Maryland's Tobacco Resource Center - Linking Professionals to Best Practices

Smokeless Tobacco

Smokeless Tobacco

Types of Smokeless Tobacco

Oral Snuff

Snuff or ‘dip' is a finely ground, cured tobacco that can be dry, moist, and finely cut. Moist snuff is put in a crevice of the mouth between the gum and one's cheek or lip where it stays as nicotine is absorbed through the mucosal lining of the mouth.1

  • Snuff. 9,10,11
    • Moist
      • Cured and fermented tobacco processed into fine particles and often packaged in round cans
      • Pinch or "dip" is placed between cheek or lip and gums
      • Market Share – 75.3%
    • Dry
      • Fire-cured tobacco processed into a powder
      • The powder is taken orally or inhaled through the nostrils
      • Market Share – 1.4%
    • Sachets
      • Moist snuff packaged in ready-to-use pouches that resemble small tea bags
      • It is placed between cheek or teeth and gums
      • Market Share – Data unavailable

Percentage of U.S. market for smokeless tobacco products.18

Chewing Tobacco

Chew (a.k.a., wad or quid) comes as loose leaf, plug, and twist tobacco. It is placed in the cheek and chewed to mix the tobacco with saliva.1

  • Chewing tobacco. 9,10,11
    • Loose leaf
      • Cured tobacco strips typically sweetened and packaged in foil pouches
      • Piece taken from pouch and placed between cheek and gums
      • Market Share – 22.2%
    • Plug
      • Cured tobacco leaves pressed together into a cake or "plug" form and wrapped in a tobacco leaf
        • Piece taken from pouch and placed between cheek and gums
        • Market Share – 0.6%
      • Twist (or roll)
        • Cured tobacco leaves (often flavored) twisted together to resemble rope
        • Piece cut off from twist and placed between cheek and gums
        • Market Share – 0.4%

Percentage of U.S. market for smokeless tobacco products.18

Prevalence of Smokeless Tobacco 12

  • Percentage of Adults Who Were Current Smokeless Tobacco Users in 2009
  • 3.5% of all adults (aged 18 years and older)
  • 7.0% of men
  • 0.3% of women
  • 1.0% of African Americans
  • 5.7% of American Indian/Alaska Natives*
  • 0.5% of Asian Americans
  • 1.1% of Hispanics
  • 4.5% of whites

Smokeless Tobacco and Cancer

  • Smokeless tobacco contains 28 cancer-causing agents (carcinogens).13,15
  • It can increase the risk of cancer of the oral cavity.15,17

Smokeless Tobacco and Oral Health

  • Smokeless tobacco is also strongly associated with leukoplakia—a precancerous lesion of the soft tissue in the mouth that consists of a white patch or plaque that cannot be scraped off.14
  • It is also associated with recession of the gums, gum disease, and tooth decay.14,16

Smokeless Tobacco and Reproductive Health

  • Smokeless tobacco use during pregnancy increases the risks for preeclampsia
    • Preeclampsia is a condition where high blood pressure, swelling, premature birth, and low birth weight may be apparent.15
  • It can also reduce sperm count and abnormal sperm cells in men.15

Nicotine Addiction

  • Smokeless tobacco use can lead to nicotine addiction and dependence.13,15
  • Adolescents who use smokeless tobacco are more likely to become cigarette smokers.14

The 1986 Surgeon General's Report stated that smokeless tobacco poses a significant health risk and is not a safe substitute for cigarettes.3 Despite warnings in the last two decades of the risks, the use of smokeless tobacco continues in the US.1

Differences between Smoked and Smokeless Tobacco

Behaviors
It can be more difficult for professionals to identify and help a smokeless tobacco user than a smoker because it can be used constantly (e.g., while working, during physical activity, etc.) and without others noticing. Smoking is easily observed and often banned in work places and other public locations. While spitting smokeless tobacco juice is one act that can identify smokeless tobacco users, some users learn to swallow the juice and even keep the tobacco in their mouth while sleeping.5

Nicotine Uptake
Since nicotine is absorbed through the mucosa of the smokeless tobacco user's mouth, uptake is affected by both the pH of the tobacco product and the pH of the mouth.6 The rate of absorption and action for smokeless tobacco is thus slower than when it enters the body via the lungs when smoked. This implies that smokeless products may be less physiologically addictive than cigarettes due to the delayed affect.5 However, some smokeless users still report an easier time quitting cigarettes than smokeless tobacco.

