Smokeless Tobacco Facts

Overview

• The two main types of smokeless tobacco in the United States are chewing tobacco and snuff.^1,2
• Smokeless tobacco is not a safe alternative to smoking cigarettes.²
• Smokeless tobacco use can cause cancer, oral health problems, and nicotine addiction.²

Chewing Tobacco

Chewing tobacco comes in the form of loose leaf, plug, or twist.^2,3,4

Form	Description	Use	Market Share (2009)*
*Percentage of U.S. market for smokeless tobacco products5
Loose leaf	Cured tobacco strips typically sweetened and packaged in foil pouches	Piece taken from pouch and placed between cheek and gums	22.2%
Plug	Cured tobacco leaves pressed together into a cake or "plug" form and wrapped in a tobacco leaf	Piece taken from pouch and placed between cheek and gums	0.6%
Twist (or roll)	Cured tobacco leaves (often flavored) twisted together to resemble rope	Piece cut off from twist and placed between cheek and gums	0.4%

Snuff

Snuff is finely ground tobacco that can be dry, moist, or packaged in sachets.^2,3,4

Form	Description	Use	Market Share (2009)*
*Percentage of U.S. market for smokeless tobacco products5
Moist	Cured and fermented tobacco processed into fine particles and often packaged in round cans	Pinch or "dip" is placed between cheek or lip and gums	75.3%
Dry	Fire-cured tobacco processed into a powder	Pinch of powder is taken orally or inhaled through the nostrils	1.4%
Sachets	Moist snuff packaged in ready-to-use pouches that resemble small tea bags	Sachet is placed between cheek or teeth and gums	Data unavailable

Although some forms of snuff can be used by sniffing or inhaling into the nose,² most smokeless tobacco users place the product between their gum and cheek.³ Users suck or chew on the tobacco, and saliva can be spat out or swallowed.^3,4 The tobacco industry has also developed newer smokeless tobacco products such as lozenges, tablets, tabs, strips, and sticks.^4,6

Health Effects

Cancer

• Smokeless tobacco contains 28 cancer-causing agents (carcinogens).^2,4
• Smokeless tobacco is a known cause of human cancer; it increases the risk of developing cancer of the oral cavity.^4,7

Oral Health

• Smokeless tobacco is also strongly associated with leukoplakia—a precancerous lesion of the soft tissue in the mouth that consists of a white patch or plaque that cannot be scraped off.³
• Smokeless tobacco is associated with recession of the gums, gum disease, and tooth decay.^3,6

Reproductive Health

• Smokeless tobacco use during pregnancy increases the risks for preeclampsia (i.e., a condition that may include high blood pressure, fluid retention, and swelling), premature birth, and low birth weight.⁴
• Smokeless tobacco use by men causes reduced sperm count and abnormal sperm cells.⁴

Nicotine Addiction

• Smokeless tobacco use can lead to nicotine addiction and dependence.^2,4
• Adolescents who use smokeless tobacco are more likely to become cigarette smokers.³

Smokeless Tobacco Use in the United States

Percentage of Adults Who Were Current Smokeless Tobacco Users in 2009⁸

• 3.5% of all adults (aged 18 years and older)
• 7.0% of men
• 0.3% of women
• 1.0% of African Americans
• 5.7% of American Indian/Alaska Natives*
• 0.5% of Asian Americans
• 1.1% of Hispanics
• 4.5% of whites

*2008 estimate; 2009 estimate not available

Percentage of High School Students who were Current Smokeless Tobacco Users in 2009⁹

• 6.1% of all high school students
• 11.0% of males
• 1.5% of females
• 1.8% of African Americans
• 1.5% of Asians
• 4.6% of Hispanics
• 7.5% of whites

Percentage of Middle Students who were Current Smokeless Tobacco Users in 2009⁹

• 2.6% of all middle school students
• 4.1% of males
• 1.2% of females
• 1.7% of African Americans
• 2.0% of Asians
• 3.4% of Hispanics
• 2.8% of whites

NOTE: "Current" user is defined as using smokeless tobacco products on 1 or more of the 30 days preceding the survey.

Tobacco Industry Information

The five largest tobacco manufacturers have spent record amounts of money on smokeless tobacco advertising and promotions:¹

• $547.9 million in 2008
• $411.3 million in 2007
• $354.1 million in 2006

The two leading smokeless tobacco brands for users aged 12 years or older are—

• Skoal^® (with 25% of the market share) and
• Copenhagen^® (with 24% of the market share).⁵

References

1. Federal Trade Commission. Smokeless Tobacco Report for 2007 and 2008.
   (PDF–137.24 KB) Washington: Federal Trade Commission, 2011 [accessed 2011 Aug 3].
2. National Cancer Institute. Smokeless Tobacco or Health: An International Perspective . Bethesda: U.S. Department of Health and Human Services, National Institutes of Health, National Cancer Institute, 1992 [accessed 2011 Jan 26].
3. U.S. Department of Health and Human Services. Preventing Tobacco Use Among Young People: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 1994 [accessed 2011 Jan 26].
4. World Health Organization. Smokeless Tobacco and Some Tobacco-Specific N-Nitrosamines . (PDF–3.18 MB) International Agency for Research on Cancer Monographs on the Evaluation of Carcinogenic Risks to Humans Vol. 89. Lyon (France): World Health Organization, 2007 [accessed 2011 Jan 26].
5. Maxwell JC. The Maxwell Report: The Smokeless Tobacco Industry in 2009. Richmond, VA: John C. Maxwell, Jr., 2010 [cited 2011 Jan 26].
6. Campaign for Tobacco-Free Kids. Smokeless Tobacco and Kids . (PDF–144 KB) Washington: Campaign for Tobacco-Free Kids, 2009 [accessed 2011 Jan 26].
7. World Health Organization. Summaries and Evaluations: Tobacco Products, Smokeless (Group 1) . Lyon (France): World Health Organization, International Agency for Research on Cancer, 1998 [accessed 2011 Jan 26].
8. Substance Abuse and Mental Health Services Administration. Results From the 2009 National Survey on Drug Use and Health: Detailed Tables . (PDF–94 KB). Rockville (MD): Substance Abuse and Mental Health Services Administration, Office of Applied Studies, 2010 [accessed 2011 Jan 26].
9. Centers for Disease Control and Prevention. Tobacco Use Among Middle and High School Students—United States, 2000—2009. Morbidity and Mortality Weekly Report 2010;59(33):1063—8 [accessed 2011 Jan 26].

For Further Information

Centers for Disease Control and Prevention
National Center for Chronic Disease Prevention and Health Promotion
Office on Smoking and Health
E-mail: tobaccoinfo@cdc.gov
Phone: 1-800-CDC-INFO

Media Inquiries: Contact CDC's Office on Smoking and Health press line at 770-488-5493.