Snus: New Form of Smokeless Tobacco Courts Controversy

A type of smokeless tobacco popular in Sweden called snus is growing in popularity in the United States. While most recognize that it is a safer alternative to cigarettes or older forms of smokeless tobacco, others are concerned that it will attract young people, becoming a steppingstone to cigarettes, says a researcher who spoke this week at the Smokeless Tobacco Summit in Austin, TX.

There is also concern that smokers may use snus in places where they can’t smoke, which will encourage them to keep smoking instead of quitting, says Lois Biener, PhD, Adjunct Professor, Department of Psychology at the University Of Massachusetts – Boston and Senior Research Fellow at the Center for Survey Research, University Of Massachusetts – Boston.

Snus (pronounced snoos) was first introduced in several U.S. test markets in 2006, and has been available nationwide since 2009. It is sold under several brands including Marlboro Snus and Camel Snus. The product is different from other types of smokeless tobacco in several important ways, Dr. Biener says. Snus is manufactured using a process that makes it lower in carcinogens called tobacco-specific nitrosamines. Snus also doesn’t stimulate saliva the way that snuff does and thus doesn’t require spitting. A person using snus puts a small pouch filled with the product between the lip and the gum.

Dr. Biener’s research has shown that the primary group of snus users in the United States is male smokers. “There is very little trial of the product among females and virtually no trial of it among nonsmokers,” she says.

Because snus comes in sweet and fruity flavors, public health officials are concerned that it is catching on with teens. The 2010 Monitoring the Future survey found that the use of smokeless tobacco (including snus) has started to increase significantly after years of declines. The survey found that 13 percent of 10th grade boys and 15.7 percent of 12th grade boys reported using smokeless tobacco in the previous 30 days.

Mixed Findings on Health Effects

Snus has been long been used in Sweden, where its health effects have been studied. “In Sweden, where cigarette smoking among men is low and snus use is high, we see lower levels of lung cancer among men compared with the rest of Europe and the United States,” Dr. Biener said.

One study of the health effects of snus, published in The Lancet in 2007, studied 125,000 Swedish male construction workers who had never smoked, and followed them for 12 to 26 years. The study found that snus use was associated with a slight increased risk of pancreatic cancer, but was not associated with any increased risk of oral cancer or lung cancer; cigarette smoking was significantly associated with all three.

Another study in the same issue of the journal found there was little difference in life expectancy between smokers who quit all tobacco and those who switched to snus. The researchers of that study concluded that snus could produce a net benefit to health if used by hard-core smokers. That study bolstered the argument that switching smokers to snus could reduce the harm caused by cigarettes.

Dr. Biener is conducting interviews with a representative sample of adults in Dallas/Fort Worth and Indianapolis, two early test markets for the product. There is currently no solid data on what proportion of the individuals who try Snus go on to use it regularly, and Dr. Biener hopes to answer this question. She also wants to find out whether regular snus users change their smoking patterns.

Dr. Biener and her colleagues are also looking at the level of nicotine in various snus products. “It’s likely that snus and cigarettes have comparable levels of nicotine and are comparably addictive, although the mode of delivery of the nicotine is different,” she said.

Another concern of snus critics is that using the product along with cigarettes might lead to higher levels of nicotine addiction and make it harder for people to quit smoking, a theory that she says has yet to be studied.

“People have a right to accurate information about these products,” Dr. Biener said. “It’s important that health agencies are upfront about the different level of risk and harm in different tobacco products, so that people don’t end up thinking, ‘One is just as bad as another so I might as well continue to smoke.’ Until there is more information on how people are using snus and what the impact is on their smoking, we can’t make a recommendation about its use.”