The Swedish are at it again. First there was Volvo. Then came IKEA. Now the world can get ready for the next major Swedish export: snus. In spite of its cuddly sounding name, snus (it rhymes with loose) isn't a character on Sesame Street. It's a smokeless tobacco product, similar to dip or chew. Though it's only appeared in American stores in the last couple of years, snus has been popular in Sweden since the middle of the 19th century. Today, more men use snus in Sweden than smoke cigarettes [source: Foulds et al.]
Smokeless tobacco comes in two primary forms: chew and snuff. Any American baseball fan can tell you about chewing tobacco -- long leaves of cut tobacco that release nicotine on mastication and have been shown to cause cancers of the mouth and stomach. Snuff can be inhaled, and was common among aristocracy in 18th and 19th century Europe, or it can be consumed orally, as is the case with dipping tobacco and snus. A snus user packs the tobacco into his or her upper lip to get a nicotine buzz on par with that of a cigarette. Unlike dip, you swallow the byproduct rather than spit it out.
In recent years, American tobacco companies have promoted smokeless tobacco products like snus. Altria (formerly Philip Morris), the manufacturer of Marlboro products, spent more than $10 billion in 2008 to acquire the popular smokeless brands Skoal and Copenhagen. The company didn't stop there. Both Altria and its primary competitor R.J. Reynolds (which produces Camel cigarettes) have recently introduced snus lines.
A wealth of research from Sweden shows that snus users are at far less of a risk of cancer than smokers and people who use dip and chew [source: Foulds et al.]. Some experts even argue that snus can help people quit smoking. But like any tobacco product, it isn't without its health risks.
Since 1992, the sale of snus has been banned throughout the European Union, with the exception of Sweden. (In contrast, the sale of cigarettes has remained legal throughout Europe.) Snus is so popular in the Scandinavian country that lawmakers there threatened to boycott the EU unless their favorite tobacco product remained legal.
This article looks at snus, the unofficial nicotine of Sweden, and why both American tobacco manufacturers and public health experts are so enamored of it.
Tobacco first arrived in Sweden in the mid-1600s from New Sweden, the country's short-lived colony in modern day Delaware. It wasn't long after that snus was invented as a way to bring snuff to the masses. Necessity was the mother of snus's invention, as tobacco was prohibitively expensive for most Swedes. Playing second fiddle to the world's colonial powers, Sweden found itself with less buying power in tobacco commodities markets, resulting in high prices for the import. Sweden was also one of the first nations to tax tobacco as a luxury product. Snus, which mixes cheaper tobacco with salt and water, was introduced as an affordable -- and, without spit, cleaner -- form of snuff.
To make snus, the tobacco leaves are first cut into small strips, air- and sun-dried, and then ground into a powder. The ground tobacco is then treated with heat for 24 to 36 hours, reaching temperatures of around 212 degrees Fahrenheit (100 degrees Celsius).
A "wet" snuff, snus tobacco contains 50 percent water and 30 percent tobacco. It's usually sold in tea bag-shaped portions that the user bundles under his or her upper lip. A heavy snus user may consume the product for 13 to 15 hours a day. With high levels of salt, moist oral snuff produces less saliva than dipping or chewing tobaccos like Skoal, Copenhagen or Red Man, and the saliva byproduct is meant to be swallowed.
The finished tobacco product is chilled below room temperature to keep its contents fresh. Expect to find American tobacconists installing refrigerators if they carry snus.
How Snus Differs from Other Tobacco
The process of heating ground snus tobacco below the point of combustion is called pasteurization, and it's what distinguishes snus from other types of tobacco. In most forms of tobacco production, the leaves are left to air-dry in order to bring out their natural flavor. Air-drying tobacco leads to fermentation in which the plant's nitrogen microbes fuse with oxygen ions in the air. Fermentation brings out naturally occurring ammonia in the tobacco, increasing its acidity and allowing the body to absorb nicotine more efficiently. Because it's pasteurized, snus tobacco has less ammonia.
Snus users have to be more patient to get their nicotine fix. That's the trade-off for removing a cleaning product from your tobacco. One 2-gram portion of snus gives a boost in blood nicotine concentration of around 15 nanograms (one-billionth of a gram) per milliliter of tobacco within 30 minutes. In contrast, a cigarette delivers about 23 nanograms per milliliter of nicotine in the first five minutes, but by 30 minutes the levels of nicotine in the body are comparable between the two products [source: Gartner et al.].
To substitute for the flavor that's lost in the pasteurization process, snus manufacturers add lots of salt and sodium bicarbonate, commonly known as baking soda. Baking soda helps release nicotine (whereas ammonia helps release nicotine in other tobacco products). This means that snus is just as addictive as cigarettes. But, as any heavy coffee drinker would argue, addictiveness alone doesn't necessarily make a product dangerous.
Is Snus Safe?
Even opponents of snus admit that it releases "cleaner" nicotine than cigarettes. The pasteurization of snus tobacco kills off nitrites (chemical compounds of one part nitrogen and two parts oxygen), especially tobacco-specific nitrosamines (TSNAs). TSNAs are one of the primary carcinogens found in tobacco, and have been correlated with cancers of the lungs, oral cavity, esophagus and liver from both cigarette and smokeless tobacco usage. When tobacco is fermented, higher quantities of TSNAs are present.
