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Smokeless tobacco (moist snuff and chewing tobacco) in
the United States is
highly effective as an aid to quitting smoking.
In 2008 in the USA, researchers
found that 73% of the most recent quit
attempts using smokeless had resulted in smokers quitting
smoking, Of these, 54% (39% overall) had quit all tobacco, and 46%
were still using smokeless. Extrapolated, this meant that in
2000, 250,000 Americans had quit using smokeless tobacco.
Figure 1. US men, success in stopping smoking by type of aid
used in most recent attempt.1
Figure 1 cannot predict success in a given future attempt,
because only the most recent attempt is recorded.
Patches and gum were more popular, and prescribed by the health
system, but smokeless enabled twice as many smokers to quit, - it
well as any short term medicinal nicotine, and in addition can provide
nicotine long term, thus suppressing cravings for smoked
nicotine.
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In 2004, in the USA, Kozlowski
found that the 42% of young males surveyed who used cigarettes
before using snuff, were 2.1 times more likely to have quit
smoking than cigarette-only users.2 This was a cohort study
of a natural experiment.
Sweden:
Among men, snus is the most popular aid for stopping smoking, and
the most likely to be successful (2-4 times more than patch or
gum). Over the long term the cumulative effect is equivalent to
an extra third of smokers quitting. The
boost to quitting from snus over and above quitting smoking and
tobacco together, suggests that if the nicotine receptors are
continually ‘placated’ with snuff nicotine, the urge
to resume smoking for nicotine will tend not be felt or heeded.
For
quitting, randomised controlled trials
are needed to prove whether snus is a superior short-term aid and
long-term aid to stop smoking. No such trial has yet been
conducted. Snus though not a medicine, is apparently
at least as effective as medicinal nicotine in weaning smokers
off smoked-cigarette nicotine.
In Sweden and
the US, the
only two OECD countries where cigarettes and snuff are used
widely, many smokers use snus/smokeless as an aid to quit
smoking, and those that do so are more likely to succeed in
quitting smoking. The lifetime differences are greater than with
the latest quit attempt.
1.
Rodu B,
Phillips CV. Switching to smokeless tobacco as a smoking
cessation method: evidence from the 2000 National Health
Interview Study. Harm
Reduction Journal, 2008-05-23
2.
Kozlowski
LT, O’Connor RJ, Edwards BQ, Flaherty BP. Most smokeless
tobacco use is not a causal gateway to cigarettes: using order of
product use to evaluate causation in a national US sample. Addiction 2004; 99: 260-2.
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