Toque Snuff Blog

Stop Smoking with Snuff

2012-01-05T03:13:00.000-08:00

We are unfortunately tied by EU laws regarding tobacco and are unable to openly talk about the health benefits and harm reduction of switching from smoking to snuff. By blogging here we can raise awareness of snuff and the potential to save lives.
Please leave a comment on stopping smoking with snuff.

Silver Dollar - US Launch

2011-05-19T08:43:00.000-07:00

We at Toque have been incredibly busy of late. The Toque brand has been quietly spreading all over the World and now we have a second brand just for the USA. Six flavours of Silver Dollar are about to hit the streets all over America and we hope it goes down, or up, as well as our own Toque brand has.

Our thanks to all the new snuff users and all our old customers for helping make Toque such an iconic brand.

Toque is runner up in the "New Exporter of the Year 2010"

2010-08-28T03:11:00.000-07:00

Toque is runner up in the "New Exporter of the Year 2010" at the Hilton Hotel, Newcastle on the 15th of July.

We are delighted to be the recipient of this prestigious award and would like to thank all of our customers for their help in making this possible.

I hope that doesn’t make us sound too much like a ‘Miss World’ contestant.

[Nasal Snuff] 09 - Toque - Champagne

2010-05-04T11:01:00.001-07:00

[Nasal Snuff] 10 - Toque - Toffee.avi

2010-05-04T11:01:00.000-07:00

[Nasal Snuff] 14 - Toque - Xmas Pudding.m4v

2010-05-04T11:00:00.002-07:00

[Nasal Snuff] 16 - Toque - Coke

2010-05-04T11:00:00.001-07:00

[Nasal Snuff] 17 - Where to get them.avi

2010-05-04T11:00:00.000-07:00

[Nasal Snuff] 18 - Toque - Peppermint

2010-05-04T10:59:00.000-07:00

[Nasal Snuff] 19 - Toque - Chocolate

2010-05-04T10:58:00.000-07:00

2010-04-30T04:42:00.001-07:00

(Reuters) - Smokers who are unable to quit should be able to get access to nicotine products which do not carry the same health risks as cigarettes, doctors said on Friday.

Encouraging people who can not, or will not stop smoking, to switch to lower-risk nicotine products could save millions of lives, says the Royal College of Physicians (RCP).

In a report: "Harm Reduction in Nicotine Addiction: Helping People Who Can't Quit," it accused the government of failing to help heavily addicted smokers through a lack of innovation and burdensome regulation.

Professor John Britton, chair of the RCP tobacco advisory group, said: "Smokers smoke because they are addicted to nicotine, but it isn't nicotine in cigarette smoke that kills: it's the hundreds of other toxic chemicals that come with it.

"The best thing that a smoker can do for his or her health is to quit all smoking and nicotine use completely.

"However, there are millions of smokers who can't quit, or else who are unlikely to quit, and those people need nicotine products that can satisfy their addiction without killing them."

Existing products like special chewing gum deliver nicotine at low and slow levels, often failing to give the smoker the hit that they crave, and therefore, failing to get the smoker off cigarettes.

The RCP believes there is a big a gap in the market, which it wants to fill.

The college said nicotine is not especially harmful, so "if we could provide the nicotine 'hit' that smokers seek in a form that is acceptable and effective as a cigarette substitute, millions of lives could be saved".

Its report blamed the regulatory system for actively discouraging the development, marketing and promotion of such products, and called for the entire nicotine market to be reformed by a new regulatory framework.

The RCP also called for a reversal of the advantage cigarettes have in the marketplace.

Cigarette smoking caused 100 million deaths in the 20th century, the report said.

Kate Matrunola, spokeswoman for British American Tobacco, said: "We agree with the Royal College of Physicians that smokers should be able to buy a lower risk alternative to cigarettes. We believe that should include snus, a smokeless tobacco product from Sweden which the Royal College has said is significantly less harmful than smoking.

"Snus is banned in the EU, bar Sweden, and some other countries. We believe it should be legal everywhere because it offers smokers who don't want to quit a far less harmful alternative to lighting up a cigarette."

Some scientists however are concerned about snus because it keeps people addicted rather than encourages them to quit and is not completely harmless, they say.

Toque Snuff Cocktails

2009-09-08T10:23:00.000-07:00

Toque Snuff Cocktails

1 part Blueberry & 1 part Vanilla = Blueberry muffin

1 part Espresso, 1 part Vanilla & 1 part Chocolate = Tiramisu

1 part Cherry, 1 part Vanilla & 1 part Chocolate = Black forest gateau

1 part Chocolate, ½ part Espresso & ½ part Peanut Butter = Mud Pie

1 part Peppermint & 1 part Chocolate = After Eight

½ part St Clements & 1 part Chocolate = Terry’s Chocolate Orange

1 part Bourbon 2 part Coke = Bourbon and Coke

1 part Chocolate & 1 part Cherry = Chocolate Covered Cherry

1 part Chocolate & 1 part Peanut Butter = Reece’s Peanut Butter Cup

1 part Peanut Butter, 1 part Vanilla & 1 part Raspberry = Peanut butter & Jelly sandwich

1 part Chocolate & 1 part Raspberry = Raspberry Truffle

1 part Vanilla, 1 part Champagne, 1 part Peach & 1 part Raspberry = fruit Trifle

1 part Champagne & ½ part Raspberry = Kir Royal

1 part Chocolate & 1 part Blueberry = Chocó berry Martini

1 part Espresso & 1 part Chocolate = Midnight Express

1 part Vanilla & ½ part Chocolate = White Chocolate Soufflé

1 part Chocolate, 1 part Vanilla, 1 part Toffee, 1 part Raspberry & 1 part Cherry = Mother Lode Parfait

½ part Absinthe & 1 part Toffee = Old Fashioned

1 part Vanilla, 1 part St. Clements & 1 part Toffee = Christmas Candy

1 part Peanut Butter & 1 part Toffee = Evening Delight

½ part Menthol, 1 part Chocolate & ½ part Peppermint = Winters Kiss

½ part Raspberry, ½ part Blueberry & 1 part Peanut Butter = Berry Good Butter

½ part Vanilla, 1 part Cherry & 1 part Chocolate = Ben & Jerry's Cherry Garcia

1 part St. Clements & 1 part Grapefruit = Vitamin C

½ part Champagne & 1 part St Clements = Bucks Fizz

½ part Peppermint , ½ part Chocolate & 1 parts Vanilla = Grasshopper

½ part Chocolate, ½ part Vanilla 1 parts Espresso = Mud Slide

3 parts Absinthe & 1 part Espresso = Flaming Sambuca with coffee beans

1 part Espresso & 1 part Vanilla = Cappuccino

1 part Espresso, 1 part Vanilla & 1 part Chocolate = Mocha

1 part Espresso, ½ part Toffee & ½ part Vanilla = Macchiato

1 part Raspberry ½ part St Clements = Raspberry Kiss

1 part Cherry, 1 part Raspberry & 1 part Blueberry = Very Berry

1 part Cherry, 1 part Raspberry, 1 part Blueberry & 1 part vanilla = Berry Smoothie

1 part Natural, 1 part St Clements & 1 part cherry = Sea Breeze

1 part SP Extra, 1 part St Clements, 1 part Blueberry, 1 part Natural & ½ part Peppermint = Long island iced tea

1 parts SP Extra & 1/2 part Toque Rose = Wild rose

1 part Coke & 1 part Vanilla = Vanilla Coke

1 part Coke & 1 part Cherry = Cherry Coke

Stop Smoking with Toque Snuff

2009-06-07T03:00:00.000-07:00

Stop Smoking with Toque Snuff

‘The British Medical Journal’
“Our findings suggest that a new age for snuff is coming and it is a feasible alternative to cigarette smoking"

