7.39 snuff, moist long cut 2007 Kodiak Premium Wintergreen 10.93 6.52 59.66 8.19 snuff, moist long cut 2006 Kodiak Premium Wintergreen 10.70 8.18 76.39 8.53 snuff, moist long cut 2007 Longhorn Long Cut Wintergreen 13.79 5.72 41.45 7.87 snuff, moist long cut 2007 Red Seal Fine Cut Natural 13.17 3.11 23.61 7.51 snuff, moist fine cut 2007 Renegades Wintergreen 13.36 2.40 17.95 7.36 snuff, moist pouch 2007 Skoal Fine Cut Original 13.31 3.85 28.95 7.63 snuff, moist fine cut 2006 Skoal Long Cut Cherry 12.70 1.67 13.15 7.20 snuff, moist long cut 2006 Skoal Long Cut Mint 12.93 3.68 28.47 7.62 snuff, moist long cut 2006 Skoal Long Cut Straight 13.37 3.94 29.42 7.64 snuff, moist long cut 2006 Skoal Long Cut Wintergreen 12.84 2.87 22.38 7.48 snuff, moist long cut 2006 Timberwolf Long Cut Wintergreen 14.13 5.16 36.53 7.78 snuff, moist long cut 2007
Health effects Various national and international health organizations, including the World Health Organization, the US National Cancer Institute, the UK Royal College of Physicians, stated that, even if it is less dangerous than smoking, using smokeless tobacco is addictive, represents a major health risk, has no safe level use and is not a safe substitute for smoking.
Using smokeless tobacco can cause a number of adverse health effects such as dental disease, oral cancer, oesophagus cancer, and pancreatic cancer, cardiovascular disease, asthma, and deformities in the female reproductive system. It also raises the risk of fatal coronary artery disease, fatal stroke and non-fatal ischaemic heart disease. Globally it contributes to 650 000 deaths each year with a significant proportion of them in Southeast Asia.
Smoking cessation and harm reduction Quitting smokeless tobacco use is as challenging as smoking cessation. There is no scientific evidence that using smokeless tobacco can help a person quit smoking. It is not recommended to use any smokeless tobacco product as part of a harm reduction strategy. Tobacco companies that sell smokeless tobacco products promote them as harm reduction products and a less harmful substitute to cigarettes. This creates a false perception of safety while real risk reduction can be achieved by smoking less.
Safety
Smokeless tobacco products vary extensively worldwide in both form and health hazards. The level of health risk varies between different types of products (e.g., low nitrosamine Swedish-type snus versus other smokeless tobacco with high nitrosamine levels from South Asia). Even though smokeless tobacco poses a lower health risk than traditional combusted products, contrary to common belief it is not a "safe" alternative to conventional tobacco. There is no safe level of smokeless tobacco use. The declines in smokeless tobacco initiation among adolescents and young adults is particularly relevant to improving their health because smokeless tobacco use is often linked to subsequent cigarette initiation. Smokeless tobacco users can experience negative health consequences at any age. Youth use of tobacco in any form is unsafe.
Cancer
Smokeless tobacco (including products where tobacco is chewed) is a cause of oral cancer, oesophagus cancer, and pancreas cancer. Increased risk of oral cancer caused by smokeless tobacco is present in countries such as the United States but particularly prevalent in Southeast Asian countries where the use of smokeless tobacco is common.
Smokeless tobacco can cause white or gray patches inside the mouth (leukoplakia) that can develop into oral cancer.
Carcinogens