By refrigerating the snus after production, snus tobacco resists fermentation that tobacco stored at room temperatures undergoes even after its been packaged. Storing tobacco at room temperature for six months increases TSNA levels by 30 to 130 percent, whereas in refrigerated snus tobacco there's no increase in TSNAs [source: Foulds et al.].
According to tobacco researchers, a snus user is 90 percent less likely to get cancer than a smoker [source: Levy et al.]. Because there's no combustion when someone consumes snus, carcinogenic chemicals that lead to lung cancer like polycyclic aromatic hydrocarbons (the byproduct of combustion of the tar in cigarettes), aren't present. In fact, researchers report that there's no statistical difference in lung cancer rates between snus users and those who never use tobacco in any form [source: Foulds et al.].
Unlike dip and chew, which contain higher levels of TSNAs resulting from the fermentation of the tobacco, snus doesn't present a risk of oral or other head cancers [source: Gartner et al.]. On the other hand, smoking doubles the risk of oral cancer and increases the risk of lung cancer tenfold [source: Gartner et al.].
When it comes to tobacco and safety, there's always a catch. One study found that almost nine out of every 100,000 snus users develop pancreatic cancer, compared to 13 out of every 100,000 smokers (and 3.9 nonsmokers) [source: Foulds and Kozlowski]. Pancreatic cancer is one of the most intractable forms of cancer; the majority of cases are diagnosed at a late stage once the disease has spread to other parts of the body, as there are no universal screening methods for earlier detection.
Pregnant women using snus gave birth to babies weighing an average of 1.4 ounces less than non-tobacco users, were twice as likely to deliver prematurely, and are more likely to suffer pre-eclampsia than both smokers and nontobacco users [source: Gartner et al.]. Snus also creates greater risk of oral lesions and tooth decay.
In spite of its risks, tobacco companies have been eager to point out that snus is safer than cigarettes. Keep reading to learn more about how snus has been marketed and regulated.
American Snus Products
If you've never heard of snus, you're not alone. Both Altria and R.J. Reynolds have launched major national advertising campaigns to introduce the strange-sounding product to American markets. Both companies are advertising in magazines and wherever cigarettes are sold. Altria and R.J. Reynolds sell their snus lines in pre-packaged bundles along with packs of Marlboro and Camel cigarettes. Depending on local taxes, Altria and Reynolds are charging from $2 to $5 for a pack of snus.
Congressional legislation that passed in June 2009 authorized the U.S. Food and Drug Administration (FDA) with new powers to restrict marketing of cigarettes. Until this legislation, tobacco marketing was restricted through a patchwork of judicial rulings. Tobacco companies can no longer use terms like "light" and "low tar" in their marketing materials, and will soon be required to add prominent warning labels such as "Smoking Kills" (these will be more dramatic than the traditional Surgeon General's warning). The 2009 bill didn't specify how smokeless products would be regulated, though it prohibits manufacturers from making claims that they are less harmful.
With greater latitude to market smokeless products than cigarettes, tobacco companies have high hopes for snus. They have tried to make the claim that snus can help smokers quit. In a controversial letter to the FDA, Altria suggested that its smokeless products are designed to "complement proven prevention and cessation strategies, not to compete with them" [source: Wilson and Creswell]. The companies have marketed the products as a way to get a nicotine fix when you can't smoke, like a nicotine gum.
Tobacco control experts are saying not so fast. They warn that American snus products aren't actually snus. The tobacco delivers far lower levels of nicotine than traditional Swedish snus. This means that Marlboro and Camel snus won't calm nicotine cravings as effectively as nicotine replacement therapy (NRT). If you think this undermines the companies' claim that snus can help people stop smoking, you're not alone.
This raises the question whether the companies are using snus to create new smokers. Unlike Swedish snus, which uses only light flavor additives, both products come in a variety of mint flavors, which have long been thought to appeal to young users. One line of Skoal, Altria's flavored dipping tobacco, has eight times the quantity of methyl salicylate flavoring, or wintergreen, as Wint-O-Green Life Savers [source: Wilson and Creswell]. While there haven't been any studies showing the quantity of flavoring in Altria's and R.J. Reynolds snus products, the companies have demonstrated a willingness to stretch the definition of the truth -- or the snus, as the case may be.
Can Snus Help You Quit Smoking?
In Sweden, one in five men and one in 25 women use snus [source: Gartner et al.]. Because so many Swedes use snus, Sweden has become a laboratory for tobacco experts to study the role smokeless tobacco products can play in getting people to quit smoking cigarettes. Swedish snus delivers more nicotine to the body than pharmaceutical NRT products like the patch or nicotine gum. (Marlboro and Camel snus have less nicotine, and therefore aren't effective cessation tools.) If it delivers more nicotine than NRT, can it help the most intransigent smokers quit?
