Types of Smokeless Tobacco and Health Risks

Harmful Even Without Smoke

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Smokeless tobacco, sometimes called chewing or dip tobacco, poses significant health risks including addiction. It is not a safer alternative to cigarette smoke.

While smoking tobacco is dangerous, using tobacco in other ways, like chewing it, also raises your risk of some types of cancer and other health conditions. This is a notable concern for younger people because the Food and Drug Administration (FDA) reports that every day, 840 people under age 18 try smokeless tobacco for the first time.  

This article looks at some of the reasons for why people use smokeless tobacco products. It explains the serious health risks associated with chewing tobacco and offers tips on how to quit.

Tobacco chewing pouches

Douglas Sacha / Getty Images

Smokeless Tobacco and Nicotine


Nicotine is a highly addictive substance. When you chew tobacco, nicotine is absorbed orally. According to one study from 2014, nicotine blood levels tend to peak within about a half-hour of ingestion.

Smokeless tobacco products, regardless of the flavor or brand, are formulated to ensure nicotine absorption. Traditional smokeless tobacco products evaluated in a 2022 study of 25 different types, including modern alternatives, found the nicotine content to range from 6.9 milligrams (mg) to 12 mg in a one-gram portion, depending on the brand and style.

By comparison, cigarettes deliver 0.1 to 3 mg for each one smoked, depending on the type, according to Centers for Disease Control and Prevention (CDC) data released in 2020.

Your body absorbs nicotine from chewing tobacco a lot slower than with cigarette smoke. Still, the amount that ends up in your body may actually be more than if you were smoking cigarettes.

What Is Smokeless Tobacco?

Smokeless tobacco is available in various forms. It’s made from different dried parts of the tobacco plant. To use chewing tobacco, you typically place it between your cheek and gums or teeth. You can spit or swallow the juices. Some forms of dip tobacco are spitless.

When you put chewing tobacco in your mouth, the tissues in your oral cavity absorb the nicotine. Your blood’s nicotine concentration slowly increases. Nicotine tends to make its way to and concentrate in certain organs like the liver, spleen, and kidneys. It also makes its way to the brain. 

Why do people use chewing tobacco? Here are a few possible reasons:

  • Some use it to help quit smoking, though there’s no evidence that it’s useful for this purpose.
  • Some people like the taste.
  • Like cigarettes, smokeless tobacco products are highly addictive. People may return to chewing tobacco because they are addicted.
  • Flavored smokeless tobacco products may be more appealing and may attract new users.

Traditional Smokeless Tobacco

Traditional chewing tobacco is a dried smokeless tobacco product. It’s available in loose-leaf, twist, or plug form. Loose leaves look a lot like tea leaves. A plug is a compressed block of tobacco, and a twist is a braided leaf product that looks like a very odd, dark-colored pretzel.

Carcinogens in Smokeless Tobacco

All tobacco products contain harmful ingredients. Some of the carcinogens in chewing tobacco include:

  • Nitrosamines 
  • Aldehydes 
  • Polynuclear aromatic hydrocarbons 
  • Polonium-210 and other heavy metals 

Chewing tobacco and other tobacco products may cause the following types of cancer:

What Are Tobacco-Free Nicotine Products?

Tobacco-free nicotine products (TFNPs) are designed to replace traditional smokeless tobacco and reduce the health risks associated with it. Some are still plant-based while others are made from powders. Some studies find the powder-based brands reduce the exposure to harmful elements beyond nicotine, such as the metals (arsenic and cadmium) found in some tobaccos, but others do not. Much more research is needed to understand their health impacts.

Health Risks of Smokeless Tobacco

Chewing tobacco carries a host of health risks. While many people are aware of the oral cancer risk, they may not know about other health impacts.

Cancer

There’s strong evidence that smokeless tobacco products, including chewing tobacco, have serious health risks. Notably, they contain a host of cancer-causing ingredients. 

According to the American Lung Association, these products have links to several cancers, including oral cancers, pancreatic cancer, and esophageal cancer.

Cardiovascular 

Using chewing tobacco can also have impacts on your heart and circulatory system. According to the American Cancer Society, smokeless tobacco products can increase heart disease and stroke risk.

Oral Health

Using chewing tobacco can increase your risk of developing oral cancers, and it can wreak havoc on your oral health. It can cause leukoplakia, erythroplakia, and gum disease. It can also permanently stain your teeth. 

Leukoplakia is a condition where white spots or patches crop up inside your mouth. These lesions are sometimes precancerous. Erythroplakia is a similar condition characterized by red patches in the mouth. You can also develop both simultaneously. This condition is called erythroleukoplakia.

Pregnancy

Chewing tobacco while pregnant carries a risk of stillbirth and premature birth.

Poisoning 

Some chewing tobacco products look a lot like candy. Children may mistake them for treats, which can lead to nicotine poisoning.

According to one study, there were over 120,000 reports of child-related nicotine poisoning between 2001 and 2016. The research also suggests that these numbers are likely low due to underreporting.

Smokeless Tobacco and Other Health Impacts

Researchers continue to look at the associations between smokeless tobacco use and other health conditions, such as diabetes, damage to the nervous system, and kidney disease, but the results have been mixed. More studies are needed to understand the other ways in which smokeless tobacco harms your health.

Prevention

The only way to prevent adverse health effects caused by chewing tobacco is to quit altogether. Unfortunately, quitting can be difficult because of the highly addictive qualities of nicotine. 

Here are a few strategies to help you tackle quitting this habit:

  • Expect withdrawal symptoms and try to find a replacement for chewing tobacco. Gum is a good substitute.
  • Enlist the help of friends and family.
  • Consult a professional for help and ask about medications that might help you quit.

As of Dec. 20, 2019, the new legal age limit is 21 years old for purchasing cigarettes, cigars, or any other tobacco products in the U.S.

A Word From Verywell

You might think that chewing tobacco is less harmful than smoking. However, evidence suggests that using smokeless tobacco products can have a similar adverse effect to inhaling cigarette smoke. It’s true that your lungs won’t be affected in the same way, but chewing tobacco increases your risk for oral and other cancers. 

If you’re thinking of using chewing tobacco as a way to quit smoking, think again. Chewing tobacco contains nicotine, too, and can be just as addictive. Seek professional help if you’re struggling with quitting any kind of tobacco product. 

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14 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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