Snus is a moist powder tobacco product that is consumed by placing it under the lip for extended periods of time. It is a form of
snuffSnuff is ground or pulverized tobacco, which is generally inhaled or "snuffed" through the nose. It is a type of smokeless tobacco. There are several types, but traditionally it means Dry/European nasal snuff...
that is used in a manner similar to American
dipping tobaccoDipping tobacco, also known as moist snuff or spit tobacco, is a form of smokeless tobacco. It is commonly referred to as dip. The act of using it is called dipping. Dip is colloquially called "chew"; because of this, it is commonly confused with chewing tobacco...
, but typically does not result in the need for spitting. Snus is also unique in that it is steam-cured rather than fire-cured, is not fermented, and is lower in TSNA compounds, making it less carcinogenic than American snuff or cigarettes. The sale of snus is illegal in most of the European Union, but due to exemptions, it is still manufactured and consumed primarily in
SwedenSweden , officially the Kingdom of Sweden , is a Nordic country on the Scandinavian Peninsula in Northern Europe...
and
NorwayNorway , officially the Kingdom of Norway, is a country in Northern Europe occupying the western portion of the Scandinavian Peninsula, as well as Jan Mayen and the Arctic archipelago of Svalbard under the Spitsbergen Treaty...
and more recently, the
United StatesThe United States of America is a federal constitutional republic comprising fifty states and a federal district...
with the introduction of various snus products by R.J. Reynolds, Philip Morris USA, and Lorillard. Swedish brands are also shipped direct to end users the USA by a variety of online retailers.
Types
There are two main types of snus on the market:
- Original snus or loose snus is a loose, moist powder which can be portioned and packed into a cylindrical or spherical shape with the fingertips or snus portioner
A snus portioner is a tool used to help form and place a portion of loose snus under the lip. Snus portioners come in various sizes and materials....
. The end result is often referred to as a pris (pinch) or prilla or prell (slang for pris).
- Portion snus, is prepackaged powder in small bags made from the same material as teabags. It comes in smaller quantities than the loose powder but is considered easier to handle (and expectorate) than the loose powder.
Swedish snus is made from air dried tobacco from various parts of the world. In earlier times tobacco for making snus used to be laid out for drying in
ScaniaScania is a geographical region on the southernmost tip of the Scandinavian peninsula, an occupied province in the Kingdom of Sweden, before 1658 a province in the Kingdom of Denmark and part of the historical lands of Denmark.To the north, it borders the provinces Halland, Småland and Blekinge,...
and Mälardalen. Later
KentuckyThe Commonwealth of Kentucky is a state located in the East Central United States of America. Kentucky is a Southern state situated in the Upland South, although the state is infrequently placed, geographically and culturally, in the Midwest. Kentucky is one of four U.S. states constituted as a...
tobaccos were used. The ground tobacco is mixed with water, salt,
sodium carbonateSodium carbonate , , is a sodium salt of carbonic acid. It most commonly occurs as a crystalline heptahydrate, which readily effloresces to form a white powder, the monohydrate; and is domestically well known for its everyday use as a water softener...
and aroma and is prepared through heating, generally via steam. Moist snus contains more than 50% water, and the average use of snus in Sweden is approximately 800 grams (16 units) per person each year. 12% (1.1 million people) of the population in Sweden use snus
http://www.tobaksfakta.org/Default.aspx?id=3436. Unlike
dipping tobaccoDipping tobacco, also known as moist snuff or spit tobacco, is a form of smokeless tobacco. It is commonly referred to as dip. The act of using it is called dipping. Dip is colloquially called "chew"; because of this, it is commonly confused with chewing tobacco...
, snus has not gone through a
fermentationFermentation is the process of deriving energy from the oxidation of organic compounds, such as carbohydrates, using an endogenous electron acceptor, which is usually an organic compound. This is in contrast to cellular respiration, where electrons are donated to an exogenous electron acceptor,...
process.
