Consumption Of Snuff Research Articles

Smoking and non-smoking tobacco as risk factors in subarachnoid haemorrhage

Swedish snuff is a particular form of non-smoking tobacco with high nicotine content. It is unknown whether this form of tobacco is a risk factor similar to smoking for suffering subarachnoid haemorrhage (SAH). In the present study we report our finding concerning smoking and snuff as risk factors for the disease. We analysed 120 consecutive patients with SAH regarding consumption of tobacco, in order to evaluate if snuff also is associated with an increased risk of SAH. The relative risk of SAH was about 2.5 times higher for smokers compared with the background population. Consumption of snuff was not associated with an increased risk. It seems unlikely that nicotine is solely responsible for the rupture of cerebral aneurysms. The final cause of the increased risk for suffering SAH has to be sought in other factors associated with tobacco smoking.

Re: “Smokeless tobacco use and risk of cancer of the pancreas and other organs” by Boffettaet al.

The study presented recently in the Journal of Cancer by Boffetta et al.1 suffers from several weaknesses that make the conclusions highly questionable. Their conclusion that “…smokeless tobacco products may be carcinogenic on the pancreas” is, somewhat surprisingly, based on the finding that users of smokeless tobacco had an increase of the relative risk of pancreatic cancer that “…was restricted to current tobacco smokers.” This calls for a careful assessment of the possible confounding of tobacco smoking, something that requires a good set of exposure data both at baseline and follow-up. Baseline data are weak by neglecting to identify the different kinds of smokeless tobaccos (skrå, Norwegian snuff, Swedish snuff) with different characteristics that were in use in Norway at that time. Even more seriously, follow-up data are totally absent. Commenting on this, Boffetta et al.1 speak about “…the decrease in the prevalence and use of snus among Norwegian men during the study period.” This is highly misleading, because the full picture shows a downward trend till 1983 only, and after that year, a substantial increase. According to the official Norwegian statistics the per capita consumption of snuff at the end of the study period, 2001, was 41% higher than that in 1983. During the study period there have also been quite substantial changes of the smoking habits of Norwegian men. The annual smoking surveys by Statistics Norway, commissioned by the Directorate for Health and Social Affairs, report that the prevalence of daily smoking among Norwegian men has decreased from above 50% in 1973 to 30% in 2001. The picture is further complicated by the probability that, in addition to the changes during the study period in smoking and snus use per se, there has been an interaction between smoking and snuff use. Many of those who have quit smoking may have done so using snus as a cessation aid, so as has been the case in Sweden. Another development during the study period is the switch from Norwegian snuff to Swedish snuff, the only one of these products that has been recognized as a low-Nitrosamine product. At the beginning of the study period the market share of Swedish snuff was small, but has thereafter been rapidly increasing to reach a dominating position.2 The total absence of analysis of all these developments during follow-up is a very serious weakness of the study. Beside their core subject area Boffetta et al.1 also discuss whether the use of products like low-Nitrosamine snuff should be encouraged as an alternative to tobacco smoking. Although their own findings confirm that snuff entails no risk for a number of cancers and less risk than smoking for pancreatic cancer, they try to deny that tobacco-attributed mortality would be lower if people were using snuff instead of smoking. The absurdity of this “conclusion” of theirs is well illustrated by the recent study by Levi et al.3 They report an international expert consensus that snuff users' excess mortality above the level of non-tobacco-users is <10% of smokers' excess mortality. This is well consistent with assessments by prestigious and authoritative bodies like the Royal College of Physicians of London, that in its Response to Commissioner Byrne's Reflection Process for a New EU Health Strategy, makes the following statement (under the headline “Encourage the use of safer sources of nicotine”): “Medicinal nicotine products are safe and should be strongly encouraged as an alternative regular source of nicotine. Some smokeless tobacco products (such as snus, which is widely used in Sweden) can also provide nicotine in a formulation that is a proven acceptable alternative to cigarettes for many smokers, and although more harmful than medicinal nicotine is much less harmful than cigarettes.” The divergent position expressed by Boffetta et al.1 further illustrates the weakness of their article. Yours sincerely, Lars RamstrÖm.

Short report. Smokers and non-smokers: differences in alcohol consumption and intake of other health-related substances in Norway. A general population study

Background: This study addresses the problem of clustering of risky habits, i.e. the drinking and substance use habits of smokers and non-smokers. Methods: A sample survey of the general non-hospitalized, Norwegian population (>15 years), excluding abstainers from alcohol was used. We investigated differences in yearly consumption of beer, wine, liquor and total alcohol consumption and intake of sedatives, snuff, coffee and tea for a sample of daily smokers (n=763) and non-smokers (n=938) (mean age 38.7 years and SD 16.2 years). Results: Compared to non-smokers, male daily smokers drank significantly more beer, wine and liquor than non-smokers and used snuff more frequently than non-smokers. Female daily smokers drank more beer than non-smokers, but there were no significant differences for wine and liquor. For both genders, the total yearly intake of alcohol was approximately twice as high for daily smokers compared to non-smokers. Daily smokers also used marihuana more frequently and they drank significantly more coffee but less tea than non-smokers. There were no significant differences in use of sedatives. Conclusion: Increased drinking and several risky health habits are linked to daily smoking. Smoking cessation should be tried out as a preventive strategy for alcohol consumption as well.

The Swedish Snus and the Sudanese Toombak: are they different?

