Chewing Tobacco (Smokeless Tobacco, Snuff)

  • Medical Author:
    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

  • Medical Editor: Charles Patrick Davis, MD, PhD
    Charles Patrick Davis, MD, PhD

    Charles Patrick Davis, MD, PhD

    Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

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Chewing tobacco facts

  • Smokeless, snuff, or chewing tobacco contains nicotine as well as many known carcinogens (cancer-causing substances).
  • More nicotine is absorbed by chewing tobacco use that by smoking a cigarette.
  • Chewing tobacco use is a risk factor for the development of oral cancers and precancers.
  • Other health risks of chewing tobacco include gum disease, tooth decay and tooth loss, and possible links to other cancers and cardiovascular disease.
  • Products that are designed to help smokers quit can also be used to help quit chewing tobacco use.

What is chewing tobacco?

Chewing tobacco is sometimes known as chewing tobacco or spitting tobacco. It is available in two forms, snuff and chewing tobacco. Both types of chewing tobacco are held in the mouth inside the cheek or between the cheek and gum. Snuff and chewing tobacco are commonly available in tins or pouches; popular brand names include Skoal and Copenhagen. Snus (pronounced like "snoose") is a finely ground form of snuff that originated in Norway and Sweden that comes in small tins. The amount of snuff placed in the mouth is referred to as a pinch, dip, lipper, or quid. A portion of chewing tobacco is referred to as a plug, wad, or chew.

Chewing tobacco is known to contain at least 28 cancer-causing chemicals, medically known as carcinogens. The main carcinogens in chewing tobacco are the tobacco-specific nitrosamines (TSNAs). Some of the other cancer-causing agents found in chewing tobacco are formaldehyde, acetaldehyde, arsenic, benzopyrene, nickel, and cadmium. Many people mistakenly believed that snus is a safe form of chewing tobacco because it is steam-heated rather than fermented when produced in Norway or Sweden, causing it to have fewer nitrosamines. However, snus still contains a number of cancer-causing chemicals. Snus made in America is not necessarily processed in the same way as in Norway or Sweden.

Nicotine is also found in snuff and chewing tobacco, like all tobacco products. Although nicotine is absorbed more slowly from chewing tobacco than from cigarettes, 3 to 4 times more nicotine is absorbed from chewing tobacco than from a cigarette, and the nicotine from chewing tobacco remains longer in the bloodstream. Nicotine is the substance responsible for tobacco addiction.

Chewing tobacco is not the same thing as chewing cigarettes. Chewing cigarettes (also termed e-cigarettes) are designed to provide nicotine in vapor to the user without burning tobacco. However, the smokeless cigarettes still provide addictive nicotine to the user and secondhand nicotine to others.

What are the health risks of chewing tobacco?

A number of significant health risks are associated with the use of chewing tobacco.

Cancer risk and chewing tobacco

Users of snuff and chewing tobacco are at an increased risk for certain types of cancer, most notably cancer of the oral cavity including cancers of the:

  • cheek,
  • gums,
  • lips,
  • tongue, and
  • floor and roof of the mouth.

Some studies have suggested a link between the use of chewing tobacco and the development of:

Other health risks of chewing tobacco

Those who use chewing tobacco have an increased risk of:

  • developing gum diseases and gum recession (pulling away of the gum tissue from the teeth);
  • leukoplakia (whitish patches inside the mouth that can become cancerous);
  • abrasion (wearing down) of teeth;
  • staining of teeth;
  • tooth decay; and
  • tooth loss.

All of the above have been linked to chewing tobacco use.

Some studies have shown a link between an increased risk of cardiovascular disease (including heart attacks and stroke) in users of snuff and chewing tobacco, although these risks are not as great as those observed in smokers. Further research is needed to determine whether or not chewing tobacco use presents a significant risk of heart disease and stroke.

Is chewing tobacco safer than cigarette smoking?

