Chewing Tobacco (Smokeless Tobacco, Snuff)

Chewing tobacco contains nicotine and many known cancer-causing substances.

Chewing tobacco is sometimes known as smokeless 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 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 believe 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 several 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, smokeless cigarettes still provide addictive nicotine to the user and secondhand nicotine to others.

Several significant health risks are associated with the use of 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 following:

• Cheek
• Gums
• Lips
• Tongue
• Floor and roof of the mouth

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

• Pancreatic cancer
• Esophageal cancer
• Stomach cancer

Those who use chewing tobacco have an increased risk of the following:

• 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
• 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.

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 several 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 is not helpful for smokers who want to quit smoking.

Parents are encouraged by healthcare professionals, school authorities, and public health officials to include the topic of chewing tobacco use when they discuss the hazards of tobacco use with their children, especially teenage 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 the marketing and advertising of tobacco products, including chewing tobacco.

In 2015, San Francisco became the first U.S. 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.

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:

• Nicotine gum (Nicorette)
• Nicotine patches (Habitrol, Nicoderm CQ, Nicotrol)
• Lozenges

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