Important Facts About Smokeless Tobacco

Health Effects of Smokeless Tobacco Products

Important Facts About Smokeless Tobacco

Smokeless tobacco has many health risks and is not a safe alternative to smoking. Smokeless tobacco contains the same addictive chemical, nicotine, that is in other tobacco products.

Key Facts about Smokeless Tobacco

  • Smokeless tobacco is linked to several different types of cancer, including cancer of the mouth, esophagus and pancreas.1
  • Smokeless tobacco contains at least 28 cancer-causing chemicals (carcinogens).2
  • Smokeless tobacco use can cause gum disease, tooth decay, tooth loss and the formation of white or gray patches inside the mouth called leukoplakia that can lead to cancer.1
  • Smokeless tobacco use during pregnancy increases the risk for early delivery and stillbirth.1

There are two main types of smokeless tobacco used in the U.S., chewing tobacco and snuff.

  • Chewing tobacco comes in loose leaf, plug and twist.
  • Snuff is finely ground tobacco that comes dry, moist or in bag- pouches.

Most smokeless tobacco users place the product in the cheek or between their gum and cheek, suck on the tobacco and spit out or swallow the juices. Smokeless tobacco is often called spit tobacco.

3 Some tobacco companies are now selling smokeless tobacco products such as snus, that do not require the user to spit, or that dissolve when put into the mouth. A U.S.

Food and Drug Administration report concluded that dissolvable tobacco products could increase overall tobacco use by encouraging kids to start using tobacco or discouraging current smokers from quitting.3

In 2016 the five major smokeless tobacco manufacturers spent more than $759 million on advertising and promotion. The largest single category of promotional expenses reported was price discounts to smokeless tobacco retailers or wholesalers to reduce the price to consumers, accounting for close to $468 million or 62% of total advertising and promotional spending.4

Smokeless Tobacco Use in the U.S

Even though cigarette smoking has decreased in recent years, smokeless tobacco has not.

  • In the U.S., an estimated 3.8% of adults are current smokeless tobacco users; use is much higher among men than women (6.8% vs. 1.0%).5
  • Among specific populations, American Indian/Alaska Natives and whites have the highest use at (2.8%).5
  • An estimated 4.1% of high school students are current smokeless tobacco users. Smokeless tobacco use is much more common among male than female high school students (6.8% versus 1.3%). 
  • Among high school students, smokeless tobacco use is highest among American Indian or Alaska Natives (9.2%), followed by whites (5.7%), Native Hawaiian or Pacific Islanders (5.3%), Hispanics (2.2%), blacks (0.9%), and Asians (0.7%).6
  • An estimated 2.2% of middle school students are current smokeless tobacco users.8

Dual Use

Dual use of smokeless tobacco with other tobacco products cigarettes or e-cigarettes is concerning. Users can face greater health impacts with dual use.

  • An estimated 9.6% of high school students and 3.1% of middle school students used two or more tobacco products, including smokeless tobacco, in the past 30 days.8

Learn about the American Lung Association's programs to help you or a loved one quit smoking, and join our advocacy efforts to reduce tobacco use and exposure to secondhand smoke. Visit or call the Lung HelpLine at 1-800-LUNGUSA (1-800-586-4872).

  1. Centers for Disease Control and Prevention. Factsheet: Smokeless Tobacco: Health Effects. December 2016.

  2. National Cancer Institute. Smokeless Tobacco and Cancer: Questions and Answers. October, 2010.

  3. Centers for Disease Control and Prevention. Factsheet: Smokeless Tobacco: Products and Marketing. July 2018.

  4. Federal Trade Commission. Smokeless Tobacco Report for 2016; Issued March 2018.

  5. Centers for Disease Control and Prevention. National Center for Health Statistics. National Health Interview Survey, 2017. Analysis performed by the American Lung Association Epidemiology and Statistics Unit using SPSS software.

  6. Centers for Disease Control and Prevention. National Youth Tobacco Survey, 2017. Analysis by the American Lung Association Epidemiology and Statistics Unit using SPSS software.