‘Cancer Research UK’
"Snuff seems an entirely acceptable substitute for smoking and could be recommended for addicted smokers because, if they could substitute snuff-taking for smoking, they would greatly reduce the risk to their health"

‘The Lancet’
"Switching from cigarettes to snuff could have enormous health benefits"।

‘Cancer Research UK’
"Studies show that the health hazards surrounding snuff are much less than cigarettes and the risk is approximately one per cent compared with the risks associated with smoking"

‘The British Medical Journal’
"Switching from cigarettes to snuff could have enormous health benefits.... the absence of tar and gases such as carbon monoxide, oxides of nitrogen, and many other toxic combustion products, would virtually eliminate smoking-related cancer, bronchitis, and possibly heart disease. Also, snuff does not contaminate the atmosphere for non-users”

‘The Lancet’
"Snuff could save more lives and avoid more ill-health than any other preventive measure likely to be available to developed nations well into the 21st century"

‘Cancer Research UK’
‘By smoking you are setting fire to the products which causes their combustion. Snuff doesn’t have the combustion products which are carcinogenic and all the user is getting is the nicotine."

These are all genuine customers who have successfully stopped smoking using snuff.

1. I quit smoking and moved onto snuff about 2 and a half months ago and haven't looked back. I was actually very surprised at how easy the transition was. I smoked 'roll-ups' (loose cigarette tobacco with papers) for 14 years. *lungs take a deep clear sigh*. Just wondered if there are any other peeps like me who have quit smoking with nasal snuff.

2. There are many here, me being one of them. Snuff is much more enjoyable I think.

3. I also quit strong smoking for 26 years, 10 weeks ago. The transition was easy and pleasant.. I didn’t miss cigarettes,but had some little infections during the first weeks.. Maybe a problem with the immune system.After 10 weeks I just can say, happy to be here :)

4. That's me as well....

5. I quit recently. When I started taking snuff it wasn't my intention, I just didn't like smoking any more and ended up having just one a day out of habit until I figured out I didn't want that one. I still have a nearly full pouch of rolling tobacco that I haven't touched since the day I didn't feel like smoking. No willpower required!My enjoyment of tobacco has also increased immeasurably since ditching cigarettes which includes smoking it. I am now a lot more aware of why I use tobacco.

6. My experiences were just the same, just sick of smoke. I still have the odd one and always will, but snuff is the main thing now - I might not have a cigarette for weeks and the thing that’s helped me most has been not going through any mental quitting saga. No guilt, no willpower, just choosing not to smoke today; a bit like the AA approach. After many, many attempts to quit this has been the best way for me, with snuff (which I’ve used on and off of for years) playing a big part. I owe a lot to Wilsons and Toque! It’s also great not to have to loose tobacco from my daily life and snuffing is a much purer way of using it.
7. I smoked for 25 years, I quit cold turkey, and I did have a bit of incentive though... I was diagnosed with emphazema and COPD, but I did find that months later, when the addiction started getting the best of me, that a couple of sniffs killed the cravings.

8. I quit cigarettes because of snuff as well. The more I used snuff, the less cravings I'd get for smoking. I have started smoking a pipe on occasion. However, that is even a rare thing. The only time I'll have a cigarette now is when I have a sinus cold and am too plugged up to use snuff. Right now, snuff is my main thing.
9. Smoked for 20 years or so. The little woman wouldn't tolerate my smoking and coughing any longer, after quitting herself two years earlier. I've successfully kicked the habit again after trying snuff about three years ago. I still have a smoke once in a great while but snuff is my main tobacco vice now. It's discrete, satisfying in its own wonderful way and the flavours.....my god the sheer number of flavours and scents.... I only regret that I may not live long enough to try them all.....

10. I actually quit cigs with snus but someday I will probably quit snus with snuff... who knows for sure but snuff is something that I have no qualms about admitting to be a lifer.

11. Yeah I quit with snus defiantly. The funny thing is I wasn't trying to quite cigarettes at all I just decided why the heck would I smoke if I can snus it's definitely better

12. I quit cigs with snuff. I was coughing up something nasty and remembered something about snuff and some smoke shop had some old dusty snuffs. Instant quitting thanks to snuff.

13. Plan to be an ex-smoker soon. Just can't let go of the apron string quite yet. The snuffis definitely taking care of my need for nicotine. But there is the "habit" and "hand to mouth"issue going on. Plus, I am one of those folks who actually likes the smell of burning cigs!So been trying to incorporate "tea tree Australian chewing sticks" in my life for the hand to mouthneed. It does help, I treat it like a cig in a way. Just have one in my hand and put it in my mouthhere in there for a moment. Taste real nice too!When I am in public or just even with company, I don't miss the smokes so much because I am chatting with them or just enjoying observing. But I live alone and spending a few hours alone in front of the compy just makes me want to smoke. So that is when I use the toothpicks, alternately with cigs still, 8/8/08 isn't hereyet! In public don't really want to use toothpick, so then I use a small "rubbing stone" for my thumbto at least have something to do with my smoking hand and sometimes put a tic tac in my mouth for the oral fixation. Good luck to all wanting to quit the cigs with snuff!

14. I quit last July, after smoking a pack a day for 30 years. It didn't make it "easy", but it does separate the addiction from the habit, so I can still have my vitamin N, while I'm working on beating the habit. This is what Grace is talking about. The need to bend your elbow. If you really want to quit, it's amazing the stuff you'll try. My son has come home and found me out on the porch with such a big pinch of O&G up my nose, he could smell it when he walked by, feverishly throwing one of his yoyos up and down. I've got a good friend that says that between the "habit" and the easy availability, cigarettes are harder to quit than heroin. And knowing him, he's probably speaking from experience!
15. Well cigarettes are more addictive then heroin (it's a fact). In a large part because of the manipulation of chemicals put into cigarettes. Plus the fact you can always find smokes doesn't help much either.Though I found when switching to snuff it helped if I play smoked one of my pipes while snuffing. Yeah everything but packing the bowl and lighting it. Though I feel too silly to do it in public. Maybe a bubble pipe would work well for that.

16. Just thought I would add my thoughts here.I smoked cigarettes for about 30 years. I never really can recall at all enjoying any of them, I was just a nicotine addict, and gave little thought to taste. Indeed I have heard it said that if cigarette smokers smoked for taste they would never get past their first one.About five years ago I had gotten to the point that I was really scared how cigarettes were controlling my life, and I turned to pipe smoking as a way to get off them. The big problem was I was still looking at pipes as a tool to get nicotine from, and as a result I could not smoke without roasting my mouth off. So I was back on the cigs again.In a last ditch effort to stop I bought a nicotine nasal spray. It worked a treat and with it I was able to stop smoking quite easily, however cost was a big problem with the nicotine spray. I had heard of snuff, knew it was tobacco and hence came to the conclusion that it might provide me with enough nicotine to wean me off cigarettes without busting the bank.I did a bit of Internet research and came across Griff's web site and his advice on how to use snuff to give up cigarettes.I never looked back after that and have been ciggie free ever since. There are times when I do not use any tobacco products at all, but now when I do I really do so for flavour and taste and not as a means of quenching a drug addiction. I have even revisited pipe smoking, and on many nights will enjoy a bowl of tobacco while reading a book. Some evenings I will take a pinch of snuff instead, and on others nothing at all.I now look upon tobacco as one of life’s little pleasures much similar to an occasional glass of wine. In addition being a non drinker and non gambler an occasional pinch of snuff or the odd bowl of tobacco are my only vices now I am pleased to say.

