Health Effects of Swedish Snus

A large body of public health researchers has concluded that Swedish snus, while addictive, is a less risky product than cigarettes and that individuals who substitute cigarette smoking with use of Swedish snus can significantly reduce their risks of tobacco-related diseases. We agree with them. Substantial epidemiological data, in particular data from Sweden, support their views.  

It is important for tobacco users to clearly understand that Swedish snus, while significantly less hazardous than cigarette smoking, is addictive and can cause harmful health effects. Further, any reduction in health risks may be diminished or lost if an individual smokes cigarettes in addition to using Swedish snus.

This is what some scientific and public health authorities have said about snus: 

  • "Among the smokeless tobacco products on the market, products with low levels of nitrosamines, such as Swedish snus, are considerably less hazardous than cigarettes….”  WHO Study Group on Tobacco Product Regulation (2008) [1]
  • “It is undeniable that for an individual substitution of tobacco smoking by the use of moist snuff [snus] would decrease the incidence of tobacco related diseases.” EU Commission, SCENIHR (2008) [2]
  • “Snus is an example of a reduced harm product that is widely recognised to have contributed to reductions in tobacco-attributable mortality and oral cancer incidence rates in Sweden, and thus to reduce the net harm to health from tobacco use.” (Le Houezec, McNeill, Britton, 2011) [3]
  • “Snus is the least harmful of the smokeless tobacco products because of how it is produced and stored, and ‘everyone who has studied this agrees there is a 95%–99% reduction in the health risk of snus, compared to use of cigarettes,’ said Kenneth Warner, Ph.D., dean of the School of Public Health at the University of Michigan in Ann Arbor.” (Twombly, 2010) [4]
  • “In recent years a growing number of studies and systematic reviews have concluded that use of snus is substantially less hazardous than cigarette smoking...the magnitude of the overall reduction in hazard is difficult to estimate, but it is at least 30% for pancreatic cancer, at least 50% and probably more for oral and other gastrointestinal cancer, and possibly 100% for lung cancer and chronic obstructive pulmonary disease. A study using a modified Delphi approach (judgment by a panel of experts) to estimate the relative hazard concluded that snus was likely to be at least 90% less harmful than smoking.” (Sheffels, Lund, McNeill, 2012) [5]
  • “Proof of concept for harm reduction arises from the availability in Sweden of an oral smokeless tobacco product, known as ‘snus’, that is prohibited elsewhere in the European Union. In Sweden, large numbers of smokers have switched from smoking to using snus, and in combination with a substantial cohort of tobacco users that initiated snus use and have never become regular smokers this means that while around one-third of Swedish men use tobacco, only about 12% are daily smokers. As a result, Sweden has the lowest smoking prevalence, and lowest male lung cancer incidence in Europe. Snus has been proven a viable harm-reduction product because it delivers high doses of nicotine and is as freely available as cigarettes, but also less expensive, as well as being generally socially acceptable. Snus is not a safe product, but its health risks are minimal compared with those of regular smoking.” (Royal College of Physicians, March 2012) [6]

Nevertheless, some organizations and individuals in the public health community contend that smokeless tobacco harms public health because it contains toxins, can create and/or sustain addiction to nicotine and can lead to increased cigarette smoking. Some of their views are presented below: 

  • Despite its specific findings on snus, SCENHIR stated, “STP [smokeless tobacco products] are addictive and their use is hazardous to health. Evidence on the effectiveness of STP as a smoking cessation aid is insufficient, and relative trends in progression from STP into and from smoking differ between countries. It is thus not possible to extrapolate the patterns of tobacco use from one country where oral tobacco is available to other countries.” EU Commission, SCENIHR (2008)
  • “There is sufficient evidence in humans for the carcinogenicity of smokeless tobacco.” (WHO, International Agency for Research on Cancer, 2012) [7]  

Some in the public health community have also expressed concern about the potential for snus becoming a “gateway” product to cigarettes. But, as many public health advocates have noted, the data do not show that this has happened.

  • “The Swedish data, with its prospective and long-term follow-up do not lend much support to the theory that smokeless tobacco (i.e. Swedish snus) is a gateway to future smoking." EU Commission, SCENIHR (2008) [2]
  • “There is little empirical data from Scandinavia to support the hypothesis that snus increases the risk of starting to smoke. There is some empirical data to support the hypothesis that snus reduces the risk of starting to smoke.” (Lund, 2009)  [8]
  • “[W]e found no evidence for an increased risk of smoking among the SLT [smokeless tobacco] users.
     “Researchers have argued convincingly that even if SLT use can lead to cigarette smoking, it would affect only a minority of SLT users…
    “[M]ost users of SLT in the United States either never initiated smoking or initiated smoking prior to their use of SLT.
    “[R]esults (…) do suggest that SLT use in adolescence does not increase an individual’s likelihood of becoming a daily smoker.”
    (Timberlake, Huh, Lakon, 2009) [9]

For more detailed information from public health authorities on smokeless tobacco, cigarette smoking and disease, please refer to the links on the right of this page.

[1]  WHO, 2008. The scientific basis of tobacco product regulation: second report of a WHO study group. (WHO technical report series; no. 951).

[2] European Commission, 2008. Scientific Committee on Emerging and Newly Identified Health Risks (SCENIHR). Health Effects of Smokeless Tobacco Products.

[3] Le Houezec, Jacques, McNeill, Ann, Britton, John., Tobacco, nicotine and harm reduction, Drug and Alcohol Review, Volume 30, Issue 2, March 2011.

[4] Snus Use in the U.S.: Reducing Harm or Creating It? by Renee Twombly, Journal of the National Cancer Institute, Sept 24 2010.

[5] Scheffels, Janne, Lund, Karl E., McNeill, Ann, Contrasting snus and NRT as methods to quit smoking. An observational study, Harm Reduction Journal, February 2012.

[6] Reducing harm from nicotine use by Ann McNeill, Royal College of Physicians. Fifty years since Smoking and health. Progress, lessons and priorities for a smoke-free UK. Papers from a conference held in March 2012 to mark 50 years since the publication of the RCP report Smoking and health. March 2012

[7] IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, Volume  100E: A Review of Human Carcinogens: Personal Habits and Indoor Combustions, WHO, International Agency for Research on Cancer, 2012.

[8] Lund, Karl Erik, A tobacco-free society or tobacco harm reduction? Which objective is best for the remaining smokers in Scandinavia?,  Norwegian Institute for Alcohol and Drug Research, SIRUS report no. 6/2009.

[9] Timberlake, David S., Huh, Jimi, Lakon, Cynthia E., Use of propensity score matching in evaluating smokeless tobacco as a gateway to smoking, Nicotine & Tobacco Research, April 2009.

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