Smokeless Tobacco (ST)
Types of Smokeless Tobacco
Oral Snuff
Snuff or ‘dip' is a finely ground, cured tobacco that can be dry, moist, and finely cut. Moist snuff is put in a crevice of the mouth between the gum and one's cheek or lip where it stays as nicotine is absorbed through the mucosal lining of the mouth.1
Chewing Tobacco
Chew (a.k.a., wad or quid) comes as loose leaf, plug, and twist tobacco. It is placed in the cheek and chewed to mix the tobacco with saliva.1
Prevalence of Smokeless Tobacco
Data from the 2005 National Health Interview Survey (NHIS) estimated that 2.3% of adults in the United States use smokeless tobacco. Among adults, men (4.5%) typically use smokeless tobacco more often than women (0.2%).2
The 1986 Surgeon General's Report stated that smokeless tobacco poses a significant health risk and is not a safe substitute for cigarettes.3 Despite warnings in the last two decades of the risks, the use of smokeless tobacco continues in the US.1
Differences between Smoked and Smokeless Tobacco
Behaviors
It can be more difficult for professionals to identify and help a smokeless tobacco user than a smoker because it can be used constantly (e.g., while working, during physical activity, etc.) and without others noticing, while smoking is obvious and often banned in work places and other public locations. While spitting smokeless tobacco juice is one act that can identify smokeless tobacco users, some users learn to swallow the juice and even keep the tobacco in their mouth while sleeping.5
Nicotine Uptake
Since nicotine is absorbed through the mucosa of the smokeless tobacco user's mouth, uptake is affected by both the pH of the tobacco product and the pH of the mouth.6 The rate of absorption and action for smokeless tobacco is thus slower than when it enters the body via the lungs when smoked. This implies that smokeless products may be less physiologically addictive than cigarettes due to the delayed affect. 5 However, some smokeless users still report an easier time quitting cigarettes than smokeless tobacco.
References
1. Severson, H. H. & Hatsukami, D. (1999). Smokeless tobacco cessation. Primary Care: Clinics in Office Practice, 26(3), 529-551.
2. Centers for Disease Control and Prevention (2006). Tobacco use among adults - United States, 2005. Morbidity & Mortality Weekly Report, 55(42), 1145-1148.
3. U.S. Department of Health and Human Services (1986). The health consequences of using smokeless tobacco. A report to the advisory committee to the Surgeon General. Bethesda, MD: U.S. Department of Health and Human Services, Public Health Service. NIH Pub. No. 86-2874. Available from: http://profiles.nlm.nih.gov/NN/B/B/F/C/. Accessed: August 2007.
4. Gartner, C. E., Hall, W. D., Vos, T., Bertram, M. Y., Wallace, A. L., & Lim, S. S. (2007) Assessment of Swedish snus for tobacco harm reduction: An epidemiological modeling study. Lancet. 369, 2010-2014.
5. Severson, H. H. (2003). What have we learned from 20 years of research on smokeless tobacco cessation? American Journal of Medical Science, 326(4), 206-211.
6. Hatsukami, D. K., & Severson, H. H. (1999). Oral spit tobacco: Addiction, prevention and treatment. Nicotine & Tobacco Research, 1, 21-44.
7. Severson, H. H., & Klein, K. J. K. (2002). Tobacco use among professional baseball players: 1998 to 2001. Tobacco Control, 14(1), 31-36.
8. Dale, L. C., Ebbert, J. O., Glover, E. D., Croghan, I. T., Schroeder, D. R., Severson, H. H., & Hurt, R. D. (2007). Buproprion SR for the treatment of smokeless tobacco use. Drug and Alcohol Dependence, 90, 56-63.
