Smokeless Tobacco

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Call To Action

Because smokeless tobacco products are not harmless, their regulation should be tightly integrated into tobacco control policies.

Percentage of adults using smokeless tobacco, 2013 or most recent

Over 300 million people around the world, the vast majority of whom live in South Asia, use smokeless tobacco products. In over a dozen countries, more women than men use smokeless tobacco, reflective of the differing norms in each culture of smokeless use. Smokeless tobacco use definitively causes cancers of the head and neck. More than 40 types of smokeless tobacco products are ingested by nose or mouth around the world. An ongoing chain of chemical reactions during the preparation of smokeless tobacco products between bacteria and tobacco leaves makes up the chemical-microbial dynamic. This dynamic influences the concentration of the same deadly chemicals in smokeless tobacco that cause disease in combustible tobacco users.

The size of the smokeless tobacco market in high-income countries remains relatively stable. The 2014 European Union Tobacco Products Directive left a ban on snus sales in place in every EU country except Sweden. In recent years, the test marketing of dissolvable products failed in the United States, and snus brand extensions were commercial failures in Canada and South Africa. By contrast, in 2012, the Indian Supreme Court disrupted the world’s largest smokeless tobacco market when it ruled that gutkha and pan masala were dangerous food products, the sale of which could be temporarily banned under Indian food safety laws. India’s manufacturers responded by producing smokeless tobacco products that are not classified as food. The reaction of India’s smokeless tobacco users to the bans remains unclear.

Bringing smokeless tobacco products into tobacco control regulatory frameworks is essential to managing the harms caused by these products. Research will inform future policy action on smokeless tobacco. The question of whether using smokeless tobacco changes the likelihood of a person to use cigarettes is hotly debated. There is more to learn about opportunities to regulate product flavorings, health warnings, and novel products.

Education and Use

Adult male tobacco use by level of education in Madagascar; ages 15–59, 2009

Smokeless tobacco use in Malagasy men decreases as they become more educated, making smokeless the burden of the poor. By contrast, smoking tobacco is used equally by men of all education levels.

By using existing laws, tobacco control proponents were able to ban gutkha sales in India: “Product not to contain any substance which may be injurious to health: TOBACCO AND NICOTINE SHALL NOT BE USED AS INGREDIENTS IN ANY FOOD PRODUCTS.” —Food Safety and Standards Authority of India, 2011

Processing Impacts Carcinogens

Youth Use

Prevalence of smokeless tobacco use among youth; aged 13 to 15 years, by region, 2013 or most recent

Smokeless tobacco use among youths ensures that the health harms caused by smokeless tobacco are not likely to soon fade.

Smokeless tobacco products are often sold with more flavorings than candy.

Wintergreen smokeless tobacco products have been found to have 6 TIMES MORE flavoring than wintergreen candies.

Without these flavorings, smokeless tobacco use would be much more difficult to initiate.

Flavored smokeless tobacco products have consistently been perceived… as “for beginners” or a way to recruit younger men to try the product. A former [US Tobacco] sales representative revealed that “CHERRY SKOAL IS FOR SOMEBODY WHO LIKES THE TASTE OF CANDY, IF YOU KNOW WHAT I’M SAYING.”—Wall Street Journal, 1994

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