Over the past few years, increasing cigarette taxes and restrictions on public use have hit tobacco industry profits hard. But believe it or not, manufacturers have found a way to get around these obstacles. They have devised a perfect springboard for introducing a new product.

Enter snus (rhymes with "moose"), a smokeless, spit-free tobacco that has been popular in Sweden for nearly 200 years. Tobacco giants R.J. Reynolds and Philip Morris created their versions of snus and began test marketing the product in 2007. Most recently they've kicked their publicity campaign into high gear.

Many cigarette packs now include coupons for free or discounted samples. Snus, packaged in colorful tins, can be found behind the counters in local convenience stores where it is stored in small refrigerators to keep the moist tobacco fresh. With sleek designs and flavors like "frost," "mellow," spearmint, and peppermint, they seem as innocuous as a pack of gum. But they're not.

Even though studies have suggested snus may be less harmful than cigarettes, it still contains nicotine and carcinogens. New ads for smokeless tobacco products must make that point clear in large print that takes up 20 percent of the page. This law takes effect June 22, the first anniversary of H.R. 1256: The Family Smoking Prevention and Tobacco Control Act.

Currently advertisements tout snus as a convenient, liberating alternative to cigarettes. Users can place a flavorful dime-sized pouch between their lips and gum where its presence will be unbeknownst to others, making it possible to get a nicotine fix at bars, airports, sporting events, or even in a work cubicle. "Change the rules and enjoy tobacco on your own terms," suggests one Camel ad. "Boldly go anywhere." There is no second-hand smoke to annoy others.

Snus advertisements will carry warnings that the product is not a safe alternative to cigarettes, is addictive, and can cause mouth cancer, gum disease, and tooth loss. Earlier ads required similar statements but in much smaller, inconspicuous type.

Anti-tobacco advocates hope these warnings will communicate the very real danger snus poses. Not only could its use make it easier for smokers to stay addicted to tobacco, but it could also act as a gateway to the use of cigarettes and other tobacco products among younger kids.

Bottom line: You snus, you lose.

Contact Colleen Mullarkey, associate editor of ADVANCE for Audiologists, at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

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Miss Mullarkey’s article on snus omits some important information. First, no tobacco product is absolutely safe, but smokeless use is 98% safer than smoking. Unlike cigarettes, smokeless does not cause lung cancer, heart disease or emphysema. The risk for mouth cancer is far lower among smokeless users than among smokers. In fact, smokeless users have about the same risk of dying from mouth cancer as automobile users have of dying in a car wreck. A recent meta-analysis published in BMC Medicine demonstrated that cancer risks from long-term use of American and Swedish smokeless products are so low that they are barely measurable by modern epidemiologic methods.

Switching from cigarettes to smokeless is called harm reduction, and it’s not just an industry ploy; it has been endorsed by two prestigious medical organizations, the British Royal College of Physicians and the American Association of Public Health Physicians. The Royal College concluded “...that smokers smoke predominantly for nicotine, that nicotine itself is not especially hazardous, and that if nicotine could be provided in a form that is acceptable and effective as a cigarette substitute, millions of lives could be saved.” (www.rcplondon.ac.uk/pubs/brochure.aspx?e=234 )

In 2008 the AAPHP became the first medical organization in the U.S. to formally adopt a policy of “…encouraging and enabling smokers to reduce their risk of tobacco-related illness and death by switching to less hazardous smokeless tobacco products.” (www.aaphp.org/special/joelstobac/2008102...olutionAsPassedl.pdf )

In Canada the Non-Smokers’ Rights Association has just endorsed tobacco harm reduction (www.nsra-adnf.ca/cms/file/pdf/NSRA_harm_...alysis_June-2010.pdf ). This prestigious group recommends snus as a far less harmful substitute for “…smokers who are unable to quit or unwilling to make a quit attempt,” under the principle that “the public has the right…to accurate information about the relative risks of using tobacco products and to make choices based on the facts.”

Brad Rodu
Professor of Medicine
Endowed Chair, Tobacco Harm Reduction Research
University of Louisville



Brad Rodu, Professor, University of Louisville June 22, 2010
Louisville, KY