17. I once heard a smoking cessation author (Alan Carr?) liken the 'pleasure' of cigarettes to that of taking off a pair of ill fitting shoes that are hurting you; i.e. simple relief that we condition ourselves to equate to pleasure. Remember your first cigarette - it made you feel nauseous and tasted dreadful. On this argument no smoker has ever really enjoyed a single cigarette, anytime, anyplace; but the conditioning is massively powerful. I'm not sure how much I agree with this because I still have the odd cigarette and still think I enjoy that occasional cigarette, but it’s an interesting point I think.

18. Ok all, I am doing a daredevil move here and have these last 29 ciggie I have at my disposal be my last. Just can’t see myself shelling out the dough for more cigs after these, not with this huge stash of snuff I have.Wish me luck!

19. Grace, I found that once you make the decision to quit and really mean it the battle is won. I now enjoy my little indulgences, I can never really remember enjoying any cigarettes. I now cannot even picture myself smoking a cigarette, and I hate the smell, they don't half stink!Best of luck

20. Grace, you can do it!Just hold off as long as you can, until you get twitchy, then take a few pinches, it will set you right.I used to smoke cigarettes, for over 20 years. I quit, and told myself I hated them, but at times, the urge became strong. One smoke and I was back on the hook. Terrible. I remember buying a pack of smokes, guiltily, then smoking 5 or 6 in a chain, then throw the pack out the car window. Only to do it again. And again. I can't count the number of times I've quit.

21. Finally got a few years smoke free under my belt, and then took a liking to cigars. Too expensive. Then started roll-ups, because sometimes there was no time to commit to a cigar...ah, slipping down the slope again. I decided to try the pipe. I still like the pipe, it's a very nice way to smoke, and is acceptable to my wife. In fact I am allowed to puff (non-"stinky" blends) indoors. Some pipe blends are quite satisfying in terms of nicotine, but the delivery is very slow. I still find pipe smoking very relaxing and good. I found out about snuff through the pipe forums. I thought: "That's crazy! People still do that??" I had to find out more, and then found this forum. Here I learned a lot about snuffs and flavours, met lots of nice people and now NO urge for cigarettes or roll-ups. Been 3 days since I finished off those last smokes! Have not been on computer for those three days as that isa "trigger" for the "bending of the elbow" Feeling pretty good now however, and enjoying being around people and not having to worry if I offend them by smoking!

22. It’ll get easier. I quit the death sticks with snuff. In my case it was instant because by that point I desired the nicotine far more then the cigs because I was coughing up the nasty. My fav part of quitting is that everything of mine does not reek and taste and smell again. Pretty soon your foods will be much tastier then before.

23. I've been a pipe & cigar smoker for years. My wife is veryanti-smoking so, no smoking in the house. I started using snuff so Icould partake in tobacco without smoking. It turns out I enjoy thesnuff so much, it has really cut down on my pipe/cigar smokingalthough I don't see me quitting completely.

24. I began snuffing off and on back in '99 while I was smoking and dipping. I hadno intentions on quitting any of it at that time. So during that time I wasenjoying snuff for the sake of it. At one time I was utilizing nicotine in everyway that I knew.>>I then realized I could use snuff to get rid of my cig habit which I was tiringof. I am now back to snuff for the sake of enjoying it.

25. I just recently switched from smoking and using chewing tobacco to snuff

26. To me, the effect is somewhat lower but moreimmediate. I also take Swedish snus to round out mynicotine cravings (3 months and 1 week without acigarette today!)

27. I've quit smoking with just snuff. Just recently I ran across a page about snuff while browsing the web and I remembered that I had tried snuff years ago and didn't like it. Now, I love the stuff and haven't been smoking at all for about the last week! You can do it...just have a pinch whenever you get a craving and keep having pinches until the caving goes away.

28. I am still committed to quitting and have found for me the only real alternative is a good snuff.

29. I sat down one day and carefully thought about what I was doing and how I was probably killing myself with a habit which I was coming to thoroughly hate. However I had gone through the hell of giving up many times and had considered that I would never succeed at all. However I was going to give snuff a try since patches, gum etc all had failed, I even started smoking while eating filthy nicotine gum. I was determined to replace a foul stinking habit with maybe one I would enjoy. To cut a long story short, every time I felt like a cigarette I took a pinch of snuff which gave me probably as much nicotine as a cigarette seemed to give, but in a more acceptable way. My first little tin of Snuff lasted almost a week. Compared to a 105 pack of 4mg gum which would last three days, maybe even less?

30. Eventually I even reduced my snuff intake drastically as my nicotine tolerance decreased. Yes I noted that I was beginning to need less and less snuff until I was using it occasionally as a pleasure, not a habit.

31. What I can say is I was a very heavy smoker and once I stopped I found snuff was the answer to a prayer. I use to wake up coughing and had a permanent wheeze and could no longer get a full compliment of air into my lungs. Snuff was the answer and I used it by the bucket load in those first few days of stopping smoking. Today I have no problem whatsoever regarding wheezing and difficulty in drawing breath, except, of course, when my nose is overly congested with snuff!!

32. Going on my third day now and I am learning the snuff. It seems that itdoes not completely stop the craving for a cig. at least for me, sofar, but it has helped to reduce the craving intensity and duration.

33. I didn't expect it to make me quit overnight, but already I'm able toresist the urge to smoke pretty well.

34. To be quite honest about it, my next goal having got off cigarettes> and pipe is to try and stop snuffing as well!! However if I do not> get there and end up using it occasionally it will not break my> heart, as the health problems of smoking are I feel much greater.

35. In my reply to that post I responded by stating how through the use> of nasal snuff I have gone from being a cigarette chain smoker to> using snuff just a few times per day.

36. I was a heavy smoker for about 20 years, more than 10 of those smoking unfiltered hand rolled cigarettes. I've quit with a combination of nasal snuff and Swedish snus...last cigarette was about a year and a half ago.

37. I read “Any ex-smokers?” But as I stated in my introduction I’m new and ended up at this forum for a different reason. I know absolutely nothing about snuff. What I did not get from the discussion “Any ex-smokers?” Are you putting a pinch in your mouth or are people stopping by sniffing snuff? Which method of using snuff is preferred and why did you pick the method you use? I’m in the US so I do not know even what brand to try. Being a woman I’m not sure I’d like spitting it out if it’s like chew tobacco. Any advice is welcomed. I’m tired of smoking, can not use the patch, Chantex pill cost to much.

38. I stopped smoking a few years back very easily using snuff, but I think the two most important things are, or at least for me were:-(1) you really got to want to stop smoking. If you are only partially motivated you will fail.(2) Only use snuff when you are really craving for a cigarette.It might be a bit hard the first week or so, also it depends on why you smoke.I smoked not for social reasons, not for hand mouth occupation, but because I was a nicotine 'Junkie'. I hated the foul taste and smell of cigs, but had to put up with it to get my fix. Now if I smell them I want to vomit!I really did not give a damn how I got nicotine, from gum, cigs; pipe anything as long as I got nicotine. As a result I think this made it real easy for me as snuff can give as much and even more nicotine than cigarette smoking.Eventually your nicotine tolerance will fall drastically. Can I also suggest that you try using either a Plain tobacco snuff or an SP type? These are probably more to the liking of ex cig smokers rather than the floral or fruit flavoured snuffs which personally I hate. You might also steer away from heavily mentholated types also as they can be kind of rough on the nose.If you don't take snuff initially just when you really want a smoke, you will likely become a chain snuffer, as well as a cigarette smoker, ending up with two nicotine habits.I would suggest you try Toque Original or Natural, or some type of SP such as Tom Buck or McChrytals S'nuff.For what it's worth I went from smoking 40+ a day, to now using a pinch of snuff every 2-3 hours. Some days I don't start till after mid-day. I very occasionally will enjoy a bowl of pipe tobacco for relaxation.I understand that American snuff is quite different from European snuff. European snuff is not (normally) taken orally. I tried sniffing American Levi Garrett snuff once and near blew my brains out! It was a rough experience indeed.Good luck and I am sure others will have found a different experience.I truly believe the secret to really enjoying snuff is with moderate use.

