Smokeless tobacco

Smokeless tobacco refers to tobacco product usuage by means other than smoking: chewing, sniffing, or placing the product between gum and the cheek or lip.

Smokeless tobacco forms: chewing tobacco, snuff, snus, and dissolvable tobacco products.

Most smokeless tobacco use involves placing the product between the gum and the cheek or lip.

Smokeless tobacco products typically contain over 3000 constituents.

All smokeless tobacco products contain nicotine, making them highly addictive.

Smokeless tobacco is lower on the risk continuum than combusted tobacco products but varies in risk within that class of products.

It is estimated the safety risk of smokeless tobacco is similar to that of electronic cigarettes.

Some common types of smokeless tobacco include chewing tobacco, snuff, and snus. 

Unlike smoking tobacco, using smokeless tobacco does not involve burning the product and inhaling the resulting smoke. 

Smokeless tobacco use carries its own set of health risks, including oral cancer, gum disease, and addiction to nicotine. 

Smokeless tobacco use can have various health implications, such as:

1. Oral cancer – The use of smokeless tobacco products can cause cancer in the mouth, throat, gums, and tongue. 

The carcinogenic chemicals in the tobacco can damage the DNA in the body’s cells, leading to the development of cancer.

2. Gum disease – Smokeless tobacco can cause damage to the gums, leading to gingivitis and periodontal disease. 

The tobacco can also cause the gums to recede, exposing the roots of the teeth and leading to tooth decay.

3. Addiction to nicotine – Smokeless tobacco contains high levels of nicotine, which is addictive. 

Nicotine can increase the heart rate and blood pressure, leading to an increased risk of heart disease and stroke.

4. Pregnancy complications – Pregnant women who use smokeless tobacco increase their risk of premature birth, low birth weight, and stillbirth.

5. Other health issues – Smokeless tobacco can also cause bad breath, stained teeth, mouth sores, and decreased sense of taste and smell.

It’s important to note that quitting smokeless tobacco can greatly reduce the risk of these health issues. 

There is no safe level of smokeless tobacco use.

It is correlated with a number of adverse effects such as dental disease, oral cancer, esophagus cancer, and pancreas cancer, as well as adverse reproductive effects including stillbirth, premature birth and low birth weight.

Smokeless tobacco products contain cancer-causing chemicals.

Approximately 28 chemical constituents present in smokeless tobacco are carcinogenic in nature, among which nitrosamine is the most prominent.

Smokeless tobacco consumption is widespread throughout the world.

Once addicted to nicotine from smokeless tobacco use, many people, particularly young people, expand their tobacco use by smoking cigarettes.

Smokeless tobacco is a noncombustible tobacco product.

Types of smokeless tobacco: 

Dipping tobacco, a type of tobacco that is placed between the lower or upper lip and gums.

Chewing tobacco, a type of tobacco that is chewed

Snuff, a type of tobacco that is inhaled or snuffed into the nasal cavity

Snus, similar to dipping tobacco although the tobacco is placed under the upper lip and there is no need for spitting

Creamy snuff, a fluid tobacco mixture marketed as a dental hygiene aid, albeit used for recreation.

Tobacco gum, a kind of chewing gum containing tobacco.

Gutka, a mixture of tobacco, areca nut, and various flavoring sold in South Asia.

In South and South-East Asia these products are considered part of the cultural heritage and there is little enthusiasm for regulation. 

Around 80% of users live in these regions.

Dissolvable tobacco, a variation on chewing tobacco that completely dissolves in the mouth

Topical tobacco paste, a paste applied to the skin and absorbed through the dermis

Products differ greatly in chemical arrangement and nicotine level.

Smokeless tobacco products typically contain over 3000 constituents which play a part in their taste as well as scent.

Smokeless tobacco differs depending on the type of product, the types of tobacco used, and the amount of each tobacco type used within a product. 

Each variable results in different level of nicotine. 

Nicotine is absorbed by the body to different degrees depending on the pH level of the product, which is known as the free nicotine or unionized nicotine level.

More than 300 million people are using smokeless tobacco worldwide.

Once addicted to nicotine from smokeless tobacco use, many people, particularly young people, expand their tobacco use by smoking cigarettes.

Young people are particularly susceptible to starting smokeless tobacco use.

Males are more likely than females to have used smokeless tobacco.

In 2016 nearly 6 of every 100 high school students in the US (5.8%) reported current use of smokeless tobacco. 

it is estimated that the consumption of non-combustible tobacco is of the order of 10–1,000 times less hazardous than smoking, depending on the product. 

The use of smokeless tobacco is not a safe substitute for smoking cigarettes, and can cause cancer and a number of noncancerous oral conditions and can lead to nicotine addiction and dependence.

Quitting smokeless tobacco use is as challenging as smoking cessation, and there is no evidence that using smokeless tobacco can help a person quit smoking.

Smokeless tobacco products vary extensively worldwide in both form and health hazards.

A number of adverse effects such as dental disease, oral cancer, oesophagus cancer, and pancreatic cancer, cardiovascular disease, asthma, and deformities in the female reproductive system.

It is estimated the safety risk of smokeless tobacco is similar to that of electronic cigarettes, which has about 1% of the mortality risk of traditional cigarettes.

Smokeless tobacco is not a healthy alternative to cigarette smoking.

There is no safe level of smokeless tobacco use.

Smokeless tobacco use is often linked to subsequent cigarette initiation.

Smokeless tobacco users can experience negative health consequences at any age.

Smokeless tobacco accounts for an abundance of deaths globally with a significant proportion of them attributed to Southeast Asia.

All tobacco products contain toxicants, and smokeless tobacco products contain cancer-causing chemicals.

28 carcinogens have been identified across a range of major smokeless tobacco products, primarily from 3 groups of compounds: nonvolatile, alkaloid-derived TSNAs; N-nitrosoamino acids; and volatile N-nitrosamines. 

TSNAs (Tobacco specific nitrosamines) are the most abundant in smokeless tobacco and the most carcinogenic.

Other chemicals found in tobacco can also cause cancer: 

Radioactive element (polonium-210) found in tobacco fertilizer, chemicals formed when tobacco is cured with heat, polynuclear aromatic hydrocarbons, harmful metals (arsenic, beryllium, cadmium, chromium, cobalt, lead, nickel, mercury, products such as 3-(methylnitrosamino)-proprionitrile, nitrosamines, and nicotine initiate the production of reactive oxygen species in smokeless tobacco, eventually leading to fibroblast, DNA, and RNA damage with carcinogenic effects in the mouth of tobacco consumers.

The activation of nitrosamine in tobacco by cytochrome P450 enzymes may lead to the formation of N-nitrosonornicotine, a major carcinogen.

These effects lead to further DNA damage and, eventually, oral cancer.

Smokeless tobacco can  cause leukoplakia that can lead to cancer.

Use of areca nut-containing smokeless tobacco is known to cause oral cancer, yet despite this, prevalence is increasing in the Western Pacific.

N-nitrosonornicotine and ketone are group 1 carcinogens to humans, and these two nitrosamines found in smokeless tobacco products are the main agents for the majority of cancers in smokeless tobacco users.

Smokeless tobacco use is associated with with adverse reproductive effects including stillbirth, premature birth, low birth weight.

Nicotine in smokeless tobacco products that are used during pregnancy can affect how a baby’s brain develops before birth.

Due to smokeless tobacco harms, use of medications shows some benefits: varenicline, nicotine lozenges, and some behavioral interventions may help.

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