In Sweden, snuff (locally known as snus), was introduced since the year 1637. Presently, Sweden has the highest per capita consumption and sale figures of snuff in the world, and the habit is becoming increasingly popular. Snus is manufactured into a dry form used in the nasal cavity and a moist form used in the oral cavity. Snus manufactured for oral use is a moist ground tobacco of Dark Kentucky or Virginia species mixed with an aqueous solution of water and other blending ingredients. This form of snuff is found in two types: (1) loose and (2) portion-bag-packed. These are the most widely used. The loose moist form (1-2 g a quid) is the most popular type consumed by 73% of the males, followed by the portion-bag-packed form (0.5-1 g a quid), consumed by 13% of the males, while 14% of the males are mixed users. The majority of snus users place the quid in the vestibular area of the upper lip, and the prevalence among persons 15 years of age or older in 15.9% among males and 0.2% among females. The pH of snus has declined from a previous range of 8-9 to a range of 7.8-8.5, moisture content ranges 35-60% and nicotine content is in the order of 5-11 mg/g dry wt tobacco-specific N-nitrosamines (TSNAs) in micrograms (N'-nitrosonornicotine: NNN 5-9; 4-(methyl-nitrosamino)-1-(3-pyridyl)-1-butanone: NNK 1-2; N'-nitrosoanatabine: NAT 2-5). In the Sudan, snuff, locally known as toombak, was introduced approximately 400 years ago. It is always processed into a loose moist form, and its use is widespread in the country. Tobacco used for manufacture of toombak is of the species Nicotiana rustica, and the fermented ground powder is mixed with an aqueous solution of sodium bicarbonate. The resultant product is moist, with a strong aroma, highly addictive and its use is widespread particularly among males. Its pH range is 8-11, moisture content ranges 6-60% and nicotine content is from 8 to 102 mg/g dry wt, and TSNAs contents in micrograms (NNN 420-1 550; NNK 620-7 870; NAT 20-290). Snus and toombak dippers develop a clinically and histologically characteristic lesion at the site of dipping. Probably due to control of the TSNAs in snus, this type of snuff is associated with a lower risk of cancer of the oral cavity (relative risk: RR 5-6-fold), whereas the risk for cancer of the oral cavity among toombak users was high (RR 7.3-73.0-fold). In conclusion, the two snuff products significantly differ in many aspects. Most notable differences are tobacco species, fermentation and ageing, nicotine and TSNAs content, pH, expression of the p53 tumour suppressor gene, and keratin types 13, 14, and 19. It was, therefore, the object of the present study to highlight the oral health hazards of toombak, and to compare it with snus regarding the aforementioned differences.

The need for regulation of carcinogenic Nnitrosamines in oral snuff

Oral snuff is carcinogenic to humans and laboratory animals. The major carcinogenic agents in snuff are the N-nitrosamines, especially the tobacco-specific N-nitrosamines. During the past decade, a gradual reduction of the levels of carcinogenic N-nitrosamines was observed in the leading snuff brands in the USA and in Sweden. However, in 1990 a newly introduced snuff brand in the USA contained the highest concentration of carcinogenic N-nitrosamines ever to be determined in a commercial tobacco product. The elevated pH and relatively high levels of nitrite in this snuff favoured the formation of N-nitrosamines, 2 yr after the product first appeared, it was replaced by a new preparation of snuff under the same brand name, and, according to chemical analyses, this material would be expected to have about the same carcinogenic potential as the leading snuff products. The interdependence of the formulation and manner of preparation of snuff products with their carcinogenic potential emphasizes the need for regulation and control of the harmful substances in smokeless tobacco, especially in view of the trend of increasing consumption of snuff.

Use of Smokeless Tobacco Among Adults— United States, 1991

Consumption of moist snuff and other smokeless tobacco products in the United States almost tripled from 1972 through 1991 (1). Long-term use of smokeless tobacco is associated with nicotine addiction and increased risk of oral cancer (2)--the incidence of which could increase if young persons who currently use smokeless tobacco continue to use these products frequently (1). To monitor trends in the prevalence of use of smokeless tobacco products, CDC's 1991 National Health Interview Survey-Health Promotion and Disease Prevention supplement (NHIS-HPDP) collected information on snuff and chewing tobacco use and smoking from a representative sample of the U.S. civilian, noninstitutionalized population aged > or = 18 years. This report summarizes findings from this survey.

Moist snuff in Sweden—tradition and evolution

Snuff-dipping was already widespread in Sweden in the 19th century. After the 1920s snuff sales went down, but Sweden still kept its position as world leader in per capita consumption of moist snuff. Following a major advertising campaign snuff consumption began rising again in the late 1960s. The Swedish Tobacco Company claims that Swedish snuff is a 'less harmful' alternative to cigarettes. Swedish epidemiological studies indicate that there is a cancer risk from snuff-dipping, but it is low compared with smoking. Accordingly, the STC claims to "do a good job replacing cigarettes with snuff". However, an analysis of the trends in tobacco usage patterns in Sweden during the last few decades does not support this claim. The marketing of moist snuff has not primarily attracted older smokers who would seek help in order to stop smoking, but young people. The use of snuff is no prerequisite and no guarantee for a decrease of smoking. On the contrary, taking up snuff must be seen as an introduction to the tobacco habit and possibly a first step towards taking up cigarettes.