CDC Knows that Its Data Puts Smokeless Tobacco Risks Near Zero

Knowing that the Centers for Disease Control (CDC) has the means to calculate deaths due to smokeless tobacco – a statistic that is likely to be near zero – I encouraged readers (here) to call the agency at 800-232-4636 or email them (here) to demand data and sources on the precise dangers of smokeless tobacco use.

Three of my blog readers requested this information from the CDC and shared the agency’s responses.

Brenden Rudnick made the first request (here) in March, after reading one of my blog entries.  The CDC replied:

“...at this time, we do not provide estimates of deaths attributed to the use smokeless tobacco products…We are not aware of a source of this estimate.”

Another reader, F. Chambers, reported a similar response on April 21 (here):

“We do not estimate deaths resulting from the use of smokeless tobacco products and we are not aware of a source of these estimates.”

On April 22, reader Rob advised that the CDC had a more elaborate excuse:

“there are methodological limitations, including in regard to sample size, which impact our ability to calculate comparable estimates for smokeless tobacco. Chapter 12 of the 2015 Surgeon General’s Report (here) describes the limitations in establishing estimates on the cause of death for products other than cigarettes…the lack of appropriate relative risks related to tobacco products other than cigarettes. Further, dual use of cigarettes and another product may complicate estimates, particularly if dual use extends to persons in age ranges where most smoking-caused deaths occur. Therefore, at this time, we do not have an estimate or a timeframe to provide.”

These excuses are unacceptable.  The CDC has all the data it needs to make informed estimates.  Here is proof: Dr. Michael Fisher, a scientist at Altria, used CDC data to calculate the following tobacco use risks, an analysis he presented at a recent tobacco research meeting (here). 

Adjusted Risks* for Tobacco Users in National Health Interview Surveys
Tobacco Use	All Causes of Death	All Cancers	Heart Diseases
Exclusive Smokeless	1.05 (0.90 – 1.23)	1.05 (0.77 – 1.43)	0.94 (0.70 – 1.28)
Exclusive Smoking	2.17 (2.09 – 2.26)	3.08 (2.84 – 3.33)	1.98 (1.85 – 2.13)
Dual Use	2.34 (1.80 – 3.02)	2.78 (1.89 – 4.10)	1.76 (1.03 – 3.01)
Former Smoking	1.35 (1.30 – 1.40)	1.64 (1.52 – 1.78)	1.21 (1.13 – 1.29)
Former Smoking, Current Smokeless	1.38 (1.14 – 1.67)	1.62 (1.13 – 2.31)	1.62 (1.16 – 2.25)
*Compared with never tobacco use

    

The headline here is that the risks for exclusive ST users are not significantly different from those for never users.  In other words, ST users had ZERO excess risks for all causes of death, all cancers and heart diseases.  The rest of the estimates are significantly elevated.  Note that, by Dr. Fisher’s calculation, the risks for dual users are not very different from those for exclusive smokers.  Also note that the risks for former smokers who use ST are about the same as those who quit altogether; both were lower than smokers.

By continuing to obfuscate about the existence and implications of it smokeless risk data, the CDC is failing in its mission to promote public health. Worse, by supporting the false claim that smoke-free products are just as risky as cigarettes, the agency denies smokers vital and persuasive reasons to quit.