Snus—what should the public-health response be?

Abstract

Cigarettes account for 96% of global sales of manufactured tobacco by value, and global cigarette production continues to increase dramatically (eg, from 1686 billion cigarettes in 1950 to 5604 billion in 2002). 1 McKay J Eriksen M Shafey O The tobacco atlas. 2nd edn. American Cancer Society, Atlanta2006 Google Scholar Snus, a form of smokeless tobacco that has lower levels of many toxins than most other smokeless tobaccos, has become the dominant form of tobacco used by Swedish men, who now have an unusually low smoking rate. 2 Foulds J Ramstrom L Burke M Fagerstrom K The effect of smokeless tobacco (snus) on public health in Sweden. Tob Control. 2003; 12: 349-359 Crossref PubMed Scopus (373) Google Scholar In most developed countries about a fifth of annual deaths are caused by smoking, and about 20 times as many people have a serious smoking-caused illness each year, most of these being chronic respiratory diseases. 3 Hyland A Vena C Bauer J et al. Cigarette smoking-attributable morbidity—United States, 2000. MMWR Morb Mortal Wkly Rep. 2003; 52: 842-844 PubMed Google Scholar It is in this context that the potential public-health impact of the availability of a smokeless tobacco product that has been estimated as 90% less harmful than cigarettes 4 Levy DT Mumford EA Cummings KM et al. The relative risks of a low-nitrosamine smokeless tobacco product compared with smoking cigarettes: estimates of a panel of experts. Cancer Epidemiol Biomarkers Prev. 2004; 13: 2035-2042 PubMed Google Scholar should be carefully considered. Assessment of Swedish snus for tobacco harm reduction: an epidemiological modelling studyCurrent smokers who switch to using snus rather than continuing to smoke can realise substantial health gains. Snus could produce a net benefit to health at the population level if it is adopted in sufficient numbers by inveterate smokers. Relaxing current restrictions on the sale of snus is more likely to produce a net benefit than harm, with the size of the benefit dependent on how many inveterate smokers switch to snus. Full-Text PDF Oral use of Swedish moist snuff (snus) and risk for cancer of the mouth, lung, and pancreas in male construction workers: a retrospective cohort studyUse of Swedish snus should be added to the list of tentative risk factors for pancreatic cancer. We were unable to confirm any excess of oral or lung cancer in snus users. Full-Text PDF