39. Yup, I QUIT!Smoking, that is.Three days with a nasty stomach virus and I haven't lit up since.Still doing' snuff Bet youBut I am not lighting-up no more.

40. Good job MM, since I quit over a year ago (I was a 25 year smoker) I cannot stand the smell of them anymore. Pipes and cigars I don't mind, but cigarettes just smell awful now. Anyways, hope you stick with it, good luck!

41. My favourite thing about not smoking cigarettes anymore is the fact that when I run my lungs don't feel all firey. That rocks plus the actually being able to smell things and plus the ladies find it sexy when a man doesn't get all wheezy when he excerpts himself. Cigarettes suck.

42. I stopped smoking 5 weeks ago, with the help of snuff and without problems, after smoking 40 cigarettesdaily for 25 years. It’s wonderful to see how much better I m feeling now after just 5 weeks, I can breathedeeply again :)

43. I've stopped totally now thanks to snuff, had a relapse a couple of weeks ago but I don't enjoy smoking, I don't like it and I'm sick of getting piss wet through and frozen while on a night out, because you can't smoke anywhere. Well done MM!Hi mountain man, haven’t seen u around for a while. Congrats on quitting. stick to it and whenever u get an urge to smoke take an extra large pinch of the good stuff

44. I used snuff to quit smoking though and I have found it to work wonders. Not only did it take my cravings away for cigs, but I actually enjoyed it. It took away that need to smoke even though I hated to smoke, just purely out of addiction, and allowed me to start really enjoying tobacco. It is nice that I can call it a hobby now instead of an addiction : )

45. Though I actually quit by using the patch for 4 weeks and then treated myself to snuff I would say that to be successful you could use snuff in place of the patch. Use the snuff and don't smoke at all anymore, no excuses. I haven't smoked cigarettes in a few months now and have no desire to, and that's after a pack a day for nearly 25 years. I also calculated how much I'd save in 4 months at $4-5 a day and went and spent the money. Basically a guilt trip on myself. If I spent one dime on cigarettes now I'd feel like a fool for spending the money.

46. For me, since I had been trying by using nrt, even though I was never 100% successful with that, I think that it sort of prepared me. Granted I have only been snuffing for a couple of weeks, but other than the first few days, I have not smoked at all nor had the craving to at all. I just remember how much I HATED to smoke. I hated myself every time I lit one, and I love to snuff so it makes it easy.

47. I smoked for years but always loved snuff and snuff boxes etc; in July 2007 in the UK it became illegal to smoke in most public places, so just switched. I was surprised that snuff really does take away the cravings - I'd not noticed this before because I hadn't used it in this way before. I've probably smoked less than 20 cigarettes since July. I will always have the odd lapse (in fact I fully intend to) but snuff more than compensates day to day, plus there is an interesting culture, different types to try, beautiful snuff boxes, whereas cigarettes are not much more than an addiction with maybe a bit of fading glamour/nostalgia for the over 40s like me! Snuffs the way forward I think, cheers, Nigel

48. I completely agree with your last post. It has been less than a week now that I have been using snuff. I was smoking about a pack a day. Well, I bought a fresh pack Monday morning and I've only smoked 9 of them so far. I have been training myself to use snuff in place of the cigs every time I get the urge to smoke. Yesterday I only smoked 1. Today I'm shooting for zero. I would also like to point out that I have been smoking for 14 years.

49. I had a 40 cigarettes per day habit. Here's how I moved over to snuff from ciggies.Firstly, try to make it not a 'hard' and final decision. Psychologically it's easier to say to yourself I can smoke whenever I want, but I want snuff...Start replacing a cigarette with a pinch. Every time you fancy a smoke have a pinch instead. If you have a cigarette don't sweat it, just realise that it was your choice to get your nicotine fix from a smoke that time rather than from a pinch of snuff... Then go back to having a pinch every time you have a craving.Rinse and repeat, if you falter, get up; dust yourself down, start again.It's all a double bluff I realise, but speaking as someone who's tried every kind of NRT from patches, spray, gum to hypnotism and finally holding metal balls and having positive energy charged through me... (No joke!) Etc, and failed - snuff can be your saviour!Snuff is better I think than NRT because you have the paraphernalia... You have a snuff box, or a bullet and all the bits and pieces that go with it. There's a ritual like with smoking... You have ‘tobacco’; you still get a nicotine hit. You're still slightly 'naughty'...!When you decide, you decide. Do it for you and for no one else, unless you really don't want to stop... I gave up for all kinds of people, but giving up because it was my decision was the one that worked.You can then become a person who uses snuff to get their nicotine hit, but has the odd occasional cigar, pipe, cigarette if you want - that's a nice feeling!I still smoke, but smoke when I want to, not the other way round. Do I want to stand outside the pub smoking in the freezing rain, or sit in the warm with my pint and snuff box...? Easy question!Best of luck and keep us updated.

50. Both my brother and my best friend (of 30 years...jeeze) gave up with snuff. Exactly as Nosebag described.... that's how they both see it. The reason snuff tends to work where other NRT does not is because of the super-fast uptake which is only marginally behind cigs (we are talking mere seconds, to at most 50 seconds difference); the hit is nice and hard and it takes a little longer to fade because of the residual effect of the snuff sitting in your nose. The paraphernalia and ritual is a good point to....personally I find myself rolling my wee tin around quite a lot; tapping the top; wee shake; another wee tap; slowly twist the lid in eager anticipation.....first little whiff (if new) then a good old pinch right into the schnozzle. If I remember to, I deliberately smile (if I am not already for some reason). I don't know why but that increases the pleasure and effect considerably for me.The key I am told and worth repeating in agreement with nosebag is: as soon as you want to smoke, snuff. Smile wait for one minute and chances are you will not want to smoke any more.

51. I just spent Thanksgiving with some relies in Chicago. The parents of my brother in law are both former smokers: the lady went cold turkey and the gent has switched to pipe. I showed them a couple of snuffs I just happened to have in my pooch and it was very interesting to see the gradual change from 'you're kidding...up your nose?' to 'this is great, do you mind leaving it with us'. I sent them a pretty decent care package today; I only left them two tins so I figured they would need more soon.The lady has some back problems for which she is taking some serious meds....di-something or other. It makes her feel queasy and low-energy. Snuff cured that! That was her reasoning why I had to leave my stash behind. She tells me, that while she hated to do it, there was no way I was taking them with me because she needs them more than I do! (All with a smile of course). It was a lot of fun.Point is, had they had snuff available to them when they were giving up the smokes, I'll bet they would have had a much easier time.

52. Hello. I was amazed of how easy it was for me to switch from heavy chain-smoking at least 20-30 cigarettes a day to snuff! I felt a bit uneasy for perhaps a day or two, and now at least two months later I never even think of lighting up! As a matter of fact I have been shaking my head occasionally thinking "why didn't I do this years ago?" I absolutely love the history, the culture and the ritual of snuff taking. I have a substantial collection of snuff boxes, and have been fascinated by snuff for years, before finally taking the step to switch over completely. At work it is a blessing never to have to steal time for a smoke break and at home - no ashtrays stinking. I can sit anywhere in restaurants, trains - theatres. It is so much better and today I wouldn't dream of buying a pack of cigarettes. And I smoked since I was 13 years old - that is for 31 years!! So - snuff out the ciggies and join the wonderful world of snuff :o)

53. I am doing pretty well giving up the cigarettes and snuffing instead. I wont pretend I don’t have any, some days I snuff only but as there have been a few Christmas parties recently, I sometimes end up on the cigarettes after a few drinks. I think I’m probably down from 15-20 a day to maybe 10 per week. I think this will stop all together eventually. Snuffing is so much nicer, though I do have a tendency to over do it!