Snus is sold mainly in
SwedenSweden , officially the Kingdom of Sweden , is a Nordic country on the Scandinavian Peninsula in Northern Europe...
and
NorwayNorway , officially the Kingdom of Norway, is a country in Northern Europe occupying the western portion of the Scandinavian Peninsula, as well as Jan Mayen and the Arctic archipelago of Svalbard under the Spitsbergen Treaty...
, and was trialed in South Africa and the United States, where it is now available in most cities. It can be found in various places frequented by
ScandinaviaScandinavia is a geographical region in northern Europe that includes, and is named after, the Scanian Province. It consists of the kingdoms of Norway, Sweden, and Denmark...
n tourists like
MurmanskMurmansk is a city and seaport in the extreme northwest part of Russia, on the Kola Bay, 12 km from the Barents Sea on the northern shore of the Kola Peninsula, not far from Russia's borders with Norway and Finland....
in
RussiaRussia , officially known as both Russia and the Russian Federation , is a country in northern Eurasia . It is a semi-presidential republic, comprising 83 federal subjects...
(with the notable exception of countries in the EU; see below). It is sold in small tins, which in the earlier years were made of
porcelainPorcelain is a ceramic material made by heating raw materials, generally including clay in the form of kaolin, in a kiln to temperatures between and...
,
woodWood is an organic material; in the strict sense wood is produced as secondary xylem in the stems of trees . In a living tree it transfers water and nutrients to the leaves and other growing tissues, and has a support function, enabling woody plants to reach large sizes or to stand up for themselves...
,
silverSilver is a chemical element with the chemical symbol Ag and atomic number 47. A soft, white, lustrous transition metal, it has the highest electrical conductivity of any element and the highest thermal conductivity of any metal...
or
goldGold is a chemical element with the symbol Au and an atomic number of 79. It has been a highly sought-after precious metal for coinage, jewelry, and other arts since the beginning of recorded history. The metal occurs as nuggets or grains in rocks, in veins and in alluvial deposits. Gold is...
. At the time of writing, portioned snus usually comes in plastic tins of 24g, while loose snus is mostly sold in compressed paper tins with plastic lids, at 45g (50g before 2008).
Portioned snus is most commonly sold in three different variants, namely mini, normal/large and maxi. The weights may vary, but the most sold snus labels share their weight. Mini portions weigh 0.5g, with 20 pieces per tin. Standard portions weigh 1g, with 24 portions per tin, and maxi portions weigh 1.7g, with 17 pieces per tin.
There are two types of portioned snus available: Original and White. Original portioned snus has water sprayed on the sachet during the manufacturing process, which results in a higher moisture content. White portioned snus does not undergo this step, which results in the snus having a mellower flavor. In Sweden, White portion snus is more common among younger tobacco consumers.
There are several different strengths of snus available. Standard snus contains approximately 8 mg of nicotine per gram, while "Ekstra Sterk/Strong" brands may contain as much as 17 mg of nicotine per gram. Mini portions usually contain 4 mg of nicotine, since there is less tobacco in each sachet. As well, there are nicotine-free varieties of snus, which are made with ingredients to resemble the consistency and flavor of real snus.
The price for the 45g product is approximately €3-5 in Sweden and €7.50 in Norway as Norwegian taxes are higher.
Health consequences
Since snus is not intended nor recommended for inhalation, it does not affect the
lungThe lung or pulmonary system is the essential respiration organ in air-breathing animals, including most tetrapods, a few fish and a few snails. In mammals and the more complex life forms, the two lungs are located in the chest on either side of the heart...
s as
cigaretteA cigarette is a product consumed through smoking and manufactured out of cured and finely cut tobacco leaves and reconstituted tobacco, often combined with other additives, then rolled or stuffed into a paper-wrapped cylinder...
s do. Because it is steam-cured, rather than fire-cured like smoking tobacco or other chewing tobacco, it contains lower concentrations of
nitrosamineNitrosamines are chemical compounds of the chemical structure R
1N-N=O, some of which are carcinogenic.- Food :...
s and other carcinogens that form from the partially anaerobic heating of proteins; 2.8 parts per mil for Ettan brand compared to as high as 127.9 parts per mil in American brands, according to a study by the Commonwealth of Massachusetts Department of Health. The
World Health OrganizationThe World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health...
