• ENGLISH ABSTRACT
Parallel to the decrease in smoking, snuff is used increasingly among people in Norway, espessially the youth. Aproximatly 180 000 were using snuff regularly in 2005. There has been a change in the cultural acceptance of snuffuse the last ten years, mainly due to growing concerns for the health effects associated with smoking, heavy anti-smoke-campaigns and the introduction of smoking restrictions to public areas. The trend is not uniqe for Norway, many other countries also see increasing consumption of snuff and smokeless tobacco.
One has known little about the health effects associated with snuffuse. Nasjonalt kunnskapssenter for helsetjenesten(the National center of knowledge for the healtservice) was given the assignment of evaluating all epidemiological evidence concerning the health effects and dependency associated with snuff consumption, and the role of snuff in smoking initiation and smoking cessation. A systematical review was published in 2005.About the same time, International Agency for Reasearch on Cancer(IARC), the cancerinstitute of the Worlds Health Organisation, published a large review on smokeless tobacco, “IARC Monographs on the Evaluaton of Carcinogenic Risks to Humans, Vol. 89, Smokeless tobacco and some related nitrosaminer”.
Several other studies concerning the healt heffects associated with smokeless tobacco consumption, especially the risk of cancer, and its role in smoking cessation have been published during the last years after the publication of the two reviews.
I have compared the two reviews and looked at some later publications and their results and conclusions.
Nicotine from snuff has a slower absorption into the bloodstream than from cigarettes, but in aproximately the same degree as when smoking.
The most abundant carcinogens in smokeless tobacco products are tobacco-specific N-nitrosamines(TSNA), N-nitrosoamino acids and volantile N-nitrosamines and aldehydes.Scandinavian snuff has shown lower consentrations of carcinogenic nitrosamines than American snuff. Many other smokeless tobacco products have shown high consentrations of carcinogenic nitrosamines.Snuff and other product of smokeless tobacco are addictive.
The two reviews conclude differently on use of smokeless tobacco and risk of cancer.IARC refer to all types of smokeless tobacco(included many different types of chewing tobacco) and different consumption around the world. Snuff has shown much lower contents of carcinogenic compounds than many other smokeless tobacco products. IARC has included documentation from animal experiments, the Norwegian review has not. Also other inclusion criterias vary among the two reviews. Epidemiological data from the USA and Asia show a raised risk of oral cancer, but this is not confirmed in northern European countries.There are limited evidence concerning use of smokeless tobacco and cancer of the oesophagus.IARC conclude that there are sufficient evidence that smokeless tobacco causes pancreatic cancer, the Norwegian review says that conclusions cannot be drawn on the sparse epidemiological evidence. A meta-analysis published in 2008 conclude that there are risk of pancreatic cancer.
The evidence on cardiovascular disease risk from smokeless tobacco use is limited.
Snuff is looked upon as less harmfull than other tobacco products for smoking, and a debate the last years has discussed wether snuff should be introduced as a product for help in quitting cigarette-smoking.Snuff is forbidden in The European Union(except in Sweden) and several other countries, but these policies has been suggested changed. Some argue that snuff could produce net benefit to health at the population level if the smokers who can’t manage quit smoking, change habit and start using snuff instead.
The reviews and studies reveal that the basis of knowledge about healheffects and risks concerning use of snuff and smokeless tobacco still is insufficient, and we will most likely see more studies and reviews on this subject the next few years.