The Swedish snus industry seems to suggest it can. According to the European Smokeless Tobacco Council, a trade industry research organization, Swedes consume just as much tobacco as the rest of the European Union, but they smoke less and suffer less tobacco-related illnesses and deaths as a result. Despite the high numbers of people who use snus, tobacco-related mortality in Sweden is among the lowest in the developed world. Any traveler in Europe can tell you how much Europeans smoke: Across the EU, 30 percent of men smoke, and 22 percent of male deaths are from smoking-related diseases. In contrast, in Sweden less than 12 percent of men smoke and 8 percent of deaths are related to smoking. As a result, Swedes are healthier and live longer. In 2000, the risk of a 35-year old man in Sweden dying from a smoking-related illness before the age of 70 was 3 percent, compared with 9 percent on average for all EU nations.
Cigarette smoking has plummeted in Sweden in the last 30 years, while the use of snus has risen dramatically. A study that looked at smoking rates among Swedish men found that between 1976 and 2002, daily smoking dropped from 40 percent to 12 percent, while snus use doubled from 10 to 20 percent in that same time period [source: Foulds et al.].
A large percentage of the smoking quitters switched to snus instead. The same study found that 71 percent of daily smokers who also use snus were able to quit smoking, compared to 54 percent of non-snus users. Sixty-two percent of men who quit smoking reported using snus as a cessation aid. This contrasts with only 38 percent who said they used NRT products. In other words, Swedish snus got people to quit smoking more than nicotine gum, the patch and other tools designed for that purpose.
In spite of these findings, snus is banned in the EU and Australia. Legislators there consider snus a "gateway" product that could lead people to smoke. Critics of snus point out that promoting the product could undermine existing tobacco control strategies, such as public bans, advertising restrictions and high sales taxes. They refer to the experience of so-called light cigarettes, which the tobacco industry promoted as safer products when they were first introduced in the 1960s and '70s. Subsequent research has shown that smokers of light cigarettes suffer the same rates of illnesses as other smokers. They observe that it's better policy to get people to quit smoking by weaning them off tobacco using proven pharmaceutical methods rather than replacing one product with another.
While snus helped many Swedes quit smoking, American snus, with lower levels of nicotine than nicotine replacement therapy, likely won't do the same. There's plenty more on the health impact of smoking and smokeless tobacco in the next section.
More Great Links
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- European Smokeless Tobacco Council. "The Swedish Experience."http://www.estoc.org/key-topics/the-swedish-experience. (Accessed online Aug. 5, 2010).
- Foulds, Jonathan and Helena Furberg. "Is low-nicotine Marlboro snus really snus?" Harm Reduction Journal. Feb. 27, 2008. (Accessed online July 26, 2010).http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2288606/
- Foulds, Jonathan and Lynn Kozlowski. "Snus-what should the public-health response be?" Lancet Magazine. May 10, 2007. (Accessed online July 29, 2010).http://www.tobaccoprogram.org/pdf/snus-response-lancet07.pdf
- Foulds, Jonathan, L. Ramstrom, M. Burke, and K. Fagerstrom. "Effect of smokeless tobacco (snus) on smoking and public health in Sweden." Tobacco Control. June 6, 2003. (Accessed online July 26, 2010.)http://www.tobaccoprogram.org/pdf/TC12349.pdf
- Gartner CE, Hall WD, Chapman S, Freeman B. "Should the Health Community Promote Smokeless Tobacco (Snus) as a Harm Reduction Measure?" Public Library of Science. July 3, 2007. (Accessed online July 26, 2010).http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0040185
- Landler, Mark and Andrew Martin. "Swedish Smokeless Tobacco Aims at U.S. Market." New York Times. Oct. 3, 2007. (Accessed online July 26, 2010.)http://www.nytimes.com/2007/10/03/business/03tobacco.html?_r=2&pagewanted=all
- Levy, David T., Elizabeth A. Mumford, K. Michael Cummings, Elizabeth A. Gilpin,
- Gary Giovino, Andrew Hyland, David Sweanor, and Kenneth E. Warner. "The Relative Risks of a Low-Nitrosamine Smokeless Tobacco Product Compared with Smoking Cigarettes: Estimates of a Panel of Experts." Cancer Epidemiology, Biomarkers, & Prevention. July 7, 2004. (Accessed online Aug. 17, 2010.)http://cebp.aacrjournals.org/content/13/12/2035.abstract
- SwedishMatch, "By Brand List of Ingredients." May 9, 2008. (Accessed online July 29, 2010.)http://www.swedishmatch.com/en/Our-business/Snuff-and-snus/Ingredients-in-snuff/By-brand-list/
- SwedishMatch, "History of Snus." July 8, 2010. (Accessed online July 27, 2010.) http://www.swedishmatch.com/en/Our-business/Snuff-and-snus/History-of-snuff/
- Science Daily. "Use Of Swedish 'Snus' Is Linked To A Doubled Risk Of Pancreatic Cancer." May 11, 2007. (Accessed online July 29, 2010.)http://www.sciencedaily.com/releases/2007/05/070510095314.htm
- Wilson, Duff and Julie Creswell. "Where There's No Smoke, Altria Hopes There's Fire." New York Times. Jan. 30, 2010. (Accessed online Aug. 17, 2010.)http://www.nytimes.com/2010/01/31/business/31altria.html