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).