Public Health

Pouch vs. Patch


Judging from a new study reported in Harm Reduction Journal, switching to smokeless tobacco is one of the most effective ways to stop smoking. Based on data from the 2000 National Health Interview Survey, University of Louisville researcher Brad Rodu and University of Alberta researcher Carl Phillips estimate that 359,000 men had switched to smokeless tobacco in their most recent quit attempt, of whom 261,000 were former smokers at the time of the survey. That represents a success rate of 73 percent, which looks pretty good compared to the rates for the other methods:

Smokeless Tobacco: 73%

Stop Smoking Clinic/Program: 50%

One-on-One Counseling: 43% 

Nicotine Patch: 35%

Nicotine Gum: 34%

Bupropion (a.k.a. Zyban/Wellbutrin): 29%

Nicotine Inhaler: 28%

Nicotine Nasal Spray: 0%

Notably, the vast majority of successful quitters used none of the above methods. Of smokers who said they "stopped all at once (cold turkey)," a group that consisted mainly of smokers who quit without drugs or professional assistance but also included smokers who used one or more of the listed methods, 64 percent were successful.

The differences in success rates may be partly due to self-selection bias. Smokers who quit abruptly on their own, without nicotine replacement or pills, may be less attached to the habit or more strong-willed than smokers who use other methods. Smokers who attend clinics or counseling sessions may be more highly motivated and therefore more likely to succeed, regardless of how effective the professional help is. Likewise, perhaps quitters who switch to smokeless tobacco are different from quitters who try patches, gum, or pills in a way that makes them more likely to succeed. It seems plausible, however, that smokeless tobacco is a more satisfying/acceptable cigarette substitute than patches or gum, largely because the nicotine dose it delivers is closer to what smokers are used to getting. The fact that it is viewed as a long-term replacement, as opposed to a stopgap measure or cure, may also be a factor.

As Rodu and Phillips note, switching to smokeless tobacco (especially low-nitrosamine snus) eliminates almost all of the health risks associated with cigarette smoking. Judging from this study (which, it should be noted, considered only each smoker's most recent quit attempt), it is the most effective method of quitting. Yet it was much less popular than nicotine patches, which were used by nearly 3 million of the men who tried to quit (eight times the number who switched to smokeless tobacco). It was also less popular than nicotine gum or the antidepressant bupropion, each of which was used in about 1 million quit attempts.

Switching to smokeless tobacco presumably would become a more popular method of quitting if more smokers realized that snus is much less hazardous than cigarettes. Surveys indicate that the vast majority still think the two forms of tobacco are equally dangerous. This is not very surprising, since public health officials and anti-smoking activists have not only resisted promoting snus as a harm-reducing alternative to cigarettes but have misrepresented the evidence about smokeless tobacco's health advantages.    

The full text of the study is here (PDF).

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  1. I like the nicotine wafers myself. No, I was never a smoker and I don’t plan on starting. I like them because they help me study and finish projects for college. I feel more creative after taking them. I get the benefits of nicotine without the lung or jaw cancer!

  2. I smoke myself, and I’d rather go cold turkey than mess around with smokeless.

  3. This is not very surprising, since public health officials and anti-smoking activists have not only resisted promoting snus as a harm-reducing alternative to cigarettes but have misrepresented the evidence about smokeless tobacco’s health advantages.

    It’ss not about health with the anti-smoking advocates. It never was. It’s about embracing their inner puritan.

  4. Nice thing about snus is that there is no need to spit the juices. I love a nice portion of Grovsnus. Very nice tobacco flavor.

  5. i quit smoking with chew. No I’m addicted to chew. not joking. but at least i dont wake up not being able to breath because i got shitfaced and smoked two packs the prior night.

  6. Wow… does this mean those commercials are an ineffective way to stop smoking?

    I know non-smokers who want to light up after watching those ads.

  7. Is “smokeless tobacco” the new, “handi-able” version of “chewing tobacco”?

  8. My Father was a 3-pack a day man… he really was a human chimney.. But when he started “coughing up lung” around 60 he tried to quit and took to the gum which apparently worked well enough. Been smoke free for almost two decades.

    I never got into tobacco. Figured that if you can’t make a brownie out of it, you probably shouldn’t smoke it.

  9. I tried using the patch, but it didn’t work. I couldn’t keep the damn things lit!

    Thank you, thank you. I’ll be here all week. Try the fish.

