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Snus: Stealth Health Risk

Snus smokeless tobacco: Less harmful than cigarettes, but not safe.
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Snus: Harm Reduction or Multiplication?

OK, so snus isn't without harm. But if it's so much safer than cigarettes, wouldn't it be good for smokers to switch to snus?

In Scandinavia, there's some evidence that snus contributed to a decline in smoking. Whether that happens in the U.S. depends on young people, says Michael Eriksen, ScD, director of the Institute of Public Health at Georgia State University and former director of the CDC Office on Smoking and Health.

"If we see that existing smokers are the primary users of snus and go from smoking to snus, that would be a public health success story," Eriksen tells WebMD. "But if kids start out on snus and then grow into smoking, that is going to be a disaster."

It's a huge public health experiment -- and the results already are plain to see, says Terry Pechacek, PhD, associate director for science at the CDC's Office on Smoking and Health.

Pechacek notes that more than a fourth of white, male high school students report having used smokeless tobacco products in the last month. Overall, nearly 7% of all U.S. high school students already use smokeless tobacco.

And they are not using snus instead of cigarettes.

"The overwhelming pattern is to smoke cigarettes along with smokeless tobacco -- and two-thirds of this is among young adults," Pechacek tells WebMD. "Over half of teens using smokeless tobacco are also using cigarettes. … It is of great public health concern."

This isn't an accident, says Michael Steinberg, MD, MPH, director of the tobacco dependence program at the University of Medicine and Dentistry of New Jersey.

Steinberg notes that in 2006, major U.S. cigarette companies bought the major smokeless tobacco brands. And the two major brands of snus? They're from leading cigarette makers Altria/Philip Morris (Marlboro Snus) and RJ Reynolds (Camel Snus).

"Snus is being co-marketed with cigarettes," Steinberg tells WebMD. "The companies are not shy in saying, 'When you can't smoke, use snus.' But when you can smoke, it is clear they want you to smoke cigarettes. They make more money from cigarettes sales than anything else on the planet."

Steinberg also notes that U.S. snus deliver less nicotine than do cigarettes.

"So if people try to get nicotine from snus, they will not get what they are used to. They will go through nicotine withdrawal and so will not use snus alone," Steinberg says. "My conclusion is that companies do not want to replace cigarettes with snus."

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