(WHO) acknowledges that Swedish men have the lowest rate of
lung cancerLung cancer is a disease of uncontrolled cell growth in tissues of the lung. This growth may lead to metastasis, which is the invasion of adjacent tissue and infiltration beyond the lungs. The vast majority of primary lung cancers are carcinomas of the lung, derived from epithelial cells...
in Europe, partly due to the low
tobacco smoking Tobacco smoking is the practice where tobacco is burned and the vapors either tasted or inhaled. The practice began as early as 5000–3000 BC. Many civilizations burnt incense during religious rituals, which was later adopted for pleasure or as a social tool. Tobacco was introduced to the old world...
rate, but does not argue for substituting snus for smoking, citing that the effects of snus still remain unclear. Around 2005 several reports pointed to the fact that no carcinogenic effects could be attributed to Nordic snus and this resulted in the warning label that snus could cause cancer could be removed. It was replaced with the more neutral label "May affect your health negatively". Research is still going on but at the moment no conclusive reports have been made regarding the health effects of snus.
The
European UnionThe European Union is an economic and political union of 27 Member States, located primarily in Europe. Committed to regional integration, the EU was established by the Treaty of Maastricht on 1 November 1993 upon the foundations of the pre-existing European Economic Community...
banned the sale of snus in 1992, after a 1985
WHO study concluded that "oral use of snuffs of the types used in North America and western Europe is
carcinogenA carcinogen is any substance, radionuclide or radiation that is an agent directly involved in the promotion of cancer or in the increase of its propagation. This may be due to the ability to damage the genome or to the disruption of cellular metabolic processes...
ic to humans", but a WHO committee on tobacco has also acknowledged that evidence is inconclusive regarding health consequences for snus consumers.
http://www.irishtimes.com/newspaper/health/2009/0421/1224245059341.html. Only Sweden and
EFTAEFTA may refer to:* European Family Therapy Association, an NGO.* European Fair Trade Association, an association of eleven Fair Trade importers in nine European countries....
-member Norway are exempt from this ban. A popular movement during the run-up to the 1994 referendum for Sweden's EU membership made exemption from the EU sale ban of snus a condition of the membership treaty. American style "dip" tobacco is legal throughout Europe, and was not included in the ban.
Recent actions by many European governments to limit the use of cigarettes has led to calls to lift the ban on snus, as it is generally considered to be less harmful than cigarette smoke, both to the user and to others.
Debate among public health researchers
There is some debate among
public healthPublic health is "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals." It is concerned with threats to the overall health of a community based...
researchers over the use of "safer" tobacco or nicotine delivery systems, generally dividing along two lines of thought. Most researchers are currently of the "
abstinenceAbstinence is a voluntary restraint from indulging a desire or appetite for certain bodily activities that are widely experienced as giving pleasure. Most frequently, the term refers to abstention from sexual intercourse, alcohol or food. The practice can arise from religious prohibitions or...
" belief, believing that no form of tobacco or nicotine use is acceptable or safe, and should be minimized among the population. A minority (primarily in the European Union and Canada) believes in "
harm reductionHarm reduction, or harm minimisation, refers to a range of pragmatic and evidence-based public health policies designed to reduce the harmful consequences associated with drug use and other high risk activities ....
