Smokeless Tobacco FAQ: 7 Things You Need to Know

What you need to know about smokeless tobacco:

• About 360 million people use smokeless tobacco around the world, including chewing tobacco, snus, snuff, gutkha, khaini, Zarda, paan (with tobacco) and many other products.
• Smokeless tobacco isn’t a safe alternative to smoking. Smokeless tobacco products are a leading cause of head and neck cancers and can lead to heart disease and severe oral diseases.
• Nicotine pouches, which are gaining popularity around the world, are similar to snus, but do not contain tobacco.
• Governments should strongly regulate smokeless tobacco, in line with other tobacco products.

As tobacco and nicotine companies promote more products that don’t involve smoking, like snus, nicotine pouches and others, questions about what these products are and whether they’re safe are becoming more urgent. Here’s a quick need-to-know look at smokeless tobacco products:

Q: What is smokeless tobacco?

A: Smokeless tobacco is tobacco that’s consumed without smoking it.

There are several kinds:

• Snuff: Tobacco meant to be sniffed or snorted
• Oral tobacco: Tobacco meant to be chewed or sucked on, like chewing tobacco, gutkha, khaini, Zarda, paan (with tobacco) and moist snuff, among many others. Most are a mixture of tobacco and other ingredients, such as betel nut, spices, herbs and/or flavor agents.
• Snus: Loose tobacco, often sold in small pouches, meant to be placed between the gum and lip.

Q: Are e-cigarettes, commonly called vapes, and heated tobacco products, like IQOS, considered smokeless tobacco products?

A: Generally, no.

E-cigarettes do not contain tobacco, and so are not considered smokeless tobacco products. Heated tobacco products, on the other hand, do contain tobacco. The tobacco industry often tries to position heated tobacco products as smokeless, since they claim the device heats tobacco instead of burning it. However, this has been contested by independent researchers, and some have said HTP emissions meet the definitions for both aerosol and smoke.

Q: Are nicotine pouches like Zyn, Velo and ALP considered smokeless tobacco?

A: No. Nicotine pouches, like Philip Morris International’s Zyn and British American Tobacco’s Velo, are smokeless products, but they don’t contain tobacco and therefore are generally not classified as smokeless tobacco products.

But because both Zyn and Velo nicotine pouches contain nicotine derived from tobacco plants, versus synthetic nicotine, some may consider them not completely tobacco-free.

Nicotine pouches are mainly comprised of powdered nicotine and other additives that cause addiction.

Q: Does smokeless tobacco cause cancer?

A: Yes. Smokeless tobacco, such as chewing tobacco, is a leading cause of head and neck cancers.

In 2017, smokeless tobacco was responsible for more than 90,700 deaths from oral cancer, esophageal cancer and pharyngeal cancer, and nearly 260,000 deaths from heart disease.

• Smokeless tobacco also causes serious mouth diseases that can lead to cancer.
• People can develop tobacco pouch keratosis, which causes the area of the mouth exposed to smokeless tobacco, such as a snus pouch, to become wrinkled and leathery.
• This can develop into conditions called leukoplakia and erythroplakia, red and/or white markings or wounds on the inside of the mouth that can be pre-cancerous.
• Gutkha and paan have been linked to oral submucous fibrosis, a pre-cancerous condition that can cause burning, pain, limited tongue mobility and can lead to malignant tumors.

Q: Is smokeless tobacco safer than smoking?

A: No form of tobacco use is safe.

Smokeless tobacco may expose people to lower levels of some toxic chemicals, especially those inhaled in tobacco smoke, but it is not a safe alternative to smoking.

Like smoking, it carries the risk of several cancers, heart disease and stroke. And similar to cigarettes and other smoked tobacco, it causes other oral health problems such as tooth decay and gum recession.

Some people may underestimate or be unaware of the risk of disability, disease and premature death related to smokeless tobacco. Often, packaging doesn’t have the same health warnings as cigarettes. A 2021 study found that more than 90% of smokeless tobacco products sold in India either had health warnings that were too small, or had no health warnings at all.

Researchers have also discovered a high rate of young people using both smokeless tobacco and smoked tobacco, suggesting smokeless tobacco may act as a gateway to smoking for teens.

Q: Do the “Big Four” transnational cigarette companies sell smokeless tobacco?

A: Yes, all four of the world’s biggest international cigarette companies, British American Tobacco, Imperial Brands, Japan Tobacco International and Philip Morris International sell snus.

To compensate for declining smoking rates in many areas and to keep people hooked despite growing smoke-free regulations, major tobacco companies began acquiring smaller Swedish snus manufacturers in the early 2000s.

Snus makes up a relatively small portion of these companies’ product portfolios, but their investment in snus may have been a precursor to their current investment and aggressive promotion of nicotine pouches, such as Zyn and Velo.

The industry sometimes conflates snus and nicotine pouches, especially when citing the supposed “Swedish Experience,” which credits the high use of snus for declining smoking rates in Sweden—though public health groups point to strong tobacco control for this decline.

Q: What can governments do to protect people from the harms of smokeless tobacco?

A: Of the roughly 1.3 billion people around the world who use tobacco, about 360 million use smokeless tobacco. Given the serious health harms of smokeless tobacco, governments must do more to regulate it in order to reduce the harms it causes.

In places where smokeless tobacco products are not banned, such products must be officially categorized as tobacco products and be subject to existing tobacco laws, such as tobacco taxation; advertising, promotion and sponsorship regulations; retail restrictions, such as not selling near schools; flavor bans; age limits and others.

Importantly, governments, health care providers and civil society groups should run public education campaigns to ensure everyone knows about the health harms of smokeless tobacco.