  10. Another reason that smokeless tobacco is less popular than the patch is that it’s a mess. Few things in life are more disgusting than spilling your spit cup on the floorboard of your car.

  11. Few things in life are more disgusting than spilling your spit cup on the floorboard of your car.

    One of those few things is mistaking your spit cup for your coffee cup.

  12. I smoked for a while in college, had no trouble quitting. Never had any overpowering urge to smoke.

    You may feel free to hate me now.

  13. Figured that if you can’t make a brownie out of it, you probably shouldn’t smoke it.

    Well, that’s just common sense.

  14. Mr. DNA,

    I know, I want to smoke just to say fuck you to them.

  15. I smoked a pack a day from the age of 19 up through about 23-24. I tried quitting a few times, but always for the wrong reasons… Mainly because other people wanted me to quit, not because *I* wanted to quit.

    The day finally came when I was fed up with being a slave to cigarettes. I quit cold turkey, and I’ve been smoke-free about 5 years now. But I’m probably one of the “high willpower” types discussed…

  16. I am now 23. I started smoking a pack a day when I was 16.

    After several attempts, I am now semi smoke free.
    I still smoke at parties and such, but that is currently at a rate of about one pack every two months.

    The solution for me was snus. I had used it as a substitute when working for a medical institution before, and its working out great for me.
    Im still addicted to nicotine, but I have no problems with that. At least I dont have to face the Norwegian winter* every time I need my fix.

    I find it amusing that the word snus has been adopted more or less world wide though.

    * (yes, both the white and the green one)

  17. I’ve been cigarette free for two months now. The urges are fading and I feel that I’m able to control them now. Wish me luck !

    And what about my way of quitting? Get an ounce and light that up when I feel the urge to smoke. Same smoking satisfaction, no nicotine, and I don’t care about smoking cigarettes afterwards.

    Embrace the Libertarian quitting method!

  18. As a snuff manufacturer I know not to push my own products on here, however there is an independent snuff forum called and on there, there are a number of topics where smokers all say they were unable to stop smoking until they switched to snuff.

    As most people believe all tobacco is the same and equally harmful, I have included the following quotes from Cancer Research, The Royal College of Physicians and The Lancet. These quotes are for English nasal snuff and must not be confused with other forms of nasal snuff.

    Professor Martin Jarvis, of Cancer Research UK: says that the health implications surrounding English nasal snuff use are significantly lower than smoking. “Studies show that the health hazards surrounding snuff are much less than cigarettes and the risk is approximately one per cent compared with the risks associated with smoking,” he explains. “The reason for this is that by smoking you are setting fire to the products which causes their combustion. Snuff doesn’t have the combustion products which are carcinogenic and all the user is getting is the nicotine.”

    The late Dr Michael Russell, father of tobacco addiction research:
    English nasal “Snuff could save more lives and avoid more ill-health than any other preventive measure likely to be available to developed nations well into the 21st century”. “Switching from cigarettes to snuff could have enormous health benefits”. Snuffing has two major advantages… Firstly there are no products of combustion such as tar, carbon monoxide and oxides of nitrogen. Secondly it cannot be inhaled into the lungs, which eliminates any risk of lung cancer.”

    Professor (Sir) Robert Peto, Oxford University, World renowned epidemiologist on smoking:
    “If this or some other such habit were to become widespread and did to any substantial extent replace smoking (particularly of cigarettes) then the net effect would be likely to be a reduction in tobacco-induced mortality.
    As a way of using nicotine, the consumption of non-combustible tobacco is of the order of 10-10,000 less hazardous than smoking, depending on the product. Some manufacturers want to market smokeless tobacco as a harm reduction option for nicotine users, and they may find support for that in the public health community.

  19. matth – Snus is smokeless tobacco that doesn’t require spitting. I believe it’s just a pouch that you stick in your lip… when it’s done you put it in the trash.

    I guess I fall under the cold turkey quitters, but also didn’t just up and quit. I quit smoking at home, then they banned it in bars, then stopped in my car, and finally quit (well, I’ve had a couple a day here and there, but none in 6 months) after I realized I hadn’t smoked in two weeks when I was off work for a vacation.

    That didn’t feel like cold turkey to me, but I also didn’t use a patch or anything.

  20. The problem with smokeless tobacco is that under current laws, we can’t force the brutes using it to stand outside in the cold while using it. What’s the point of tobacco without society’s shaming and judgment?

  21. Roderick – actually, this is probably one place where most people wouldn’t care if you pushed your products, although I’m sure they’d be a lot happier if you bought ad space.

