Smokeless tobacco risks now being studied


December 14th, 2008, 12:18 pm #1

Smokeless Tobacco
Risks Being Studied

Once again history sees the nicotine cart out before the horse. While smoking harm reduction advocates point to smokeless tobacco as "safer" than smoking, to date none have been able to tell us what "safer" really means.

Until now nearly all tobacco research funding has been directed at smoking. But a flood of new products into the smokeless tobacco market at last have researchers beginning to examine the long-term costs of spending years in chemical bondage to smokeless tobacco. This thread will be home to their findings.

Let us not forget that while smoked nicotine generates more than 4,000 chemicals, unadulterated oral tobacco contains at least 2,550 chemicals.[1] While 81 potential cancer causing chemicals have so far been associated with smoking[2] up to 28 potential carcinogens have been found in oral tobacco[3].

[1] U.S. Surgeon General, Reducing the Health Consequences of Smoking: 25 Years of Progress: A Report of the Surgeon General: 1989, Page 79.
[2][font=&AMP] Smith CJ et al,[/font] [font=&AMP] IARC carcinogens reported in cigarette mainstream smoke and their calculated log P values[/font][font=&AMP], Food and Chemical Toxicology, June 2003, Volume 41(6), Pages 807-817.
[/font][3][font=&AMP] IARC Monographs on the Evaluation of Carcinogenic Risks to Humans,[/font] [font=&AMP] Smokeless Tobacco and Some Tobacco-specific N-Nitrosamines[/font][font=&AMP], 2007, Volume 89.[/font]
Last edited by FreedomNicotine on December 14th, 2008, 12:37 pm, edited 3 times in total.


December 14th, 2008, 12:39 pm #2

Smokeless tobacco
and the risk of stroke

Epidemiology, November 2008, Volume 19(6), Pages 794-799
Hergens MP, Lambe M, Pershagen G, Terent A, Ye W.

Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.

Email address of lead researcher: Dr. Maria P. Hergens: [][/url]

BACKGROUND:: In Sweden, use of smokeless tobacco (oral moist snuff) is common among adult men. Research on cerebrovascular effects associated with long-term use of snuff is limited and inconclusive. We aimed to study whether long-term use of snuff affects the risk of stroke.

METHODS:: Information on tobacco use was collected by questionnaire among Swedish construction workers attending health check-ups between 1978 and 1993. In total, 118,465 never-smoking men without a history of stroke were followed through 2003. We used the Inpatient Register and Causes of Death Register to identify subsequent morbidity and mortality from stroke and its subtypes (ischemic, hemorrhagic, and unspecified stroke). Relative risk estimates were derived from Cox proportional hazards regression model.

RESULTS:: Almost 30% of the nonsmoking men had ever used snuff. Overall, 3248 cases of stroke were identified during follow-up. Compared with nonusers of tobacco, the multivariable-adjusted relative risks for ever-users of snuff were 1.02 (95% confidence interval; 0.92-1.13) for all cases and 1.27 (0.92-1.76) for fatal cases. Further analyses on subtypes of stroke revealed an increased risk of fatal ischemic stroke associated with current snuff use (1.72; 1.06-2.78), whereas no increased risk was noted for hemorrhagic stroke.

CONCLUSION:: Snuff use may elevate the risk of fatal stroke, and particularly of fatal ischemic stroke.

PMID: 18854704 [PubMed - in process]

Abstract Link:


Related Story: Snus Smokeless Tobacco May Raise Stroke Risk

Story Link:

Story Quotes:

"Last week, we reported that R.J. Reynolds was preparing for the national debut of Camel Snus, a new type of smokeless chewing tobacco and that, according to a New York Times report, R.J. Reynolds is hoping Camel Snus catches on with consumers as a more "socially acceptable" form of tobacco. Health officials are worried about the product's potential to cause health problems. Also, according to the Associated Press, the European Union banned Snus in 2004 over cancer worries. Unlike regular chewing tobacco, users can swallow the juice Snus produces, so there is no spitting. And unlike cigarettes, there is no second hand smoke. Apparently, those properties are what R.J. Reynolds thinks will make Camel Snus, which is currently being test marketed nationwide, more "socially acceptable."

The New York Times also reported that the amount of nicotine contained in a single-dose pouch of Camel Snus is higher than is what is found in most other chewing tobaccos. A spokesperson for R.J. Reynolds told the Times that each pouch of Snus contains 8 milligrams of nicotine. The New York Times also noted that there is concern that R.J. Reynolds is manipulating the nicotine in Snus and that an earlier version of the product that was test marketed in the U.S. which contained only 2 milligrams per pouch. The West Virginia University researcher who made that discovery told the Times that the nicotine increase likely didn't happen by accident.

According to an article published by, smokeless tobacco products contain 28 carcinogens and raise the risk of oral, pancreatic, and esophageal cancers, mouth lesions. and gum disease."


December 14th, 2008, 12:47 pm #3

Gruen Von Behrens'
Missing Jaw

Guren was just thirteen and on a camp-out with friends when one pulled out a can of snuff he'd stolen from his father's dresser drawer. "I thought, 'Why not?' " he said. "I was 13. I had not a care in the world. So I took a dip." "At first it made me kind of sick and real dizzy. Next thing I knew I was addicted."

By age 14 Gruen Von Behrens was seriously hooked on nicotine. At his peak he was consuming more than half a can a day. Then it happened, at sixteen he noticed a small white spot on his tongue, a spot that would gradually start to grow.

"As a teenager, [Gruen] was a handsome lad who hit .400 for the local Comets and wanted to play for the Chicago Cubs. Ryne Sandberg was his hero. 'The only things I cared about were baseball, food, and women, in that order,' he said. At the high school field he still can point out the houses in the neighborhood beyond the center-field fence that he hit with home runs."

