Research articleSnuff use and smoking in U.S. men: Implications for harm reduction1
Introduction
Oral use of snuff is capable of delivering rapid, high dosages of nicotine1, 2 and can result in levels of nicotine dependence comparable to those seen in smokers.3 There is substantial evidence that manufacturers of snuff can and do manipulate the nicotine-dosing characteristics of their products to create low nicotine dosage “starter” products, which are targeted toward novice users, and a range of medium- and high-dosage products, which are targeted toward more experienced users as they progress in their levels of nicotine tolerance and dependence.4, 5, 6, 7, 8
Several expert panels have concluded that oral use of snuff can cause cancer in humans.9, 10, 11 This conclusion recently has been questioned, at least concerning Swedish brands of moist snuff, or “snus.”12 Other researchers acknowledge that snuff is a risk factor for cancers of the oral cavity and pharynx, but claim that switching from smoking to use of snuff would save thousands of lives because of a reduction in risk for other smoking-associated diseases.13, 14 On that basis, the use of snuff has been advocated as a method for quitting smoking in both professional and lay publications,13, 15 although the only evidence supporting the efficacy of snuff use as a method for quitting smoking comes from one uncontrolled pilot study16 whose methodology and approach have been criticized.17, 18, 19, 20 Some researchers have attributed the decline in cigarette smoking among Swedish men from 36% in 1980 to17% in 1998 to a switch to use of snus,21, 22 and there have been recent calls for a lifting of the ban on sales of oral snuff products in European Union (EU) countries (Sweden was exempt when it joined EU in 1995).12 However, there is little evidence supporting the role of snus in reducing smoking among men in Sweden: the prevalence of smoking among Swedish women also has been declining in recent years without any appreciable use of snus by women, snus use by men increased by less than two percentage points between 1980 and 1998, and Sweden has experienced a broad range of tobacco-control efforts during that time period.23, 24 U.S. Smokeless Tobacco Company (USST), the nation’s leading manufacturer of smokeless tobacco products, clearly has been marketing some of its products as supplements to smoking, particularly in response to smoke-free policies. USST recently petitioned the U.S. Federal Trade Commission for permission to make explicit claims that its products are less hazardous than cigarettes. Despite the theoretical benefits of getting smokers who are unable to quit to switch to less harmful forms of tobacco use, the feasibility of such a “harm-reduction” approach to tobacco control is unknown.25
The widespread availability of moist snuff products, the increased prevalence of clean indoor air policies in the United States,26 marketing of snuff products to smokers, and advocacy by some health professionals of switching to the use of snuff raises two opposing questions of public health relevance:
- •
Can snuff help smokers to quit smoking?
- •
Does partial substitution of smoking with snuff reduce smokers’ success in quitting?
The purpose of this study was to examine the patterns of snuff use in relation to current smoking, former smoking, and quit attempts in a representative sample of U.S. men.
Section snippets
Subjects
Data for this study were drawn from the 1998 National Health Interview Survey (NHIS), a multipurpose health survey conducted by the National Center for Health Statistics (NCHS), Centers for Disease Control and Prevention (CDC). The NHIS is representative of the civilian, noninstitutionalized, household population of the United States, and has been conducted continuously since 1957. Data were collected through personal household interviews. Adult participants in the 1998 NHIS were asked about
Prevalence of tobacco use
In 1998, 26.4% of U.S. males aged ≥18 years were current smokers and 3.6% were current snuff users (Table 1). Snuff use was more prevalent among males aged 18 to 44 years than among those in older age groups and was more prevalent among non-Hispanic white males than among Hispanics or non-Hispanic blacks. Smoking was more prevalent among males with a high school education (33.2%) or less (35.4%) than among those with more than a high school education (19.5%). In contrast, snuff use did not
Discussion
Daily snuff users were significantly more likely than men who never used snuff to have quit smoking. This pattern suggests that snuff may serve as an alternative form of nicotine dosing for smokers who will not or cannot overcome their nicotine dependence, and perhaps can help smokers to quit. However, 2.5 times as many men in the United States followed the opposite pattern, and were former snuff users who were current smokers at the time of the interview.
This study provides further evidence
References (50)
A qualitative and quantitative risk assessment of snuff dipping
Regul Toxicol Pharmacol
(1998)An alternative approach to smoking control
Am J Med Sci
(1994)- et al.
A pilot study of smokeless tobacco in smoking cessation
Am J Med
(1998) - et al.
Evidence that smokeless tobacco use is a gateway for smoking initiation in young adult males
Prev Med
(2001) - et al.
Smokeless tobacco use among male adolescentspatterns, correlates, predictors, and the use of other drugs
Prev Med
(1987) - et al.
Prevalence and correlates of smokeless tobacco use in a sample of Connecticut students
J Adolesc Health
(2000) - et al.
Chewing tobacco use by adolescentsprevalence and relation to cigarette smoking
Addict Behav
(1984) - et al.
Smokeless tobacco use among ninth graders in a north-central metropolitan populationcross-sectional and prospective associations with age, gender, race, family structure, and other drug use
Prev Med
(1988) - et al.
Typology and correlates of smokeless tobacco use
J Adolesc Health Care
(1989) - et al.
Dual tobacco use among Native American adults in southeastern North Carolina
Prev Med
(2001)
Nicotine absorption and cardiovascular effects with smokeless tobacco usecomparison with cigarettes and nicotine gum
Clin Pharmacol Ther
Pharmacokinetics and pharmacodynamics of moist snuff in humans
Tob Control
Oral spit tobaccoaddiction, prevention and treatment
Nicotine Tob Res
The marketing of nicotine addiction by one oral snuff manufacturer
Tob Control
Smokeless tobacco brand preference and brand switching and U.S. adolescents and young adults
Tob Control
Estimation of available nicotine content of six smokeless tobacco products
Tob Control
Nicotine in cigarettes and smokeless tobacco is a drug and these products are nicotine delivery devices under the Federal Food, Drug, and Cosmetic Actjurisdictional determination
Fed Regist
Review of the evidence that pH is a determinant of nicotine dosage from oral use of smokeless tobacco
Tob Control
Tobacco habits other than smoking; betel-quid and areca-nut chewing; some related nitrosamines
Health implications of smokeless tobacco use
NIH Consensus Statement
The health consequences of using smokeless tobaccoa report of the advisory committee to the Surgeon General
Tobacco-related mortality
Nature
For smokers onlyhow smokeless tobacco can save your life
Can smokeless tobacco rid us of tobacco smoke?
Am J Med
Treating cigarette smoking with smokeless tobaccoa flawed recommendation
Am J Med
Cited by (0)
- 1
Information for the full text of this article is available via AJPM Online at www.ajpm-online.net.