In Sweden, as snus use has increased, cigarette consumption has fallen
The research, development and test marketing of smokeless tobacco products, including Swedish-style snus, have been important parts of our approach to tobacco harm reduction.
Smokeless does not mean harmless and the best way to avoid the risks associated with consuming tobacco is not to consume it at all. However, there are indications that the use of smokeless products such as snus has had a positive effect on lessening the impact of smoking on public health.
Using smokeless snus is acknowledged by several independent health experts to be at least 90 per cent less harmful than smoking cigarettes.
We currently sell snus in Sweden and Norway. In other countries, such as Australia or European Union (EU) member states (Sweden obtained an exemption from the ban when it joined the EU in 1995). We have test marketed snus in other markets however the low level of awareness of this category of product among consumers proved to be an issue. The regulatory environment in those markets did not allow the communication of the relative risks of snus compared to cigarettes to adult smokers.
We believe that smokeless tobacco products could still play an important role in a harm reduction approach. So we are looking at developing other innovative low-toxicant smokeless tobacco products that we hope will appeal to tobacco consumers and be approved by regulators.
What is snus?
Snus is not smoked. It is finely-ground moist tobacco that comes either loose or in tiny pouches – a bit like tiny tea-bags – that are placed under the upper lip and held in the mouth for about an hour before being discarded. The snus we are selling is the pouch-type. Snus has a long history in Sweden and amongst Swedish men is now more popular than smoking.
Sweden has the highest consumption of smokeless tobacco per capita in the world and it has been found there that as snus use has increased, cigarette consumption has fallen. More than 25 per cent of men in Sweden use snus regularly, while fewer than 15 per cent smoke. Long-term studies have shown that Swedish men now have among the lowest lung cancer rates in the world and Sweden's mouth cancer rate is amongst the lowest in Europe.
In manufacturing snus, it is heated in a process similar to pasteurisation. This reduces the formation of nitrosamines, which are chemicals that are potentially carcinogenic and have historically been found at relatively high levels in other forms of oral tobacco, such as some types of chewing tobacco. In 2004, the Swedish National Food Administration Service reported research showing that nitrosamines in Swedish snus had fallen by around 85% over 20 years.
What health studies show
Some independent researchers say that Swedish snus is much safer than smoking.
Studies of snus use in Sweden suggest it leads to no increase in risk for lung cancer and chronic obstructive pulmonary disease, two diseases strongly associated with cigarette smoking. This is not surprising, as consuming snus does not involve inhaling smoke.
While research on various other forms of smokeless tobacco has found associations with oral cancer, research to date on snus in Sweden suggests no increase in risk overall.
Research on snus and heart disease is less clear and some public health bodies have also concluded that snus use is also associated with increased risks of pancreatic cancer and other diseases. However, any risks associated with snus use are lower than those associated with cigarette smoking.
Snus releases about the same amount of nicotine a smoker would get from a cigarette, so it is assumed that some snus users would be defined as being dependent. However, it’s the smoke generated from burning tobacco that presents the serious risk to health for smokers. Nicotine is a stimulant, like caffeine, that can cause dependency and has effects on blood pressure. Not enough science exists to compare difficulty in quitting for cigarette smokers and people who use snus.
What some health experts say
So it is possible (however, reluctantly) to agree with BAT and Swedish Match that snus is a harm-reduction product, but only when compared with the cigarette.
Nigel Gray (Tobacco Unit, the World Health Organisation’s International Agency for Research on Cancer) writing in The Lancet, Vol 366, September 17, 2005.
By telling people their only choices are to quit nicotine entirely or keep smoking and die from it, anti-tobacco advocates will cause a lot of people to die. We want to provide smokers with another alternative.
Dr Carl V Phillips, associate professor at the University of Alberta School of Public Health. Interview: Canada Newswire, 30 May 2006.
As a way of using nicotine, the consumption of non-combustible tobacco is of the order of 10 - 1,000 times less hazardous than smoking, depending on the product. Some manufacturers want to market smokeless tobacco as a “harm reduction” option for nicotine users, and they may find support for that in the public health community.
Tobacco Advisory Group, UK Royal College of Physicians, 2002.
In comparison with smoking, experts perceive at least a 90% reduction in the relative risk of low-nitrosamine smokeless tobacco use.
Estimates of a nine-member panel of experts: Cancer Epidemiology Biomarkers & Prevention, Vol. 13, 2035-2042, December 2004.