Abstract
Smokeless tobacco products include chewing tobacco, oral tobacco and snuff for inhalation. These products are consumed without burning the tobacco. Smokeless tobacco products contain tobacco specific nitrosamines and several other carcinogenic substances and additives. Epidemiologic studies from North America, Europe, Asia and Africa provide sufficient evidence that smokeless tobacco causes oral cancer and cancer of the pancreas. The evidence for an association of smokeless tobacco with cardiovascular disease and diabetes is limited. Furthermore, there is some evidence for adverse pregnancy outcomes in pregnant women who use smokeless tobacco. The health consequences of smokeless tobacco products are discussed critically against the background of the international debate about a proposed strategy of harm reduction, which involves offering smokeless tobacco as a smoking cessation aid.
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