Smokeless, oral tobacco products refer to a range of products that do not require burning, such as snus, chew, moist snuff, and nicotine pouches. These products typically contain leaf tobacco or non-tobacco plant material infused with nicotine and are absorbed through the lining of the mouth. Smokeless tobacco products have a long history of use, with many people preferring them for their convenience, discreetness, and lower health risks compared to smoking.
Types of Smokeless Products
Smokeless tobacco comes in many forms globally, but in the United States, the primary categories of smokeless tobacco products are:
Chewing tobacco is made from shredded tobacco leaves and stems that are sold in plugs, twists, or loose-leaf form. It is heavily flavored and sweetened and is usually placed between the gums and cheek. Chewing tobacco produces a lot of “juice” and requires spitting.
Moist snuff or "dip" is made from fire-cured tobaccos that are fermented and ground up, then sold loose or in pouches. Moist snuff is available in flavors but is not sweetened. Users place a “pinch” or pouch inside the lower lip between the cheek and gum, which requires spitting.
Swedish snus is a version of moist snuff developed in Sweden that is pasteurized, rather than fermented, and has a different flavor than American styles of moist snuff/dip. Snus is available in many flavors, sold loose or in pouches, and is placed inside the upper lip instead of the lower lip. Snus generally does not require spitting.
Nicotine pouches are almost identical to snus in form and use, but they do not contain any tobacco. Instead, they use non-tobacco plant matter infused with nicotine and flavorings.
Why Do People Use Smokeless Tobacco?
Before the invention of the cigarette rolling machine, which made smoking cheap and popular, smokeless tobacco was the most widely used tobacco product because of its convenience. Many people today prefer smokeless tobacco because it is discreet, available in a variety of flavors, and delivers nicotine with dramatically lower health risks than smoking.
Oral tobacco is comparable to nicotine replacement therapies (NRT), like patches or gum, when it comes to quitting smoking. Like NRT, it provides a slow and steady dose of nicotine which can help people avoid the uncomfortable aspects of withdrawal from smoking. Plus, some products can be used virtually anywhere.
Why Have I Heard That Smokeless Tobacco Causes Cancer?
A careful and critical review of 50+ years of epidemiological research on smokeless tobacco users shows the health risks are very low. The prevalence of diseases like oral cancer, heart disease, and dental issues among people who use smokeless tobacco (who do not smoke) is virtually the same rate as people who don’t use any tobacco products at all. In short, using smokeless oral tobacco does not increase your risk of developing cancer or other diseases typically associated with tobacco use.
Most of the misinformation associated with smokeless tobacco in the United States comes from a single study published in 1981 that found an increased risk of cancer in women who used powdered “dry nasal snuff.” As previously stated, CASAA does not consider powdered dry nasal snuff to be a harm reduction product. However, the author of that study (and the medical establishment forever after that) conflated the risks of that one niche product to ALL smokeless tobacco products. This is how the myth was born.
There are many misconceptions surrounding smokeless tobacco and its relationship to cancer. One of the biggest myths is that smokeless tobacco causes cancer, especially in the mouth and throat. However, this is not entirely true.
While it's true that some famous American baseball players, such as Tony Gwynn and Curt Schilling, developed cancer, it's not accurate to attribute their cancer to smokeless tobacco. Gwynn developed cancer of the salivary gland, which is extremely rare and not associated with tobacco use, while Schilling's throat cancer is also not linked to smokeless tobacco use.
Even Babe Ruth, who many people believe developed nasopharyngeal carcinoma due to his use of smokeless tobacco, actually had a cancer that is most commonly caused by the Epstein-Barr virus and not smokeless tobacco.
It's important to note that smokeless tobacco and traditional tobacco products, such as cigarettes, have different risks and health effects. Decades of research have shown that smoking cigarettes poses a far greater risk to health than using smokeless tobacco products.
Excessive alcohol use, cigarette smoking, and the human papillomavirus (HPV) infection are the risk factors most highly associated with oral and throat cancers, not smokeless tobacco.
In some parts of the world, such as India and southeast Asia, there is a conflation between traditional smokeless tobacco and products like gutka/ghutka/betel quid/paan masala, which have been used to misrepresent the health risks associated with all forms of smokeless tobacco.
While it's important to acknowledge the risks associated with tobacco use, it's also important to recognize the complexity of the issue. Anti-tobacco campaigns should not exaggerate the risks of smokeless tobacco while downplaying or ignoring research that challenges their opinions. Acknowledging that some tobacco products are safer than others doesn't dilute the anti-tobacco message that abstinence is the best solution.
Ultimately, it's essential to be informed and aware of the risks associated with tobacco use, whether it's smoking or using smokeless products. However, it's equally important to be aware of the facts and avoid perpetuating myths and misconceptions.
Stay informed and take care of yourself.
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