Helpful Links for Quitting Smokeless Tobacco

Smokeless Tobacco Information from the American Cancer Society (ACS)

An online resource to quit smokeless tobacco recommended by ACS - Kill The Can

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References: 

1 Severson, H. H. & Hatsukami, D. (1999). Smokeless tobacco cessation. Primary Care: Clinics in Office Practice, 26(3), 529-551.
2 Centers for Disease Control and Prevention (2006). Tobacco use among adults - United States, 2005. Morbidity & Mortality Weekly Report, 55(42), 1145-1148.
3 U.S. Department of Health and Human Services (1986). The health consequences of using smokeless tobacco. A report to the advisory committee to the Surgeon General. Bethesda, MD: U.S. Department of Health and Human Services, Public Health Service. NIH Pub. No. 86-2874. Available from: http://profiles.nlm.nih.gov/NN/B/B/F/C/. Accessed: August 2007.
4 Gartner, C. E., Hall, W. D., Vos, T., Bertram, M. Y., Wallace, A. L., & Lim, S. S. (2007) Assessment of Swedish snus for tobacco harm reduction: An epidemiological modeling study. Lancet. 369, 2010-2014.
5 Severson, H. H. (2003). What have we learned from 20 years of research on smokeless tobacco cessation? American Journal of Medical Science, 326(4), 206-211.
6 Hatsukami, D. K., & Severson, H. H. (1999). Oral spit tobacco: Addiction, prevention and treatment. Nicotine & Tobacco Research, 1, 21-44.
7 Severson, H. H., & Klein, K. J. K. (2002). Tobacco use among professional baseball players: 1998 to 2001. Tobacco Control, 14(1), 31-36.
8 Dale, L. C., Ebbert, J. O., Glover, E. D., Croghan, I. T., Schroeder, D. R., Severson, H. H., & Hurt, R. D. (2007). Buproprion SR for the treatment of smokeless tobacco use. Drug and Alcohol Dependence, 90, 56-63.

9National Cancer Institute. Smokeless Tobacco or Health: An International Perspective Exit Notification. Bethesda: U.S. Department of Health and Human Services, National Institutes of Health, National Cancer Institute, 1992.

10U.S. Department of Health and Human Services. Preventing Tobacco Use Among Young People: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 1994.

11World Health Organization. Smokeless Tobacco and Some Tobacco-Specific N-Nitrosamines Exit Notification. (PDF–3.18 MB) International Agency for Research on Cancer Monographs on the Evaluation of Carcinogenic Risks to Humans Vol. 89. Lyon (France): World Health Organization, 2007.

12Substance Abuse and Mental Health Services Administration. Results From the 2009 National Survey on Drug Use and Health: Detailed Tables Exit Notification. (PDF–94 KB). Rockville (MD): Substance Abuse and Mental Health Services Administration, Office of Applied Studies, 2010.

13National Cancer Institute. Smokeless Tobacco or Health: An International Perspective Exit Notification. Bethesda: U.S. Department of Health and Human Services, National Institutes of Health, National Cancer Institute, 1992

14U.S. Department of Health and Human Services. Preventing Tobacco Use Among Young People: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 1994

15World Health Organization. Smokeless Tobacco and Some Tobacco-Specific N-Nitrosamines Exit Notification. (PDF–3.18 MB) International Agency for Research on Cancer Monographs on the Evaluation of Carcinogenic Risks to Humans Vol. 89. Lyon (France): World Health Organization, 2007

16Campaign for Tobacco-Free Kids. Smokeless Tobacco and Kids Exit Notification. (PDF–144 KB) Washington: Campaign for Tobacco-Free Kids, 2009

17World Health Organization. Summaries and Evaluations: Tobacco Products, Smokeless (Group 1) Exit Notification. Lyon (France): World Health Organization, International Agency for Research on Cancer, 1998

18Maxwell JC. The Maxwell Report: The Smokeless Tobacco Industry in 2009. Richmond, VA: John C. Maxwell, Jr., 2010