," where the belief is generally that, while it should remain a goal to reduce addiction to nicotine in the population as a whole, the reduction of harm to the health of those who choose to use nicotine should override the need to reduce overall nicotine addiction. For example, some research
http://www.tobaccoprogram.org/pdf/TC12349.pdf available today shows that snus use reduces or eliminates the risk of cancers that afflict other users of tobacco products such as "
chewing tobaccoChewing tobacco refers to a form of smokeless tobacco furnished as long strands of whole leaves and consumed by placing a portion of the tobacco between the cheek and gum or teeth and chewing. Unlike dipping tobacco, it isn't ground and must be mechanically crushed with the teeth to release...
" (the type primarily used in the United States and Canada, created in a process similar to cigarette tobacco) and cigarettes. It is hypothesized that the widespread use of snus by Swedish men (estimated at 30% of Swedish male ex-smokers), displacing tobacco smoking and other varieties of snuff, is responsible for the incidence of tobacco-related mortality in men being significantly lower in Sweden than any other European country; in contrast, since women traditionally are less likely to use snus, their rate of tobacco-related deaths in Sweden can be compared to that of other European countries.
Snus may be less harmful than other tobacco products; according to Kenneth Warner, director of the University of Michigan Tobacco Research Network,
- "The Swedish government has studied this stuff to death, and to date, there is no compelling evidence that it has any adverse health consequences. ... Whatever they eventually find out, it is dramatically less dangerous than smoking." http://books.google.com/books?id=VHdZw2zOuzoC&pg=PA375&lpg=PA375&dq=kenneth+warner+the+swedish+government+has+studied+this+stuff+to+death+and+to+date+there+is+no+compelling+evidence+that+it+has+any+adverse+health+consequences+whatever+they+eventually+find+out+it+is+dramatically+less+dangerous+than+smoking&source=web&ots=cx51KVW46S&sig=Foo-qrULHni9qURU1Izv5ZmBUPE
Ongoing discussion and debates among primary scientific researchers of the effects of snus use on life expectancy appears to indicate that there is a significant increase in life expectancy among persons who previously smoked tobacco and switch to Swedish snus, depending on the age of the persons who switch, even when it is assumed that 100% of the risk of cardiovascular diseases among smokers transfers to snus users. It is also noted, in the correspondence seen in the previous citation that concerns about the effect of marketing by the tobacco industry, as influenced by the results of these scientific studies, is of primary concern to many researchers in the field, including the risk of emboldening the industry to attempt to increase snus sales among young people and promote dual-use of snus and smoked tobacco, and that the use of medical nicotine, rather than snus, can better target at-risk populations, given better access and pricing.
Opponents of snus sales maintain that, nevertheless, even the low nitrosamine levels in snus cannot be completely risk free, but snus proponents point out that inasmuch as snus is used as a substitute for smoking or a means to quit smoking, the net overall effect is positive, similar to the effect of nicotine patches, for instance.
In addition, rather obviously, this eliminates any exposure to second-hand smoke, further reducing possible harm to other non-tobacco users. This is seen by public health advocates who believe in "harm reduction" as a reason for recommending snus in addition to other
nicotine replacement therapiesNicotine replacement therapy ' is the use of various forms of nicotine delivery methods intended to replace nicotine obtained from smoking or other tobacco usage. These products are marketed for use in smoking cessation efforts to help deal with withdrawal symptoms and cravings caused by the loss...
rather than continued use of cancer-causing nicotine delivery systems.
This does not, however, eliminate any harm to health caused by the nicotine itself. Current research focuses on possible long-term effects on
blood pressureBlood pressure is the pressure exerted by circulating blood on the walls of blood vessels, and is one of the principal vital signs. During each heartbeat, BP varies between a maximum and a minimum pressure...
,
hypertensionHypertension is a chronic medical condition in which the blood pressure is elevated. It is also referred to as high blood pressure or shortened to HT, HTN or HPN. The word "hypertension", by itself, normally refers to systemic, arterial hypertension.Hypertension can be classified as either...
and possible risk of
pancreatic cancerPancreatic cancer is a malignant neoplasm of the pancreas. Each year in the United States, about 42,470 individuals are diagnosed with this condition and 35,240 die from the disease. The prognosis is generally poor; less than 5 percent of those diagnosed are still alive five years after diagnosis...
due to
tobacco-specific nitrosaminesTobacco-specific nitrosamines is one of the most important groups of carcinogens in tobacco products, particularly cigarettes and American style dipping snuff.-Background:...