Page last updated: March 3, 2020


Chewing Tobacco Health Effects (Cancer Facts, How to Quit)

Important Facts About Smokeless Tobacco

Chewing tobacco contains nicotine and many known cancer-causing substances.

What is chewing tobacco?

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Chewing tobacco is sometimes known as smokeless tobacco or spitting tobacco. It is available in two forms, snuff and chewing tobacco. Both types of chewing tobacco are held in the mouth inside the cheek or between the cheek and gum.

Snuff and chewing tobacco are commonly available in tins or pouches; popular brand names include Skoal and Copenhagen. Snus (pronounced «snoose») is a finely ground form of snuff that originated in Norway and Sweden that comes in small tins.

The amount of snuff placed in the mouth is referred to as a pinch, dip, lipper, or quid. A portion of chewing tobacco is referred to as a plug, wad, or chew.

Chewing tobacco is known to contain at least 28 cancer-causing chemicals, medically known as carcinogens. The main carcinogens in chewing tobacco are the tobacco-specific nitrosamines (TSNAs). Some of the other cancer-causing agents found in chewing tobacco are formaldehyde, acetaldehyde, arsenic, benzopyrene, nickel, and cadmium.

Many people mistakenly believe that snus is a safe form of chewing tobacco because it is steam-heated rather than fermented when produced in Norway or Sweden, causing it to have fewer nitrosamines. However, snus still contains a number of cancer-causing chemicals.

Snus made in America is not necessarily processed in the same way as in Norway or Sweden.

Nicotine is also found in snuff and chewing tobacco, all tobacco products. Although nicotine is absorbed more slowly from chewing tobacco than from cigarettes, 3 to 4 times more nicotine is absorbed from chewing tobacco than from a cigarette, and the nicotine from chewing tobacco remains longer in the bloodstream. Nicotine is the substance responsible for tobacco addiction.

Chewing tobacco is not the same thing as chewing cigarettes. Chewing cigarettes (also termed e-cigarettes) are designed to provide nicotine in vapor to the user without burning tobacco. However, the smokeless cigarettes still provide addictive nicotine to the user and secondhand nicotine to others.

It's the world's leading cause of death, but about 1 in 3 cases can be prevented, according to the World Health Organization. There's no magic pill to keep you from getting cancer, but you can do some things to improve your odds.

  • Lose excess weight.
  • Eat less red meat.
  • Wear sunscreen.
  • Eat more vegetables.
  • Cut down on sugar.
  • Exercise.
  • Quit using tobacco.

Find other tips to lower your risk of cancer »

What are the health risks of chewing tobacco?

A number of significant health risks are associated with the use of chewing tobacco.

Other health risks of chewing tobacco

Those who use chewing tobacco have an increased risk of:

  • developing gum diseases and gum recession (pulling away of the gum tissue from the teeth);
  • leukoplakia (whitish patches inside the mouth that can become cancerous);
  • abrasion (wearing down) of teeth;
  • staining of teeth;
  • tooth decay; and
  • tooth loss.

All of the above have been linked to chewing tobacco use.

Some studies have shown a link between an increased risk of cardiovascular disease (including heart attacks and stroke) in users of snuff and chewing tobacco, although these risks are not as great as those observed in smokers. Further research is needed to determine whether or not chewing tobacco use presents a significant risk of heart disease and stroke.

25 Effects of Smoking on Your Looks and Life See Slideshow

Is chewing tobacco safer than cigarette smoking?

Chewing tobacco has been widely marketed as a way for cigarette smokers to use tobacco in smoke-free areas, so it is safer for other people because they are not exposed to secondhand smoke. However, in 1986, a statement from the U.S.

Surgeon General concluded that users of chewing tobacco should know that chewing tobacco «is not a safe substitute for smoking cigarettes.» Chewing tobacco contains nicotine, which is highly addictive, as well as a number of known cancer-causing chemicals.

