Smokeless Tobacco Helps Smokers Quit

For a smoker, trying to quit can be difficult. Popular smoking cessation methods include cold turkey, nicotine gum, inhalers and patches, medications, quit-smoking programs, and counseling. One method that has been effective in Sweden is the use of smokeless tobacco. Smokeless tobacco products, chewing tobacco and snuff, have a reputation for being just as hazardous as cigarettes, when in actuality, medical experts concur that they carry a much smaller health risk than cigarettes. In a process known as tobacco harm reduction, switching to a safer source of nicotine, such as a patch, gum, or medication, has become an acceptable form of smoking intervention. Because of the low smoking rate and low incidence of smoking related illness attributed to use of smokeless tobacco in Sweden, the authors of a study published earlier this year in Harm Reduction Journal wanted to know how smokeless tobacco use in the United States compared with other smoking cessation methods. This analysis of data from a national health survey found that smokeless tobacco use lead to greater success than other methods.

The authors used data from a 2000 National Health Interview Survey, which collected information on the methods used by smokers in their most recent attempt to quit. The study focused on men, because very few women in the United States use smokeless tobacco products. Twelve methods were examined. These included 1) stopping all at once (cold turkey), 2) gradual decrease, 3) following guidelines (pamphlet or book), 4) counseling, 5) clinic or program, 6) nicotine patch, 7) nicotine gum, 8) nicotine nasal spray, 9) nicotine inhaler, 10) medication, 11) switching to chewing tobacco, or snuff (smokeless tobacco), 12) other unspecified methods. The authors used analytic methods to generate an estimate of the entire population of men who attempted to quit using a particular method.

Smokeless tobacco use showed the highest proportion of success when compared with other methods. Out of an estimated 359,000 men who switched to smokeless tobacco in their most recent attempt to quit, 74%, or 261,000, were nonsmokers at the time of the survey. Statistics reported in the survey for other smoking cessation methods are listed according to their popularity. The nicotine patch had a 35% success rate. Next was buprion, an anti-smoking medication, with a 29% success rate, followed by nicotine gum, at 34%. Clinics and quit-smoking programs were the next in popularity, and showed a 50% success rate, with 43% for people who entered counseling. Nicotine inhalers had a 28% success rate; however, nicotine nasal spray had a 0% success rate. Other unspecified methods showed a 63% success rate. Some of the data indicated that the switch to smokeless tobacco may be a permanent one for some former smokers, with 46% of men surveyed still using smokeless tobacco. However, 54% of those who had quit smoking by replacing cigarettes with smokeless tobacco were not using any tobacco products at the time of the survey, suggesting that for some smokeless tobacco can be a first step in complete nicotine withdrawal.

The majority of smokers in the United States are not aware that a switch from cigarettes to smokeless tobacco is nearly as beneficial as quitting tobacco altogether, with only about 0.1% to 10% of the health risks of smoking. Studies of the Swedish population show that the high prevalence of smokeless tobacco use has two benefits. First, men who use smokeless tobacco and have never smoked are less likely to begin smoking. Second, use of smokeless tobacco allows a smoker to quit without completely abstaining from tobacco and nicotine. The authors looked at later editions of the survey, expecting to find that increased knowledge of the benefits of smokeless tobacco would result in increased use; however, they found instead that the option for smokeless tobacco use had been removed from the survey.

Some questions cannot be answered through analysis of a survey like this one, and the data is based on self-reported information. The value of a particular method is based on how well it works for people on an individual basis. The study only covers data pertaining to the most recent attempt, not previous ones. Still, the survey is a credible one, based on the same data used by the American Cancer Society. A large number of American men became former smokers following their transition to smokeless tobacco, despite the fact that the majority of smokers are not even aware that smokeless tobacco can be a reliable option for smoking cessation. For smokers who want to quit, the results of this study provide evidence that using smokeless tobacco could be one way to get there. No single method will work for everyone; therefore, a variety of choices, including smokeless tobacco, would be helpful to people looking for the option that will work for them. The authors concluded that if smokers were better informed about the comparative risks between smokeless tobacco and cigarettes, perhaps making the transition to a healthier, smoke-free lifestyle would be just a little easier.

References

Rodu, B., Phillips, C.

Switching to smokeless tobacco as a smoking cessation method: evidence from the 2000 National Health Interview Survey

http://www.harmreductionjournal.com/content/5/1/18