(TSNAs). TSNAs are the only component of tobacco shown to induce pancreatic cancer in laboratory animals. Nicotine may also exacerbate pancreatic illness, because nicotine stimulates the
gastrointestinal tractThe human gastrointestinal tract , digestive tract, guts or gut is the system of organs within humans that takes in food, digests it to extract energy and nutrients, and expels the remaining matter...
's production of
cholecystokininCholecystokinin is a peptide hormone of the gastrointestinal system responsible for stimulating the digestion of fat and protein...
, which stimulates pancreatic growth and may be implicated in pancreatic cancer. Thus far the evidence specifically implicating snus in pancreatic cancer is only suggestive. It should also be noted that the probability of developing pancreatic cancer from cigarettes is higher than the suggested chance of developing pancreatic cancer from snus.
The effects of Swedish snus on blood pressure has been studied at Umeå University in a randomly selected population sample of 4,305 Swedish men between 25 and 74 years of age. In the study, published in November 2008, the researchers found no elevation of blood pressure in snus users who had never been smokers compared to non tobacco users. In fact, snus users had lower systolic blood pressure than non tobacco users in the unadjusted data.
Published peer-reviewed studies
Cardiovascular diseases
Cancer
- Juhua Luo MSc, Weimin Ye MD, Kazem Zendehdel MD, Johanna Adami MD, Prof Hans-Olov Adami MD, Prof Paolo Boffetta MD and Prof Olof Nyrén MD Oral use of Swedish moist snuff (snus) and risk for cancer of the mouth, lung, and pancreas in male construction workers: a retrospective cohort study The Lancet, Volume 369, Issue 9578, Pages 2015-2020 (abstract - full text by subscription only)
Medical community discussions and reports
General media articles
- A Smokeless Alternative To Quitting (Unabridged Version), The New York Times, April 6, 2004
- Should Snuff Be Used as a Tool To Quit Smoking?, The Wall Street Journal, September 16, 2006; Page A1.
- Doctors: Swedish snus cut risk of cancer, Associated Press via USA Today, May 10, 2007
- Swedish Smokeless Tobacco Aims at U.S. Market New York Times, October 3, 2007
- Doctors call for new nicotine products Reuters (UK) Oct 5, 2007 12:48pm BST
Tobacco Industry-sponsored discussion forums
- The harm reduction Bulletin Board The Eudoxa
Eudoxa is a Swedish think tank, formed in 2000. Eudoxa has a transhumanist, and liberal political profile, with a focus on promoting dynamism, emerging technologies, harm reduction policy and discussing the challenges of the environment and the future...
think tank's Bulletin Board for discussing snus and harm reduction, funded by the U.S. Smokeless Tobacco CompanyThe U.S. Smokeless Tobacco Company manufactures dipping tobacco and is a subsidiary of UST Inc....
Articles
Non-medical blogs and commentary
See also
- Smokeless tobacco
Smokeless Tobacco may refer to:* Dipping tobacco, a type of tobacco that is placed between the lower or upper lip and gums.* Chewing Tobacco, a type of tobacco that is chewed.* Snuff, a type of tobacco that is inhaled or "snuffed" through the nose....
- Herbal smokeless tobacco
Herbal smokeless tobacco is a term used to describe a variety of products which imitate types of smokeless tobacco, although do not contain tobacco or nicotine...
- Smoking cessation
Smoking cessation is the process of discontinuing the practice of inhaling a smoked substance, mainly tobacco, but it may encompass cannabis or other substances.- Treatment for smoking related constipation :...