54. I smoke when I'm at work in the pub, (I'm a barman as well as running my own business. Luckily I hope to finish in pubs after 5 years in February), just to skive off for 5 minutes no other reason. Hey I'm a lazy sod lol. I now only smoke abut 10 a week though rather than 20 a day.

55. It took awhile for me to quit smoking cigs mainly because I couldn't really do snuff at work for a while.

56. When I started snuff it wasn't to quit smoking. Although I wanted to quit, I didn't choose snuff as a method of doing so. So at first I did both, even though I didn't crave cigarettes as much I would still smoke because for me it was normal to smoke. After a little while I just didn't smoke as much and that’s when I decided to quit. So I just kept from smoking as much as possible, and had a cigarette whenever I really needed one. Now it’s been a few months and I still have the occasional cigarette but I don't let it bother me. I went from smoking a pack a day to on a bad day having two smokes. Most days none at all. The only thing I can say is Snuff is perfect for helping quit, and being much healthier for you why not?

57. I stopped very heavy smoking after 27 years 3 months ago, with the help of snuff. I used very big quantities of snuff during the first weeks. This has changed now; I still use relatively much snuff, but largely for fun. I never had any abstinence symptoms. I maybe had a problem with my immune system; a mycotic infection that was not treatable for some weeks, but things like that can happen if you stop smoking. Maybe the question is if you can use enough snuff during your working time.

58. I've lapsed a bit this week - a real stressful time at work and I ended up smoking a few cigs, what the hell? I'm back on to the Toque now and feeling better already. As I said before, don't beat yourself up if you do lapse. We can feel really guilty when we do that but its not important and its our life not someone else’s - because people can be really judgmental when they hear you've had a lapse - its winning the war that counts, so loosing a couple of battles is not important, I'm just saying this because you are in the danger zone at 2 days.My attitude is - I will always have the odd cigarette and I accept that about myself but most of the time I am a snuffer. At 44 (nearly!) and after smoking for over 20 years, heavily, I am happy with that.

59. I've made it 2 days now. I did sleep better last night. This morning was sick, but I really believe that's from all the junk food I ate last night. I just couldn't stop eating. Tonight is a little better when it comes to eating junk.

60. The health fanatics and governments just can't believe snuff has no real danger attached to it. I hate the way that they invade our private lives by deciding what is good for us.

61. I just couldn't believe how much snuff helped. I'd tried patches and gum, the works, but snuff really does hit the spot when you want a smoke, you just kind of need to adjust your mind to it. After all, it’s the same product just being used in a different way.Just one thing about quitting though, if you do slip up don't beat yourself up. I’ve got down from a pack and a half a day to one or two a week (usually someone else’s) I don't think that’s too unacceptable and I’ve been doing it since the UK smoking ban came in nearly a year ago so I'm thinking its a pretty permanent state of affairs in the sense that I don't think I'm in any danger of my cigarette intake creeping up, because snuff has taken over to such a large extent and I actually enjoy snuffing. With cigarettes I was only ever feeding a habit, not really liking them. However, I’ve just got to admit that every once in a while I just like that major hit that a cig gives you. I calculate that I've had about a hundred cigs since July 07, which as a 43 year old confirmed heavy smoker I am really pleased about.

62. I didn't even try to quit smoking I just found my self going more and more smokeless and having less and less cigarettes as I went on. I would just find myself having more times where I'd think man I want a pinch of snuff. So you guys got the cat in the bag already in my opinion. If it happens with out trying will just make it happen faster and be slightly more of an ordeal.

63. I quit the death sticks with snuff. In my case it was instant because by that point I desired the nicotine far more then the cigs because I was coughing up the nasty. My fav part of quitting is that everything of mine does not reek and taste and smell again. Pretty soon you're foods will be much tastier then before.

64. Been 3 days since I finished off those last smokes! Have not been on computer for those three days as that is a "trigger" for the "bending of the elbow" Feeling pretty good now however, and enjoying being around people and not having to worry if I offend them by smoking!

65. I was a cigarette junkie virtually, and smoked like a chimney, and yet had no problems switching to snuff, because I felt disgusted with my cough, the smelly ash trays and the trouble of always having to step outside for a cigarette when away from home. All in all - the culture of smoking became like a warzone instead of a joy of smoking tobacco. Nowadays I feel completely liberated from all the "noise" that is around smoking, and can enjoy wonderful tobacco anywhere, anytime I want. I am extremely happy to have made the switch.

66. Quit cigs instantly as well. Ermm... I’m not sure when 7 or 8 months? Maybe 6? I dunno.

67. It's funny, when I first started this habit, I assumed I would find 4 or so favorites and stick to those. Now I find that reading reviews, deciding what to order, ordering, waiting for the order and trying all the new flavors is at least half the fun. I even keep up to date on this forum on my iphone while I'm working. I really can’t express how happy I am that I quit smoking with snuff. I tried so many other ways with NO success. Without this forum I probably would have lost interest and returned to smoking.

68. I have taken snuff everyday, all day, for the last 4 months since I stopped smoking. I have noticed an improvement in my respiratory health and therefore my overall fitness. Some of the darker snuffs can give you a moustache though. How many pinches a day? Never counted, but I get through about 1-2g per day.

69. Standard NRT didn't touch my smoking habit, but I kicked it with snuff in a few weeks for the most part, thanks to Toque.

70. I've quit smoking on 14th of February 2007 and I never want to touch a ciggie again. You just stick around and you will be rid of that bad habit for ever!!

71. But hey since I just started snuffing I have managed to go from 20 cigarettes a day to 2-3 a day....So thank you all for having this community I think I might be able to save my lungs after all.

.

72. It's funny, when I first started this habbit, I assumed I would find 4 or so favorites and stick to those. Now I find that reading reviews, deciding what to order, ordering, waiting for the order and trying all the new flavors is at least half the fun. I even keep up to date on this forum on my Iphone while I'm working. I really cant express how happy I am that I quit smoking with snuff. I tried so many other ways with NO success. Without this forum I probably would have lost interest and returned to smoking

73. Standard NRT didn't touch my smoking habit, but I kicked it with snuff in a few weeks for the most part, thanks to Toque.

74. I never realized that quitting smoking could be so much fun!

Smokeless tobacco and Health

2008-10-27T02:32:00.000-07:00

Smokeless tobacco and Health

The following articles relate mainly to oral smokeless tobacco and it should be pointed out that a further gain in harm reduction can be achieved by using nasal snuff.

In 300 years there has not been one case of harm from the use of nasal snuff filed against an English nasal snuff company.

Smokeless Tobacco Lacks Significant Negative Health Effects
By Gilbert Ross, M.D.