  22. matth-you must be my evil twin or something, or I yours, given that’s my email address in a couple domains and you know the hazards of spilling a spit cup.

    Smokeless is hell to get rid of also, one can of copenhagen is equivalent to 40 cigs in terms of nicotine content, and you ingest more as it sits in your mouth rather than breathing in and out. When I quit, it was cold turkey, but I couldn’t walk right for 10 days, couldn’t talk right, and generally was AFU’d. It may work to help one stop smoking, but it’s a royal bitch in and of itself in regards to your seratonin levels.

  23. One of those few things is mistaking your spit cup for your coffee cup.

    I used to take great amusement in watching guys use an empty beer can for spit. Sooner or later in the course of an evening, some sap is going to forget which can is which.

  24. No form of tobacco is completely safe. We should require abstinance for tobacco, not snus. I think tobacco should be banned because it isn’t good for us, since we all pay for each others health insurance though medicare taxes, the government has a right to pass laws to make us all healthy to save the governments money.

  25. Snus should be banned, if you want tou use tobacco, you should be required to smoke it so your health problems are an incentive to children to not smoke, I believe snus is illegal in Europe except Sweden, and Sweden should ban it.

  26. Oddly enough, I was told on a US Air flight that I couldn’t dip, since there were no tobacco products allowed on flights. this struck me as uber-odd.

    Also, funny thing, I went to school in Delaware, and we had a bigger anti-dipping drive (big pics of people w/ no jaws or no teeth, etc.) than anti-smoking. Geographical quirks, I guess…

  27. Fred:

    That is one of the dumbest things I have ever heard. You do realize that you are dealing with addicts here?

    Snus is a form of tobacco that is only detrimental to the users health, not everybody else. And the real effect of snus on health is still being debated.

    And snus may make you mouth smell a bit, but at least you dont stink up the whole place after a smoke break.

    If you do have a choice of allowing one, and only form of tobacco, which would you choose?
    The one who kills people every day, or the one that _may_ have bad side effects?

    And snus is very much legal in Norway too.

  28. Yeah, but somkeless tobacco is gross, while smokefull tobacoo still looks super cool.

    honestly though, i wish i could quit, i’m sick of coughing up pflegm(sp) all the time.

  29. obligatory full disclosure: i’m all in favor of everyone having the right to use any tobacco product he wishes to.

    i never smoked, but chewed for 11 years. after three surgeries for tongue cancer, i’d say anyone using any form of tobacco is an idiot (myself included)…but i’ve never been in favor of making it illegal to be an idiot.

    i did quit cold turkey after my first diagnosis w/ very little trouble. so much for “addiction.”

    and the grossness is a subjective thing. a cloud of smoke in my face is far more gross to me than seeing some dude spit. but i started chewing in ohio, and after moving to socal could never convince folks that it’s anything other than some vulgar hillbilly habit.

  30. I love Copenhagen snuff (in this case product line is same as product category; properly perhaps “Snuff” should be capitalized here?). I got one in right now. Should be working but am reading Reason looking for Obama stories. Anyway, I think that Cope’s marketing look and promotions are brilliant. I had girls get disgusted by dip before–their problem not mine. I knew this Norwegian guy who would sit right in class and shape is “snus” into a little cylinder by squeezing/molding it with his hands for about 5 minutes; I admire that kind of insouciant confidence. If you want a good-tobacco-free substitute for dip, check out; the guy has a really nice kudzu-based dip, which tastes good (esp. wintergreen, which is funny cause I never use any flavor-type snuff anymore [although Copenhagen Black is pretty good IMO]), but his tins are really hard to get open. Much better than smokey mountain chew. I put my snuff in the upper lip; Euro-style I think, and it is closer to my brain that way, plus I think the membranes and teeth are sturdier up there.

  31. I used to dip and smoke. Quit both for a year but started dipping again. For the last couple of years I’ve been using snus, mostly the loose kind i.e. not pouches. Smokeless tobacco companies have been using better cultivation and production techniques to lessen the carcinogens in smokeless for quite some time. Seems like the smart college kids who smoke aren’t nearly as smart as they think they are compared to the rednecks who dip.

    For the guy who got tongue cancer, sorry to hear about that. But I dont think the evidence supports a strong link between either chew or dip and oral cancers. Doctors and anti-tobacco folks will put forth anyone who develops oral cancer as a reason to avoid the product but correlation is not causation. Plenty of folks get oral cancers without ever having used any tobacco.

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