Smokeless Tobacco and Smoking Cessation

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Surgeon General and National Cancer Institute positions

In 1986, the US Surgeon General concluded that the use of smokeless tobacco "is not a safe substitute for smoking cigarettes. It can cause cancer and a number of noncancerous conditions and can lead to nicotine addiction and dependence." Since 1991, the National Cancer Institute has officially recommended that the public avoid and discontinue the use of all tobacco products, including smokeless tobacco. The National Cancer Institute also recognizes that nitrosamines, a group of organic compounds found in tobacco products, are not safe at any level. The accumulated scientific evidence does not support changing this position (NCI 2003).

Common misconceptions

Many people think that smokeless tobacco is less addictive than smoking cigarettes. This is not true. Self-assessments by cigarette smokers and smokeless tobacco users have shown no differences in terms of addiction, craving, difficulty quitting, and withdrawal symptoms (Holm et al. 1992). Most smokeless tobacco users describe themselves as being addicted to some extent and feeling cravings when not using (Edwards 1987; Morse et al. 1977).

Many people are not aware of the adverse health effects associated with smokeless tobacco (USDHHS 2003). It is true that lung cancer is not a problem as it is with cigarette smoking and that the risk of cardiovascular disease is less than for cigarettes (Asplund 2003). But smokeless tobacco use has been linked to oral health problems, especially gingival recession, and an increased risk of oral cancer, cardiovascular disease, and perinatal problems (Critchley and Unal 2003). The amount of harm from smokeless tobacco use varies greatly with the product and amount used. Once addicted, users tend to graduate toward more harm through greater use and more harmful products (Hatsukami and Severson 1999).

Healthier ways to quit smoking

Several non-tobacco methods have been shown to be effective for quitting cigarettes, such as nicotine replacement therapy, varenicline, and bupropion SR, individual and group counseling, and telephone quitlines (NCI 2003). Nicotine replacement products have not yet been proven to help smokeless tobacco users quit -- larger studies are needed to prove effectiveness -- but they may help reduce cravings. These products are best used in combination with other help, such as group sessions or counseling (ACS 2005).

View ReferencesHide References
Asplund K. Smokeless tobacco and cardiovascular disease. Progress in Cardiovascular Diseases. 2003; 45(5): 383-394.
Critchley JA, Unal B. Health effects associated with smokeless tobacco: a systematic review. Thorax. 2003; 58(5): 435-443.
Edwards JG. An unusual case of nicotine dependence. Psychol Med. 1987; 17(3): 779-781.
Holm H, Jarvis MJ, Russell MA, Feyerabend C. Nicotine intake and dependence in Swedish snuff takers. Psychopharmacology. 1992; 108(4): 507-511.
Morse RM, Norvich RC, Graf JA. Tobacco chewing, an unusual case of drug dependence. Mayo Clin Proc. 1977; 52(6): 358-360.
National Cancer Institute. Smokeless tobacco and cancer: question and answers. 2003. Available at: Accessed on: 2010-06-15.