Any form of tobacco use poses an increased risk of developing cancer, and no level is considered safe.

While the risks of getting cancer from chewing tobacco are lower than those associated with smoking cigarettes, the health risks of chewing tobacco are very real and potentially fatal. Chewing tobacco use also has not been shown to be helpful for smokers who want to quit smoking.

What is being done to reduce the use of chewing tobacco?

Parents are encouraged by health care professionals, school authorities, and public health officials to include the topic of chewing tobacco use when they discuss the hazards of any tobacco use with their children, especially teenaged children. It is better never to start than try to stop the addictive tobacco (nicotine) habit in any form.

Legislation has been enacted to help reduce the number of people who use tobacco products and reduce adverse health risks associated with tobacco use.

The Family Smoking Prevention and Tobacco Control Act of 2009 gives the Food and Drug Administration (FDA) the power to regulate tobacco products in the U.S.

, which will allow for increased regulation of marketing and advertising of tobacco products, including chewing tobacco.

In 2015, San Francisco became the first U.S. city to ban the use of smokeless tobacco at sporting events, including AT&T Park, home of the city's Major League Baseball team, the Giants.

What treatments are available to help people quit using chewing tobacco?

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Chewing tobacco is an addiction that can be overcome. As with cigarette smoking, various support systems, programs, and even prescription medications are available to help people quit using chewing tobacco. Examples of products available used to wean a person from nicotine addiction from chewing tobacco include:

Prescription medicines such as bupropion SR (Zyban and Wellbutrin SR) and varenicline tartrate (Chantix) have been effective in some patients who are trying to quit nicotine.

Medically Reviewed on 12/11/2019


American Cancer Society. Smokeless Tobacco.

American Cancer Society. Smokeless tobacco and how to quit.

Boffeta P, Hecht S, Gray N, Gupta P, Straif K. Smokeless tobacco and Cancer. Lancet Oncol 2008 Jul;9(7):667-75. Smokeless tobacco lesions.

Gupta R, Gurm H, Bartholomew JR. Smokeless tobacco and cardiovascular risk. Arch Intern Med 2004 Sept;164(17):1845-9.

U.S. National Cancer Institute (NCI). Smokeless tobacco and cancer, questions and answers.


Health Risks of Smokeless Tobacco

Important Facts About Smokeless Tobacco

Smokeless tobacco includes products such as chewing (spit) tobacco, moist snuff, snus (a “spitless,” moist powder tobacco, often in a pouch), and other tobacco-containing products that are not smoked. 

Some smokeless tobacco products might expose people to lower levels of harmful chemicals than tobacco smoke, but that doesn’t mean these products are a safe alternative to smoking.

Types of smokeless tobacco

There are many different types of smokeless tobacco products.

Chewing, oral, or spit tobacco

These products come as loose leaves, plugs, or twists of dried tobacco that may be flavored. They are chewed or placed between the cheek and gum or teeth. The nicotine in the tobacco is absorbed through the mouth tissues. The user then spits out (or swallows) the tobacco 'juices.'

Snuff or dipping tobacco

Snuff is finely ground tobacco packaged in cans or pouches. It’s sold as dry or moist and may have flavorings added.

Moist snuff is used by putting it between the lower lip or cheek and gum. The nicotine in the snuff is absorbed through the tissues of the mouth. Moist snuff also comes in small, teabag- pouches that can be placed between the cheek and gum. These are designed to be both “smoke-free” and “spit-free” and are marketed as a discreet way to use tobacco.

Dry snuff is sold in a powdered form and is used by sniffing or inhaling the powder up the nose.


Snus (sounds “snoose”) is a type of moist snuff. It was first used in Sweden and Norway, but it's now available in the United States as well. It’s packaged in small pouches, which are held between the gum and mouth tissues. spit-free snuff, the juices are swallowed.

Dissolvable tobacco

Dissolvable forms of smokeless tobacco come in different shapes and sizes, such as tobacco lozenges, orbs, pellets, thin strips ( melt-away breath strips), and toothpick-sized sticks.