Chewing tobacco has been widely marketed as a way for cigarette smokers to use tobacco in smoke-free areas, so it is safer for other people because they are not exposed to secondhand smoke. However, in 1986, a statement from the U.S. Surgeon General concluded that users of chewing tobacco should know that chewing tobacco "is not a safe substitute for smoking cigarettes." Chewing tobacco contains nicotine, which is highly addictive, as well as a number of known cancer-causing chemicals. Any form of tobacco use poses an increased risk of developing cancer, and no level is considered safe.

While the risks of getting cancer from chewing tobacco are lower than those associated with smoking cigarettes, the health risks of chewing tobacco are very real and potentially fatal. Chewing tobacco use also has not been shown to be helpful for smokers who want to quit smoking.

What is being done to reduce the use of chewing tobacco?

Parents are encouraged by health care givers, school authorities, and public health officials to include the topic of chewing tobacco use when they discuss the hazards of any tobacco use with their children, especially teen aged children. It is better never to start than try to stop the addictive tobacco (nicotine) habit in any form.

Legislation has been enacted to help reduce the number of people who use tobacco products and reduce adverse health risks associated with tobacco use. The Family Smoking Prevention and Tobacco Control Act of 2009 gives the Food and Drug Administration (FDA) the power to regulate tobacco products in the U.S., which will allow for increased regulation of marketing and advertising of tobacco products, including chewing tobacco.

In 2015, San Francisco became the first US city to ban the use of smokeless tobacco at sporting events, including AT&T Park, home of the city's Major League Baseball team, the Giants.

What treatments are available to help people quit using chewing tobacco?

Chewing tobacco is an addiction that can be overcome. As with cigarette smoking, various support systems, programs, and even prescription medications are available to help people quit using chewing tobacco. Examples of products available used to wean a person from nicotine addiction from chewing tobacco include:

Prescription medicines such as bupropion SR (Zyban and Wellbutrin SR) and varenicline tartrate (Chantix) have been effective in some patients that are trying to quit nicotine.

Medically reviewed by Avrom Simon, MD; Board Certified Preventative Medicine with Subspecialty in Occupational Medicine

REFERENCES:

American Cancer Society. Smokeless Tobacco.
<http://www.cancer.org/cancer/cancercauses/tobaccocancer/smokeless-tobacco>

American Cancer Society. Smokeless tobacco and how to quit.
<http://www.cancer.org/docroot/PED/content/PED_10_13X_Quitting_Smokeless_Tobacco.asp>

Boffeta P, Hecht S, Gray N, Gupta P, Straif K. Smokeless tobacco and Cancer. Lancet Oncol 2008 Jul;9(7):667-75.

eMedicine.com. Smokeless tobacco lesions.
< http://emedicine.medscape.com/article/1077117-overview>

Gupta R, Gurm H, Bartholomew JR. Smokeless tobacco and cardiovascular risk. Arch Intern Med 2004 Sept;164(17):1845-9.

U.S. National Cancer Institute (NCI). Smokeless tobacco and cancer, questions and answers.
<http://www.cancer.gov/cancertopics/factsheet/Tobacco/smokeless>

Last Editorial Review: 8/22/2016

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Reviewed on 8/22/2016
References
Medically reviewed by Avrom Simon, MD; Board Certified Preventative Medicine with Subspecialty in Occupational Medicine

REFERENCES:

American Cancer Society. Smokeless Tobacco.
<http://www.cancer.org/cancer/cancercauses/tobaccocancer/smokeless-tobacco>

American Cancer Society. Smokeless tobacco and how to quit.
<http://www.cancer.org/docroot/PED/content/PED_10_13X_Quitting_Smokeless_Tobacco.asp>

Boffeta P, Hecht S, Gray N, Gupta P, Straif K. Smokeless tobacco and Cancer. Lancet Oncol 2008 Jul;9(7):667-75.

eMedicine.com. Smokeless tobacco lesions.
< http://emedicine.medscape.com/article/1077117-overview>

Gupta R, Gurm H, Bartholomew JR. Smokeless tobacco and cardiovascular risk. Arch Intern Med 2004 Sept;164(17):1845-9.

U.S. National Cancer Institute (NCI). Smokeless tobacco and cancer, questions and answers.
<http://www.cancer.gov/cancertopics/factsheet/Tobacco/smokeless>

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