In today's edition of the medical journal The Lancet, two reports and an editorial deal with the question of the health effects of snus, a form of moist snuff or smokeless tobacco. A little background is in order first: perceived as a dangerous carcinogen -- a falsehood encouraged by our Surgeon General and zealous anti-tobacco advocacy groups -- smokeless tobacco (ST) has been banned from Australia and the EU, except for Sweden. And yet, the clearly lethal tobacco-delivery device known as the cigarette is widely available almost everywhere.Some groups -- including ACSH -- have advocated a freer approach to allowing makers of ST to tell adult smokers who are addicted to nicotine that ST might be one product that can help them quit smoking.One of the Lancet reports is by a group from Australia's University of Queensland. The authors attempted to estimate the net health effect on that population of allowing marketing of snus in Australia. Their conclusion was that making snus available would most probably result in improved public health, as more Australians would be able to quit cigarettes. "Current smokers who switch to using snus rather than continuing to smoke can realize substantial health gains," conclude the authors.Even more significantly, a group from Sweden's Karolinska Institute evaluated the actual tobacco-use-related risk of several cancers among over 100,000 male construction workers over the period of 1978 through 1992, with follow-up through 2004. Their findings confirmed other studies that Rodu and Godshall summarized in the ACSH-supported paper referred to above: there was no increased risk of oral cancer among ST users, as compared to non-tobacco users. Further, there was no increased risk of lung cancer -- no surprise, perhaps, but still of note. There was a small increased risk of pancreatic cancer, but even that was significantly less than that caused by smoking cigarettes. An editorial by Drs. Jonathan Foulds and Lynn Kozlowski says it all: "It is a perverse public health policy that makes an addictive drug widely available in its most harmful form, yet bans or fails to properly inform consumers of availability of that drug in a much less harmful form." They call upon regulators to level the playing field in the marketing of tobacco products, making snus more available and enhancing warnings about deadly cigarettes. They point out that there are 1 billion people now addicted to cigarettes (and the nicotine they deliver) -- and over 40,000,000 of these people are right here in the U.S.The time is past for anyone to argue that smokeless tobacco poses enough serious health risks that its use as an aid to cessation should be censored. This is especially true because of the abysmally low success rates of quitting utilizing the other methods that are approved and available. The message to addicted adult smokers now -- "quit nicotine completely or die" -- must be changed to encompass medical reality, and the sooner the better. Many lives are at stake.

Gilbert Ross, M.D., is Executive and Medical Director of the American Council on Science and Health (ACSH.org, HealthFactsAndFears.com).

Tobacco Harm Reduction: An Alternative Cessation Strategy for Inveterate Smokers (from Harm Reduction Journal)
By Brad Rodu and William T. Godshall

