Scientific Opinion: STP

Gartner CD, Hall WD, Chapman S, Freeman B. Should the Health Community Promote Smokeless Tobacco (Snus) as a Harm Reduction Measure? PLoS Med. 2007 July; 4(7): e185.

"Background to the debate: The tobacco control community is divided on whether or not to inform the public that using oral, smokeless tobacco (Swedish snus) is less hazardous to health than smoking tobacco. Proponents of "harm reduction??? point to the Swedish experience. Snus seems to be widely used as an alternative to cigarettes in Sweden, say these proponents, contributing to the low overall prevalence of smoking and smoking-related disease. Harm reduction proponents thus argue that the health community should actively inform inveterate cigarette smokers of the benefits of switching to snus. However, critics of harm reduction say that snus has its own risks, that no form of tobacco should ever be promoted, and that Sweden's experience is likely to be specific to that culture and not transferable to other settings. Critics also remain deeply suspicious that the tobacco industry will use snus marketing as a "gateway??? to promote cigarettes. In the interests of promoting debate, the authors (who are collaborators on a research project on the future of tobacco control) have agreed to outline the strongest arguments for and against promoting Swedish snus as a form of harm reduction."

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1904463/

Rodu B & Phillips CV, Switching to smokeless tobacco as a smoking cessation method: evidence from the 2000 National Health Interview Survey. Harm Reduct Journal. 2008 May 23;5:18

"RESULTS: An estimated 359,000 men switched to smokeless tobacco in their most recent quit attempt. This method had the highest proportion of successes among those attempting it (73%), representing 261,000 successful quitters (switchers)."

http://www.harmreductionjournal.com

Gartner CE, et al., Assessment of Swedish snus for tobacco harm reduction: an epidemiological modeling study. Lancet. 2007 Jun 16;369(9578):2010-4

"Current 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."

http://espace.library.uq.edu.au/eserv/UQ:13766/gartner_lancetpreprint.pdf


Carl V Phillips, Constance Wang and Brian Guenzel, You might as well smoke; the misleading and harmful public message about smokeless tobacco 
BMC Public Health 2005, 5:31: ST users are told, in effect, that they might as well switch to smoking if they like it a bit more. Smokers and policy makers are told there is no potential for harm reduction. These messages are clearly false and likely harmful, representing violations of ethical standards.


Lund, K.E., et al. The use of snus for quitting smoking compared with medicinal products. Nicotine Tobacco Research, 2010 August; 12(8): 817-822.

"The study has shown that snus is the preferred method for quitting smoking for men in the age group 20-50 years. In addition, those using snus were more likely to have quit smoking completely or considerably reduced their cigarette smoking than users of medicinal smoking cessation products. This is the case despite the fact that users of medicinal nicotine products had a greater tendency to use additional methods for quitting smoking, which would normally increase the probability of a positive result. With regard to snus, its effect on quitting smoking is not advertised and is unknown to the public. The OR of reporting total abstinence at the time of the survey, when controlling for the other factors, was significantly higher for use of snus only than for use of one of any of the other methods for quitting."

http://www.ncbi.nlm.nih.gov/sites/ppmc/articles/PMC2910876/ 

Accortt, N.A., et al. Chronic Disease Mortality in a Cohort of Smokeless Tobacco Users. American Journal of  Epidemiology 2002; 156:730-737

"The purpose of this study was to characterize the relation between smokeless tobacco use and the risk of all-cause and disease-specific mortality. The mortality experience of smokeless tobacco users was not significantly greater than that of non-tobacco users and was appreciably less than that of cigarette smokers. Furthermore, combined use of smokeless tobacco and cigarettes did not increase overall mortality beyond that expected from use of the individual products."
 
http://aje.oxfordjournals.org/cgi/content/short/156/8/730

Gartner CE, et al., Assessment of Swedish snus for tobacco harm reduction: an epidemiological modeling study. Lancet. 2007 Jun 16;369(9578):2010-4

"Current 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."

http://espace.library.uq.edu.au/eserv/UQ:13766/gartner_lancetpreprint.pdf

Ramstrom, L.M. & Foulds J. Role of snus in initiation and cessation of tobacco smoking in Sweden. Tobacco Control. 2006 June; 15(3): 210-214. doi: 10.1136/tc.2005.014969.

"Among men who used snus as a single aid, 66% succeeded in quitting completely, as compared with 47% of those using nicotine gum (OR 2.2, 95% CI 1.3 to 3.7) or 32% for those using the nicotine patch (OR 4.2, 95% CI 2.1 to 8.6). Women using snus as an aid were also significantly more likely to quit smoking successfully than those using nicotine patches or gum.  Conclusion: Use of snus in Sweden is associated with a reduced risk of becoming a daily smoker and an increased likelihood of stopping smoking."

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2564662/