Tobacco

Where Are the Smokers?

|

Data from CPS-II, a major epidemiological study by the American Cancer Society, indicate that smokers who switch from cigarettes to smokeless tobacco have nearly the same disease and mortality rates as smokers who give up tobacco entirely. That is, switchers get almost the same risk reduction as quitters, which is good news for smokers who are worried about the hazards of their habit but are not ready to completely abstain from tobacco. Yet an analysis of the data recently published in the journal Tobacco Control dwells on the negative:

Our study suggests that switching from smoking to using spit tobacco compares unfavourably with both complete tobacco cessation and complete abstinence from all tobacco products…The risks of dying from major tobacco-related diseases were higher among former cigarette smokers who switched to spit tobacco after they stopped smoking than among those who quit using tobacco entirely.

How much higher? The overall mortality rate for switchers was only 8 percent higher, a difference that was barely statistically significant. The differences in disease rates were 46 percent for lung cancer, 24 percent for stroke, and 13 percent for coronary heart disease. Compared to the increases in risk associated with cigarette smoking, these are quite modest, and it's not clear they can be attributed to smokeless tobacco use. 

The authors of the report, who work at the American Cancer Society and the U.S. Centers for Disease Control and Prevention, argue that "a causal relationship between the use of spit tobacco and lung cancer risk is biologically plausible given the high nitrosamine content of these products." They cite rodent studies indicating that at least one tobacco-specific nitrosamine is "a strong, systemic lung carcinogen that induces lung tumours independent of its route of administration." (It's worth noting that Swedish productions methods, which are increasingly being adopted by U.S. companies, dramatically reduce nitrosamine levels in smokeless tobacco.) The authors say "it is also biologically plausible that spit tobacco could increase cardiovascular risk, given that these products have been shown to have acute adverse effects on heart rate and blood pressure, and long-term adverse effects on blood pressure and lipid profiles." But the evidence on this score is pretty weak:

Although studies on the incidence of coronary heart disease and stroke have not observed increased risk among men who use spit tobacco, studies on mortality due to cardiovascular disease have observed higher risk among spit-tobacco users, albeit not always significantly higher in smaller studies. Spit tobacco contains numerous chemicals such as nicotine, sodium and liquorice that are known to affect cardiovascular function adversely.

As tobacco control researchers Jonathan Foulds and Lars Ramstrom note in a letter to the journal, the switchers in this study were also more likely than the quitters to develop chronic obstructive lung disease, and it's hard to imagine how using smokeless tobacco could contribute to that condition. It seems more likely that the switchers were different from the quitters in some way that raised their smoking-related disease risks. The researchers controlled for cigarettes consumed per day but not for smoking intensity. If smokers who switched to smokeless tobacco tended to be more strongly attached to nicotine (which seems plausible), they may have taken more puffs per cigarette, inhaled smoke more deeply, and/or held it longer, which could account for the observed differences in disease risk.

In any event, the differences in risk between switchers and quitters pale beside the differences in risk between cigarette smokers and smokeless tobacco users. Estimates from various researchers, based on comparisons of disease rates, indicate that smokeless tobacco is something like 90 percent safer than cigarettes. That advantage would have been clear if this report had included data on smokers who neither quit nor switched but instead kept puffing away. Oddly, the researchers—who work for organizations that are loath to admit there are any differences in risk between different forms of tobacco—did not provide that comparison.

Advertisement

NEXT: Arizona Cutting Up Real ID?

Editor's Note: We invite comments and request that they be civil and on-topic. We do not moderate or assume any responsibility for comments, which are owned by the readers who post them. Comments do not represent the views of Reason.com or Reason Foundation. We reserve the right to delete any comment for any reason at any time. Report abuses.

  1. Where Are the Smokers?

    Outside. Where have you been?

  2. If you rub some skoal on your rectum, you get a rush better than snorting Jolt cola. and you can dance all night long.

    …doin the butt snoose boogie…..

  3. brotherben,

    Learn that from granny?

  4. Yes, actually I did.

    Tell me sage, how is she these days?

  5. Spit tobacco contains numerous chemicals such as nicotine, sodium and liquorice that are known to affect cardiovascular function adversely.

    More importantly, it’s fucking disgusting.

  6. If you rub some skoal on your rectum, you get a rush better than snorting Jolt cola. and you can dance all night long.

    We don’t quite go that far in these parts. But we do rub it on Mr. Happy before entering.

    “Givin her the Hot Stick”

  7. “If you rub some skoal on your rectum, you get a rush better than snorting Jolt cola. and you can dance all night long.

    We don’t quite go that far in these parts. But we do rub it on Mr. Happy before entering.”

    “Givin her the Hot Stick”

    God damn, poor people suck!

  8. brotherben wins the thread. Shit howdy!

  9. Where Are the Smokers?

    We all quit. Now blow some of that smoke this way, junior.

  10. “Spit tobacco”? I’ve never heard that term. Are they just trying to make chewing tobacco sound even more disgusting than it actually is? I mean, I think the stuff is gross (either to chew or to smoke), but that term sounds like a very pejorative way to bias an audience — unless the term has changed in general and I just never knew it.

  11. My oral surgeon uses snuff and says that the cancer scare is bogus. Apparently, it is only a factor when mixed with alcohol.

  12. Jon H,

    Then just don’t do it and I promise not to spit on you unless you get too mouthy.

    Resoniod gathering tonight: I found the secret smoking area!

    On switching: I have good money that sez your running time will improve on smokeless tobacco than on smoking anything.

  13. Frank Nelson,

    After I finish this beer and smoke a cigarette, I’ll address what you wrote.

  14. Heh, note this:

    Also, note that we call it spit tobacco, not smokeless tobacco. Smokeless tobacco is the term preferred by the tobacco industry. It makes the products sound safe; they aren’t.

    Damn those sneaky Big Tobacco conspirators!

  15. Yeah, it’s gross, but you can use it in places where smoking is prohibited. And no one can say shit about it.

  16. “If you rub some skoal on your rectum, you get a rush better than snorting Jolt cola. and you can dance all night long.”

    If you rub some shit on your mouth, it won’t taste much different than Skoal…and you can be shit-faced all night long. Besides, your woman will just adore kissing you.

  17. Discussions of relative risk miss the point, tobacco in any for is not good for us. Spit tobbaco is not a safe alternative to cigarettes because it has risks of its own. All form of tobacco should be banned because they are not good for us.

  18. Daivd McElroy – the term spit tobacco includes both dip and chew.

  19. I for one will refuse to accept the nannies’ derogatory neologism (“spit” tobacco) until they start calling cigarettes “breathe” tobacco.

    Why should I help them advance an agenda I find repugnant by helping them win the meme war?

  20. Yeah, it’s gross, but you can use it in places where smoking is prohibited. And no one can say shit about it.

    Actually, in the mid 1990s when I was assigned to the Army Personnel Command in VA, our commander declared our offices a “smokeless tobacco free zone”.

    Of course, I discovered this when I arrived for Annual Training, was going to stop smoking and loaded up on Skoal. One of the senior officers looked at me in horror and politely told me the new policy.

Please to post comments

Comments are closed.