According to the Centers for Disease Control and Prevention, about 45 million Americans continue to smoke, even after one of the most intense public health campaigns in history, now over 40 years old. Each year some 438,000 smokers die from smoking-related diseases, including lung and other cancers, cardiovascular disorders and pulmonary diseases.
Many smokers are unable – or at least unwilling – to achieve cessation through complete nicotine and tobacco abstinence; they continue smoking despite the very real and obvious adverse health consequences. Conventional smoking cessation policies and programs generally present smokers with two unpleasant alternatives: quit, or die.
A third approach to smoking cessation, tobacco harm reduction, involves the use of alternative sources of nicotine, including modern smokeless tobacco products. A substantial body of research, much of it produced over the past decade, establishes the scientific and medical foundation for tobacco harm reduction using smokeless tobacco products.
This report provides a description of traditional and modern smokeless tobacco products, and of the prevalence of their use in the United States
and Sweden. It reviews the epidemiologic evidence for low health risks associated with smokeless use, both in absolute terms and in comparison to the much higher risks of smoking. The report also describes evidence that smokeless tobacco has served as an effective substitute for cigarettes among Swedish men, who consequently have among the lowest smoking-related mortality rates in the developed world. The report documents the fact that extensive misinformation about ST products is widely available from ostensibly reputable sources, including governmental health agencies and major health organizations.
The American Council on Science and Health believes that strong support of tobacco harm reduction is fully consistent with its mission to promote sound science in regulation and in public policy, and to assist consumers in distinguishing real health threats from spurious health claims. As this report documents, there is a strong scientific and medical foundation for tobacco harm reduction, and it shows great potential as a public health strategy to help millions of smokers.
I. Background
According to the Centers for Disease Control and Prevention (CDC), about 45 million Americans continue to smoke [1], even after one of the most intense public health campaigns in history, now over 40 years old. Some 438,000 smokers die from smoking-related diseases each year, including lung and other cancers, cardiovascular disorders and pulmonary diseases [2].
There is clear evidence that smokers of any age can reap substantial health benefits by quitting. In fact, no other single public health effort is likely to achieve a benefit comparable to large-scale smoking cessation. Surveys document that most smokers would like to quit, and many have made repeated efforts to do so. However, conventional smoking cessation approaches require nicotine-addicted smokers to abstain from tobacco and nicotine entirely (as discussed later, use of nicotine replacement medications is limited to 10–12 weeks, per labels required by federal regulations). Many smokers are unable – or at least unwilling – to achieve this goal, and so they continue smoking in the face of impending adverse health consequences. In effect, the status quo in smoking cessation presents smokers with just two unpleasant alternatives: quit or die.
There is a third choice for smokers: tobacco harm reduction. It involves the use of alternative sources of nicotine, including modern smokeless tobacco (ST) products, by those smokers who are unable or unwilling to quit tobacco and nicotine entirely. The history of tobacco harm reduction may be traced back to 1974, with the publication of a special article in the Lancet by British tobacco addiction research expert Michael A.H. Russell [3]. Citing the "high dependence-producing potency and the universal appeal of the effects of nicotine" on smokers, Russell likened "harsher restrictive measures" and "intensification" of anti-smoking efforts to "flogging a dead horse harder." Russell believed that "the goal of abstinence and the
abolition of all smoking is unrealistic and doomed to fail."
Six years later Russell's research group compared nicotine absorption rates from various tobacco products, which led them to suggest that nasal snuff use could serve as an effective substitute for cigarette smoking [4]. This article was cited shortly thereafter by a short letter in a leading American medical journal [5]. Russell et al published follow-up studies on nasal snuff in 1981 [6] and on an oral ST product in 1985 [7]. Lynn Kozlowski, a prominent American smoking and nicotine addiction expert at Penn State University, noted in 1984 and 1989 that ST products conferred fewer risks to users and therefore might serve as effective substitutes for cigarettes [8,9]. In 1994 oral pathologist Brad Rodu and epidemiologist Philip Cole from the University of Alabama at Birmingham made quantitative comparisons of the risks from oral ST use and smoking in a series of studies [10-13]. Some of that work was summarized in a 1995 ACSH publication [14].
A substantial body of research over the past decade has been transformed into the scientific and medical foundation for tobacco harm reduction, the substitution of safer sources of nicotine, including tobacco products, by those smokers who are unable or unwilling to achieve nicotine and tobacco abstinence. In 2001 the Institute of Medicine, a subsidiary of the National Academy of Sciences, provided a now widely accepted definition of a harm reduction product as "harm reducing if it lowers total tobacco related mortality and morbidity even though use of that product may involve continued exposure to tobacco related toxicants" [15]. The purpose of this report is to review the evidence for tobacco harm reduction.
II. The status quo: cigarette smoking
A. Prevalence
At first glance, the United States (U.S.) appears to be the quintessential example of the slow but substantial decline of cigarette smoking in the developed world. Smoking prevalence in the U.S. has decreased since at least the mid-1960s, following landmark reports from the Royal College of Physicians of London in 1962 and the U.S. Surgeon General in 1964. Smoking among men was 52% in 1965 [16], dropping to 23% by 2004 [1]. Prevalence among women declined from 34% in 1965 to 19% in 2004. In 1965, only 44% of American adults had never smoked and 14% were former smokers; by 2004, those percentages had increased to 58% and 21% respectively.
But declining prevalence overshadows the fact that, with population growth, the absolute number of smokers in the U.S. remained relatively constant at 45 to 50 million over the entire period. Heavily-addicted, or inveterate, smokers are resistant to conventional cessation strategies emphasizing tobacco and nicotine abstinence. Today's smoking population has a higher proportion of heavy smokers than in the past, and the National Cancer Institute (NCI)-funded Community Intervention Trial for Smoking Cessation underscores the challenges facing them [17]. Perhaps the most intensive
cessation trial ever conducted, this 4-year effort had no effect on cessation among heavy smokers. The published report called the intervention "disappointing but consistent with the findings of most other community studies...", and it described heavy smokers as "more resistant to change. Reaching these smokers may require new clinical programs and public policy changes."
B. Health effects
Cigarette smoking remains the single most important avoidable cause of death in the developed world. The CDC reports that smoking is responsible for 438,000 deaths in the U.S. annually [2], a figure which has changed little over the last 15 years.
Cigarette smoking was responsible for a large proportion of the increase in cancer mortality in the second half of the 20th Century, a trend with important social consequences, including the widespread misperception that the U.S. was being consumed by a "cancer epidemic" caused by environmental pollution and industrial chemicals. In fact, the "epidemic" consisted almost exclusively of one disease, lung cancer, and was due to one lifestyle factor, cigarette smoking. A retrospective analysis of mortality statistics revealed that, if lung cancer is excluded, the mortality rate from all other forms of cancer combined has declined continuously since 1950 [18].
The first reports linking lung cancer to cigarette smoking were published over 50 years ago [19,20]. In 2006 there will be 175,000 new cases of lung cancer in the U.S., with a five-year survival rate of just 15% [21]. The CDC estimates that smoking causes 142,000 deaths per year from lung cancer [2]. Smoking is a risk factor for other malignancies, including cancers of the oral cavity and pharynx, larynx, esophagus, stomach, bladder, kidney, pancreas, uterine cervix and leukemia [2].
According to the CDC, smoking causes 132,000 deaths per year from cardiovascular diseases, including heart attacks, strokes, atherosclerosis and aortic aneurysms [2]. Smoking is also causes 103,000 deaths per year from pulmonary diseases such as pneumonia, influenza, bronchitis and chronic airway obstruction [2].
While many Americans are aware that cigarette smoking causes cancer, cardiovascular and respiratory diseases, most are not aware that it also increases risks for neurological disorders, reproductive complications, cataracts and other eye diseases, premature aging of the skin, osteoporosis and other orthopedic and rheumatologic problems, psychiatric disorders and surgical complications [22]. Recent studies have also linked smoking to the development of type 2 diabetes [23-25].
C. Stagnation
As Russell noted 30 years ago, "There is little doubt that if it were not for the nicotine...people would be little more inclined to smoke than they are to blow bubbles or light sparklers" [3] . Nicotine fulfills all the criteria of an addictive agent, including psychoactive effects, drug-reinforced behavior,
compulsive use, relapse after abstinence, physical dependence, and tolerance. Nicotine stimulates specialized receptors in the brain which produce both euphoric and sedative effects. It has been known for many years that nicotine shares many features of drug dependence with opioids, alcohol and cocaine. This includes similar disappointing patterns of relapse [26].
It is for this reason that most attempts at smoking cessation are not successful, despite the fact that the majority of smokers are aware that smoking is harmful to their health, and so would like to quit. It is clear that most smokers would rather quit on their own, and 90% of successful quitters use self-help methods because of limited access to and cost of formal cessation programs [27].
Formal cessation programs have existed for decades and have grown more complex and sophisticated, but relapse rates remain very high. According to a 2006 National Institutes of Health (NIH) Consensus Conference on Tobacco Use, "70 percent [of smokers] want to quit and 40 percent make a serious quit attempt each year, but fewer than 5 percent succeed in any given year" [28]. The conference press release went on to make an astounding admission, "Effective tobacco cessation interventions are available and could double or triple quit rates..." This means that fewer than 15% of existing smokers, no more than 7 million, would be successful with maximum application of existing cessation strategies. The consensus statement failed to answer a vital question: What can be done for the remaining 40 million adult smokers? The rest of this report will review the scientific rationale and evidence for tobacco harm reduction as an alternative for these smokers.
III. Smokeless tobacco use
A. Introduction
The tobacco plant is native to the Western hemisphere, and the use of tobacco in smokeless forms (placed in the mouth or inhaled as a powder through the nose) predates the arrival and exploration of the West by Europeans. According to the historian Jan Rogozinski, the most common manufactured tobacco product in Europe until the early 1800s was a compressed plug or cake [29]. This product was relatively simple to produce and was amenable to transport and storage. The plug could be cut into large pieces for chewing, grated into smaller pieces for smoking, or ground into a fine powder for nasal inhalation. Smokeless forms were the favored method of use because a day's supply could be carried and conveniently used in industrial and agricultural work settings.
