Wednesday, July 20, 2016

Is Snus Safer Than Dip or Chew? Health Effects of All Are Close to Zero

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
DiseaseSwedish Studies RR (CI)American Studies RR (CI)
Oropharyngeal Cancer1.10 (0.64 – 1.90)1.04 (0.80 – 1.35)
Esophageal cancer1.10 (0.92 – 1.33)1.89 (0.84 – 4.25)
Stomach cancer0.98 (0.82 – 1.17)1.14 (0.93 – 2.12)
Pancreatic cancer1.20 (0.66 – 2.20)0.99 (0.51 – 1.91)
Heart diseases1.06 (0.83 – 1.37)1.14 (0.96 – 1.34)
Stroke1.17 (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. 



Stephen Helfer said...

Why do you question so much anti-tobacco propaganda, but post that ludicrous numbe of "smoking deaths," which we all know is based on data rigging?

Brad Rodu said...

In 2007 I published a study estimating that “there were 402,000 deaths attributable to smoking in 1987 and 322,000 in 2002.” ( I noted that despite the substantial decline in smoking prevalence, the estimate of smoking-attributable deaths from the Centers for Disease Control and Prevention had changed hardly at all. Five years later, my question is still relevant. The answer is clear: The CDC chose not to acknowledge the fact that deaths had plummeted.

In “Calculating the Big Kill,” which appeared in Regulation, the Cato Institute’s flagship publication (, I made the case that “CDC [Centers for Disease Control and Prevention] estimates of smoking-related deaths do not add up.” I noted that “U.S. smoking rates have been declining almost continuously since the mid-1960s, when 42 percent of American adults smoked. The rate dropped to 28 percent in 1988 and has now declined to 21 percent. Put simply, the proportion of Americans who smoke has been cut in half over the past 40 years.”

I asked, “Why have the CDC [Big-Kill] estimates not fallen?”