Stop smoking by using smokeless tobacco?
Except for a very vocal minority of tobacco experts, most tobacco researchers would not recommend this.
Nonetheless, with the blessing of this vocal minority, this is exactly what tobacco giant Philip Morris intends to do in August.
This summer Philip Morris will introduce a tobacco product called snus (pronounced, snoose) in the Dallas/Fort Worth area to test market its appeal to adult smokers. And some tobacco experts are applauding this effort.
Snus is a form of tobacco developed in Sweden that seems to be less risky than American smokeless tobacco products such as moist snuff (like Skoal), chewing tobacco (like Red Man) or dried, powdered snuff (Dental, Tube Rose, Peach and other brands).
Using snus for smoking cessation falls under the banner of "harm reduction," and has some support in the field of tobacco control. Such an approach seems appealing: By reducing a smoker's dependence on cigarettes, switching to smokeless tobacco (particularly snus) potentially reduces the risk for a whole host of smoking-related illnesses.
Harm reduction has been used successfully in other addictions: methadone administration for heroin addicts, for example, or clean needle exchanges for injecting drug users.
But residual tobacco-related health risks remain when a smoker quits by using smokeless tobacco, and these risks are not trivial when compared to quitting totally.
Although smokeless tobacco is much less risky than cigarettes, nonetheless mouth cancer and poor oral health definitely occur. There are also studies among large populations that show cardiovascular disease and even death by using this product.
Overall, in terms of cancer, the risk of developing mouth cancer drops from an eight-fold increased risk to a 1.2-fold increase risk when switching from cigarettes to smokeless tobacco. This is an impressive drop, but still leaves a 20 percent increase in mouth cancer risk compared to the use of no tobacco at all.
Smokeless tobacco use also seems to be associated with increased blood pressure. Among 135 middle-aged healthy volunteers, smokeless tobacco users had on average a five-point elevation in blood pressure measured throughout the day.
Another large study among over 30,000 construction workers showed that smokeless tobacco users were nearly two times more likely to have higher blood pressures than nontobacco users. This study was not without limitations, but is plausible in the light of other evidence.
Other studies, while not definitive, indicate that smokeless tobacco users may have higher rates of diabetes and abnormal cholesterol levels.
Furthermore, among youth, use of smokeless tobacco correlates with other risky behaviors such as alcohol and marijuana use, higher rates of carrying weapons, increased physical fighting, and sexual activity without condom use.
Nonetheless, some leading tobacco control advocates have championed smokeless tobacco as a means of kicking the smoking habit.
To an extent, they do have a point: Stopping smoking, even by switching to smokeless tobacco, would greatly reduce the burden of tobacco-related illnesses in the United States. They also argue that many smokers have already made the switch to smokeless tobacco and remain smoke-free -- particularly men.
But there are several reasons why, in the opinion of other well-known tobacco researchers, this approach is flawed.