Some of these also contain sweeteners or flavoring and look a lot candy. All have tobacco and nicotine. Depending on the type, they are held in the mouth, chewed, or sucked until they dissolve.

The juices are swallowed.

Heated tobacco products

Heated tobacco products (sometimes called “heat-not-burn” products) typically use an electronic heating element, which heats specially-designed sticks, plugs, or capsules containing tobacco. The heat releases nicotine (and other chemicals) that can then be inhaled into the lungs, but the tobacco doesn’t get hot enough to burn. These devices are not the same as e-cigarettes.

What are the health risks of smokeless tobacco?

Using any kind of smokeless tobacco can expose you to health risks. These products contain cancer-causing chemicals, as well as addictive nicotine.

Some smokeless tobacco products may expose users to lower levels of harmful chemicals than cigarette smoke, but this doesn’t mean they are safe.

No form of smokeless tobacco is a safe substitute for cigarettes. Still, tobacco companies often market these products as alternatives to smoking in places where smoking isn’t allowed.

Smokeless tobacco causes cancer

Overall, people who dip or chew get about the same amount of nicotine as people who smoke regularly. They are also exposed to more than 25 chemicals that are known to cause cancer. The most harmful cancer-causing substances in smokeless tobacco are tobacco-specific nitrosamines (TSNAs). TSNA levels vary by product, but the higher the level the greater the cancer risk.

Cancers linked to the use of smokeless tobacco include:

The risk of cancer with newer types of smokeless tobacco products isn’t quite as clear, mainly because they haven’t been studied as well as chewing tobacco and snuff. They still contain potentially harmful chemicals that might increase a person’s risk of cancer, although the amounts can vary by product.

Mouth and tooth problems

Many studies have shown high rates of leukoplakia in the mouth where users place their chew or dip. Leukoplakia is a gray-white patch in the mouth that can become cancer. These patches can’t be scraped off.

They’re sometimes called sores but are usually painless. The longer a person uses oral tobacco, the more ly they are to have leukoplakia.

Stopping tobacco might help clear up the spot, but treatment may be needed if there are signs of early cancer.

Tobacco stains teeth and causes bad breath. It can also irritate or destroy gum tissue.

Many regular smokeless tobacco users have receding or swollen gums, tooth decay and cavities (from the high sugar content in the tobacco), scratching and wearing down (abrasion) of teeth, and bone loss around the teeth. The surface of the tooth root may be exposed where gums have shrunken. All of these can cause teeth to loosen and fall out.

Other health problems

Other harmful health effects of smokeless tobacco include:

  • Increased risk of dying from heart disease and stroke
  • Increased risk of early delivery and stillbirth when used during pregnancy

Smokeless tobacco can lead to nicotine poisoning and even death in children who mistake it for candy.

All smokeless tobacco contains nicotine, which can lead to addiction. In teens, using nicotine can also harm the parts of the brain that control attention, learning, mood, and impulse control. It may also increase the risk for future addiction to other drugs.

Dissolvable tobacco is of special concern because at this time little is known about the health effects of these products. Still, it’s clear that they are another way for people, especially youth, to experiment with tobacco products and become addicted to nicotine. Because they are so tempting, they can easily poison children and pets.

Can smokeless tobacco be used to help quit smoking?

Manufacturers often imply or even claim that spit or smokeless tobacco can help people quit smoking. A lot of people believe and try this. But no smokeless tobacco product has been proven to help people quit smoking.

Un US Food and Drug Administration (FDA)-approved standard treatments that have been proven to work (such as nicotine replacement therapy (NRT) and certain drugs), oral tobacco products have not been tested thoroughly to see if they can help a person stop smoking. And research to date has not shown that they really help a person quit.

Even if using smokeless tobacco helps some people give up smoking, it still can cause cancer and other health problems, so it's not a safe alternative. And because it still contains nicotine, it’s also addictive and hard to quit.

For more, see How to Quit Using Tobacco.


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