Free of government regulation, The Swedish Tobacco Experience has seen the use of snus (Swedish moist snuff) largely account for the lowest prevalence of smoking among men in developed countries for decades.
A persistent misconception is the belief that snus is safer than American moist snuff or chewing tobacco. The belief is based on the fact that Swedish snus has lower levels of trace contaminants than do American products. I confirmed this in a 2004 study, co-authored by a scientist at the Swedish National Food Administration, demonstrating that Swedish snus had lower levels of tobacco-specific nitrosamines than American moist snuff products (abstract here); other research has produced similar results (here).
Small differences in contaminant levels do not, however, translate into differences in health effects. This is shown in a comparison of the results from two comprehensive reviews of Swedish and American smokeless tobacco studies with respect to cancers (discussed previously in this blog here) and cardiovascular diseases (abstract here). Biostatistician Peter Lee conducted both analyses, and some relevant results are noted below. All of the studies are adjusted for smoking and alcohol.
|Relative Risks (RR) For Cancers and Cardiovascular Diseases In Swedish and American Smokeless Tobacco Studies|
|Disease||Swedish Studies RR (CI)||American Studies RR (CI)|
|Oropharyngeal Cancer||1.10 (0.64 – 1.90)||1.04 (0.80 – 1.35)|
|Esophageal cancer||1.10 (0.92 – 1.33)||1.89 (0.84 – 4.25)|
|Stomach cancer||0.98 (0.82 – 1.17)||1.14 (0.93 – 2.12)|
|Pancreatic cancer||1.20 (0.66 – 2.20)||0.99 (0.51 – 1.91)|
|Heart diseases||1.06 (0.83 – 1.37)||1.14 (0.96 – 1.34)|
|Stroke||1.17 (0.80 – 1.70)||1.20 (1.05 – 1.36)|
CI, 95% Confidence Interval
There are essentially no differences in risk for any of these diseases in the Swedish and American studies. New research on the relative safety of American dip/chew products (here) indicates that smokeless users who had never smoked showed no significant risks for numerous diseases.
In summary, American dip/chew and Swedish snus are indistinguishable with respect to health impact. Smokers who switch to any of these products can make smoking history.