What is snus? What is better or less harmful? Snus or cigarettes?

Snus is a smokeless, moist tobacco powder pouch from Sweden that is placed under the upper lip. You don't burn it or spit when you use it.

"Compared to cigarette smoking, the use of snus is probably less harmful," says Michael Steinberg, MD, MPH, Director of the Tobacco Addiction Program at Rutgers University. "But there is a big difference between less harmful and safe."

"I'd rather a person do nothing, but with tobacco products it's at the lower end of the harm scale," says Eric Garrison, deputy director of health promotion at the College of William & Mary.

What is different about snus from cigarettes?
Snus originated in Sweden as a way of preserving tobacco. In this country it is considered to be something that has helped to reduce smoking. More than half of Swedish snus consumers are ex-smokers.

"They have reduced their cancer risk," says Garrison. "They are not risk-free, but they have drastically reduced their risk by switching to snus." Without snus, the argument goes, these people could still smoke.

In Norway, snus has also helped to reduce smoking. People there have used it either as an aid to quit smoking or as an alternative to cigarettes if they have not quit successfully. And some Norwegian young people have taken snus instead of cigarettes.

But this has not been the case in the USA.

Snus is manufactured differently in the USA. While the Swedes have limited the number of chemicals that may be contained in their snus products, such as tobacco specific nitrosamines, there are no such rules in the USA. "What we have seen is that some of the tobacco companies call their products snus, but that is not quite the same as Swedish snus," says Sward. "And these nitrosamines are carcinogenic." In other words, they can cause cancer.

Besides, snus has not replaced cigarettes in the US. The number of people who consume smokeless tobacco has remained about the same over the past few decades. Snus has not changed that.

What are the risks?
Snus contains nicotine, so it is addictive - you can get addicted to it. Stopping this habit has the same unpleasant side effects as quitting smoking, including headaches and nausea.

Smokeless tobacco products also provide more nicotine and nitrosamines than cigarettes, although snus generally contains lower levels of nitrosamines than other smokeless products.

Does it help to stop smoking?
This question is difficult to answer conclusively, as it varies from case to case. Once a person starts taking snus instead of cigarettes, it is generally less harmful. One of the big problems with snus is that it prevents people from smoking, but not nicotine. They might have stopped smoking altogether. Instead of stopping, these smokers use snus as a substitute product. So it may help to quit smoking but not nicotine. Popular snus products that keep people from smoking can be found here. 

Most harmful are the tobacco products that you burn. The least harmful are medical nicotine products like patches and chewing gum. Snus falls in the middle: safer than cigarettes, but not as safe as nicotine gum. Rule of thumb: one portion of snus is about the same as the nicotine concentration of about three cigarettes.