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Public Health - Seattle & King County

Tobacco Prevention Program Newsletter, Spring 2010
By Molly Ryan

Snus: Safe alternative to smoking?

Over the past decade, successful tobacco control efforts have forced Big Tobacco to change how they do business. Smoking restrictions have increased and sales of cigarettes continue to decline across the U.S. Cigarette companies have had to look elsewhere for new marketing possibilities and found inspiration in a Swedish smokeless and spitless tobacco product called "Snus."

What exactly is "snus"?

Literally meaning "smokeless tobacco" in Sweden, Snus is a form of finely ground tobacco, often flavored, and sold in small tea-bag like pouches. Unlike other forms of moist snuff, Snus does not require spitting because it is placed between the upper lip and gum during use, where little saliva is produced.

Snus tobacco is manufactured using a unique process that results in significantly lower levels of toxins and carcinogens compared to other tobacco products. Because of the relatively low levels of carcinogens, Snus is considered less harmful than cigarettes and other smokeless tobacco products. However Snus is by no means harmless - users are at an increased risk for cancers of the oral cavity and larynx, oral lesions, pancreatic cancer, cardiovascular disease and nicotine addiction.

.
TSNAs (ug/g)
Free nicotine (mg/g)
Marlboro Snus
Rich
1.98
1.08
Mild
1.98
.350
Spice
2.06
1.13
Mint
3.72
.701
Camel Snus
Original
1.73
6.09
Spice
1.75
9.16
Frost
1.68
6.40
Skoal Dry
Regular
4.41
1.57
Cinnamon
6.19
.751
Menthol
3.01
1.51
The Great Debate

Since Snus first appeared in the U.S. in 2007, debate emerged about whether it should be promoted for smokers who cannot or will not quit to switch to a "less harmful" tobacco product. Supporters of this approach reference Sweden's experience as evidence of Snus as a viable tool to decrease smoking-related adverse health outcomes.

Although moist snuff has been in Sweden for hundreds of years, Snus was first introduced in the 1980s as a "tobacco-derived nicotine replacement product." It has since become an acceptable and attractive alternative to cigarettes and has been credited for Sweden's dramatic decreases in smoking rates over the past several decades. Men in Sweden experienced a 25% reduction in daily smoking rates between 1976 and 2002. The reduction is often attributed to widespread use of Snus among men - about 20% of the entire Swedish male population use Snus and 30% of male former smokers reported using Snus to quit smoking.

While the Swedish experience offers compelling evidence of a positive impact at the population level, opponents of the Snus debate argue that the experience in America will be much different. In Sweden, Snus is a highly regulated product, subject to tight controls during the manufacturing, shipping and storing processes. Manufacturers have to follow quality standards which set the maximum allowable level of certain ingredients, like tobacco-specific nitrosamines (TSNAs), considered the most dangerous carcinogens commonly found in tobacco products. Because of this regulation, consumers in Sweden know exactly how products are manufactured and what ingredients were used.

In the United States, regulations on tobacco products are not as strong. Tobacco giants, like Philip Morris (PM) and R.J. Reynolds (RJR), have vigorously fought all efforts to increase regulation on their products or require product information disclosure.

America isn't Sweden

Since PM and RJR are not required to disclose product information, laboratory analysis is necessary to determine the content of their products. Of particular interest to researchers are the levels of TSNA and nicotine (which signifies a product's addictive potential). Comparing the American products to the Swedish ones, the average amount of TSNAs are comparable, but the average level of nicotine in the American products is significantly lower than Swedish Snus. While these data may appear promising, a closer examination shows an alarming degree of variation among the American products, even within the same brand (see table 1).

The low levels of nicotine are of interest to researchers, who are trying to figure out why the levels are so low in the Marlboro and Skoal brands. One emerging theory is that the low nicotine levels (and the accompanying marketing strategies) make them more effective as a "gateway product," a way to get young people to start using the products, who eventually will graduate onto products with higher nicotine content to satisfy their addiction.

The relatively high nicotine levels in the Camel products mirror those of Swedish brands, which deliver about the same amount of nicotine as a cigarette. Researchers are equally interested in this finding because Camel heavily markets and promotes dual use of their products, encouraging smokers to use Snus when they cannot smoke. This differs from Sweden where Snus is used as a permanent replacement for cigarettes. Either way, American tobacco companies are using Snus to recruit new customers and to keep existing ones using their more harmful products.

One for the history books

Many tobacco control experts in the U.S. recognize that switching from cigarettes to Snus reduces individual risk, but they are unconvinced of the potential of great impact at the population level. This cynicism is rooted in Big Tobacco's long history of being misleading and even deceitful. Given the history of these companies and their primary profit motive, it would be naive to believe that RJR and PM are introducing these products to help people stop smoking.

The potential for snus to undermine current effective tobacco control efforts by legitimizing the tobacco industry, attracting new users, and keeping existing tobacco users from quitting must be carefully addressed before snus should be used in harm reduction.