But now something was gradually eating away at his tongue and Gruen was slowly beginning to realize that he likely had cancer. He decided to hide it from his mother, a nurse. The 5'10" ball-player recalls sitting in the bathroom asking God why this was happening to him.

When his mother kept asking why he was slurring his speech, drooling, and why he couldn't seem to keep food in his mouth he'd tell her that it was his wisdom teeth.

His mom would discover the truth when she surprised him with a visit to the dentist's office. According to the Gazette story, "once in the dentist's chair and about to be put under anesthesia, [Gruen] admitted the truth. 'It's not my wisdom teeth, I have cancer,' he said, as the dentist peeked into his mouth. The dentist nodded to his mother." Gruen had squamous cell carcinoma.

"I've never seen my mom cry like that," Gruen recalls. "It ripped her heart out." Doctors gave him a 25% chance of survival going into his first surgery. "At 17, you're not supposed to think about life and death issues," he said.

One week later a 17 year-old boy would undergo 13 hours of surgery followed by a month of recovery in the hospital. Then came the radiation treatments. Within six weeks he'd lose 70 pounds, lose the skin on his face, his mouth would become a blistery white mess, and his teeth would rot.

At 19 "doctors transplanted three inches of bone from his back to his face to give him a jaw. The transplant lasted two days. Then his body rejected it."

Now 40 operations later at age 27, his lower face severely disfigured, his lower teeth and jawbone gone, half his tongue and neck muscle missing, his face patched with skin and muscle from his leg, Gruen pleads with all who'll listen, "don't do it, it ruined my life."

In slurred speech in crowded school gymnasiums across the nation he tells students, "I know I'm a little hard to understand, so you're going to have to bear with me and listen." "This isn't a mask I can take off and throw in the closet. I'm like this 365 days a year."

"I'm not here to preach to you," he tells them. "I'm not saying all of you will get cancer, but a few of you will."

Gruen tells students that "the inside of [my] mouth is grayish, like hamburger that's spent too much time in the sun." "Doctors have cut skin from his leg to cover his face wounds" and "extracted muscles from his chest to rebuild the floor of his mouth."

"I have a beautiful fiancee I can't marry because I look like this," he said. "I walk into Wal-Mart and I hear kids say, 'Mommy, Mommy, look at him. Why does he look so funny, why does he look so scary?"'

Gruen is working hard with the National Spit Tobacco Education Program to correct the false belief that smokeless tobacco is a safe alternative to smoking. Tobacco causes cancer, no matter how it is absorbed by the body.

"I wish someone came to me when I was experimenting and using it and I saw how he or she looked and talked," he added. "I used to be good looking. I was the guy all the girls wanted to date. I was a good baseball player, but I can't play now."

"If I had known then what I know now, I never would have put a dip in my mouth," said Gruen. "Spit tobacco seemed harmless, but it has ruined my life."

The above fact compilation was compiled on November 15, 2004 by John R. Polito using facts, extensive quotations and images from the below referenced online sources:
  • Garret Condon, "State Rips Plan To Label Snuff `Safer' Tobacco", Courant, July 11, 2002
  • National Spit Toacco Education Program
  • Picture of Gruen with a student - Illinois Dept. of Health
  • Maggie O'Neill, "Personal tragedy turned into warning against teen tobacco use", The Record-Courier, January 23, 2004
  • Stan Grossfeld, "For One Youngster, Life Changed Forever", The Boston Globe, July 6, 2004
To learn more about Gruen or arrange for him to speak to your school or group visit the National Spit Tobacco Education Program (NSTEP) WebSite

Last edited by FreedomNicotine on December 14th, 2008, 12:54 pm, edited 3 times in total.

Joined: November 11th, 2008, 7:22 pm

November 26th, 2010, 3:44 pm #4

Global surveillance of oral tobacco products:
total nicotine, unionised nicotine and
tobacco-specific N-nitrosamines
Tobacco Control Published Online First: 25 November 2010
Stephen B Stanfill, Gregory N Connolly, Liqin Zhang, Lily T Jia, Jack E Henningfield, Patricia Richter, Tameka S Lawler, Olalekan A Ayo-Yusuf, David L Ashley, Clifford H Watson

Oral tobacco products contain nicotine and carcinogenic tobacco-specific N-nitrosamines (TSNAs) that can be absorbed through the oral mucosa. The aim of this study was to determine typical pH ranges and concentrations of total nicotine, unionised nicotine (the most readily absorbed form) and five TSNAs in selected oral tobacco products distributed globally.

Methods:  A total of 53 oral tobacco products from 5 World Health Organisation (WHO) regions were analysed for total nicotine and TSNAs, including 4-(methyl-nitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), using gas chromatography or liquid chromatography with mass spectrometric detection. Unionised nicotine concentrations were calculated using product pH and total nicotine concentrations. Fourier transform infrared spectroscopy was used to help categorise or characterise some products.

Results:  Total nicotine content varied from 0.16 to 34.1 mg/g product, whereas, the calculated unionised nicotine ranged from 0.05 to 31.0 mg/g product; a 620-fold range of variation. Products ranged from pH 5.2 to 10.1, which translates to 0.2% to 99.1% of nicotine being in the unionised form. Some products have very high pH and correspondingly high unionised nicotine (eg, gul powder, chimó, toombak) and/or high TSNA (eg, toombak, zarda, khaini) concentrations. The concentrations of TSNAs spanned five orders of magnitude with concentrations of 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK) ranging from 4.5 to 516 000 ng/g product.

Conclusions: These data have important implications for risk assessment because they show that very different exposure risks may be posed through the use of these chemically diverse oral tobacco products. Because of the wide chemical variation, oral tobacco products should not be categorised together when considering the public health implications of their use. ... 5.abstract