ST was the dominant form of tobacco used in the U.S. until early in the 20th century [29]. Developments in tobacco cultivation, curing and manufacturing, along with the invention of the safety match, resulted in the increased popularity of cigarettes. In addition, at the beginning of the 20th century tobacco spit inaccurately was believed to transmit tuberculosis, so bans on public spitting and spittoons resulted in a decline in ST use. The transmission of tuberculosis now has been understood for decades, and it does not include expectoration [30].
Use of all types of ST traditionally has been most prevalent in Southern states and in rural areas throughout the U.S.
B. Types of ST
As described below, ST is currently used by only a small proportion of American tobacco users. This is one reason that most Americans, including smokers, know almost nothing about ST products, or – even worse – are completely misinformed about even basic product characteristics. Thus, it is important to understand what these products are and how they are used.
ST products are not burned but instead are placed in the cheek or between the lip and gum. ST is used in many countries around the world, including those in the Middle East and on the Indian subcontinent. However, ST products in those regions are considerably different from those used in the West. For example, in India ST products are made by individual farmers and small companies with little control over fermentation and curing, which affects the production of potential carcinogens called tobacco-specific nitrosamines (TSNAs) [31]. In India ST is often combined with betel leaf (Piper betle), sliced areca nut (Areca catechu) and/or powdered agricultural lime [32], additives that enhance the toxicity as well as the psychotropic effect of tobacco [33,34]. In addition, Indian ST users often smoke concurrently, which complicates efforts to assess the health effects of ST use [35,36].
This report will focus on ST products used in Western societies, mainly the U.S. and Sweden. But ST is not a homogeneous category, even in these countries. Three traditional types of ST are used in the U.S.: powdered dry snuff, loose leaf chewing tobacco and moist snuff, and it is important to understand the differences among them with respect to their manufacturing and characteristics, the populations that consume them, and the consequential health risks, especially mouth cancer.
Powdered dry snuff (Figure 1)
Figure 1. Powdered dry snuff.
Dry snuff is made from fermented, fire-cured tobacco that is pulverized into powder. Nasal inhalation of dry snuff was widely practiced in Europe in the 17th and 18th centuries but declined thereafter [37]. Manufacturers in Germany and the U.K. still provide an array of flavored dry snuff products for a small number of contemporary users in those countries. In the U.S. powdered dry snuff, also called dental or Scotch snuff, is sold in small canisters. Since the early 1800s it has been used primarily by women in Southern states [29,38], who place the powder on the gum or between the gum and cheek. Sales of dry snuff have rocketed in the past few years as smokers switch to less harmful nasal snuff.
Loose leaf chewing tobacco (Figure 2)
Figure 2. Loose leaf chewing tobacco.
Loose-leaf chewing tobacco consists of air-cured leaf tobacco from Pennsylvania and Wisconsin that is shredded, coated with sweet flavoring solutions and packaged in foil-lined pouches. It is consumed primarily by men in the U.S., commonly in conjunction with outdoor activities. Chewing tobacco is typically used in large volumes, resulting in the archetypical golf ball-sized bulge in the user's cheek and large quantities of saliva that users usually expectorate. Consequently, the popularity of this product has waned, with consumption declining gradually over the past century, dropping by about 44% in just the last 15 years [39].
Moist snuff (Figure 3)
Figure 3. Moist snuff.
Moist snuff consists of fire- and air-cured dark tobaccos that are finely cut or ground. It is packaged in round containers, and the user compresses a "pinch" between the thumb and forefinger and places it inside the lip. Much less bulky than loose leaf chewing tobacco, moist snuff produces less saliva, but expectoration is still common. It is now the most popular form of ST in the U.S.; sales of this product increased by 66% over the past 15 years [39].
In addition to the U.S., there is a long tradition of moist snuff use in Scandinavia, especially in Sweden, where "snus" (the generic term for moist snuff in Swedish, pronounced "snoose") is essentially the only type of ST product in use [40]. There are differences in how American and Swedish moist snuff products are manufactured. Traditional American products undergo fermentation, which imparts characteristic flavors but in the past resulted in higher concentrations of unwanted bacterially mediated by-products, especially TSNAs and nitrite. In Sweden, moist snuff is subjected during manufacturing to a heat treatment akin to pasteurization, yielding virtually sterile products containing very low levels of TSNAs. However, manufacturing refinements over the past 25 years have resulted in lower TSNAs in both Swedish and American products. A 1997 report by the Swedish National Board of Health and Welfare reported that TSNA concentrations in both Swedish and American ST brands had declined substantially [41]. The report concluded: "Recent data suggest that the differences [in TSNA levels reported in American and Swedish ST] have grown smaller, and that it is now questionable to make a sharp distinction between use of American and Swedish moist snuff when assessing risks – at least where TSNA content is concerned."
A separate section of this report will discuss how the high prevalence of snus use in Sweden has played an important role in the low prevalence of smoking, especially among men.
Modern ST products (Figure 4)
Figure 4. Modern smokeless tobacco products.
Over the past few years several ST products have emerged that are not easily classified into one of the previous groups. In fact, one reason for the popularity of moist snuff is that manufacturers have gradually refined the products in this category to be more user-friendly. The traditional pinch of moist snuff is difficult to keep in place, and the resultant migration is esthetically displeasing. Modern moist snuff products are sold in pre-portioned pouches similar to teabags, but much smaller. Because these products remain stationary in the mouth and generate very little juice, they can be used discreetly with no expectoration. There is a recent trend among manufacturers to offer even smaller pouches that are dry, with a wide range of non-tobacco flavors. Other products in this category consist of small pieces of leaf tobacco and pellets of compressed tobacco that dissolve completely. These products all share one important characteristic: they are of sufficiently small size that they can be used invisibly, and without expectoration.
C. Prevalence
The prevalence of ST use has not received nearly as much attention as that of smoking, but adult prevalence has been documented by the National Health Interview Survey (NHIS). For adults, NHIS defines current ST users as those individuals who have used ST at least 20 times in their lives and are using ST every day or some days. In 1991 the prevalence of current ST use among adult men in the U.S. was about 5.6% (4.8 million), which declined to 4.4% (4.4 million) in 2000. In 1991 about 0.6% (533,000) of adult women in the U.S. were current users, and prevalence declined to 0.3% (324,000) by 2000 [42,43].
In 2000 the prevalence of ST use was higher among men age 18–44 years (6%) than among those age 45+ years (3%). Men in the Southern U.S. had the highest prevalence (7%) and those in the Northeast had the lowest (2%). As with smoking, prevalence of ST use was higher among men with a high school education or less. Finally, higher male prevalence was seen in rural areas (9%), compared with urban areas (3%) [43].
In the U.S. the number of male smokers is ten-fold higher than the number of ST users, so it follows that concurrent use of both products is common among ST users, but rare among smokers. About 25% of men who use ST report concurrent smoking, whereas concurrent use occurs in fewer than 5% of men who smoke [44]. Cigarette consumption is considerably lower in combined users compared with exclusive smokers [45-47].
D. Health effects
1. Oral leukoplakia
Oral leukoplakia is an ominous sounding term used frequently in discussions about ST use. The term literally means "white plaque," and it is used to describe areas of the mouth lining that become thickened by ST use or smoking. The World Health Organization has determined that leukoplakias resulting from ST use are considerably different from those resulting from smoking. The distinctions are based on the frequency of occurrence, the location in the mouth, and how often these leukoplakias result in mouth cancer [48,49].
The condition is rare, occurring in less than 1% of the general population, primarily in long-time smokers 40 to 60 years old [50,51]. Smoking-related leukoplakias most commonly involve the undersurface of the tongue and throat area, locations that account for 75% of oral cancer in the U.S. [51,52].
Oral leukoplakias occur in up to 60% of ST users [53,54], within 6 months to 3 years of starting ST use [55,56]. They primarily occur at the site of ST use and are largely a result of local irritation [55,57]. The frequency of appearance depends on the type of ST that is used. Moist snuff, which is more alkaline than chewing tobacco, more often leads to leukoplakia [56]. However, moist snuff in pre-portioned pouches causes fewer cases of leukoplakia than does the loose form [58].
There are distinct differences in how often ST and smoking leukoplakias show pre-cancerous changes called dysplasia. Dysplasia is seen infrequently in ST leukoplakias (less than 3%) [49,59-61]. Furthermore, even when dysplasia is present in ST leukoplakia, it usually is found in earlier stages than in leukoplakias due to smoking [62,63], where it is seen in about 20% of cases [64].
ST leukoplakias only rarely progress to cancer. For example, one prospective study found no case of cancer in 1,550 ST users with leukoplakia who were followed for 10 years [65], and a second study reported no case of oral cancer among 500 regular ST users followed for six years [66]. A retrospective study of 200,000 male snuff users in Sweden found only one case of oral cancer per year, an extremely low frequency [67]. In comparison, a follow-up study reported that 17% of smoking leukoplakias transformed into cancer within seven years [68].
In conclusion, oral leukoplakia occurs commonly in ST users, but it primarily represents irritation and only very rarely progresses to oral cancer.
2. Oral cancer
ST use has been associated with oral cancer for many decades. It is widely perceived – both by laypersons and medical professionals – that the association is strong and applies to all ST products. However, epidemiologic studies dating back to the 1950s provide convincing evidence that most ST products increase oral cancer risks only minimally.
Rodu and Cole reviewed 21 epidemiologic studies published from 1957 to 1998 [69]. Unlike previous reviewers, these authors derived relative risk (RR) estimates for cancers of the mouth and associated upper respiratory sites related to use of chewing tobacco, moist snuff, dry snuff and a fourth category in which the type of ST was unclear or undetermined (ST unspecified). This study found that use of chewing tobacco and moist snuff were associated with only minimally elevated risks, while use of dry snuff conferred somewhat higher risks.
Chewing tobacco has been studied at least once in each of four decades from the 1960s to the 1990s. The data clearly show that chewing tobacco use is associated with only slightly elevated cancer risks; RRs for all anatomic sites are under 2 with confidence intervals including 1 (i.e. the risk elevation was not statistically significant) (Table 1). The first study evaluating the risk of chewing tobacco appeared in 1962 [70]. There were two studies in 1977 [71,72], two in 1988 [73,74], and four studies from 1993 to 1998 [75-78].
Table 1. Chewing Tobacco and Cancer of the Mouth and Upper Respiratory Sites
As with chewing tobacco, summary RRs are only slightly elevated for moist snuff, with three RRs at or below 1 and the highest RR at 1.2 (Table 2). RRs for moist snuff were reported first in 1977 [71]. Another study appeared in 1988 [74], and five additional studies were published from 1993 to 1998, as this ST type came under intense scrutiny [75-79].
Table 2. Moist Snuff and Cancer of the Mouth and Upper Respiratory Sites
Two of the seven studies on moist snuff were Swedish, both appearing in 1998 [78,79]. These studies have received considerable attention among tobacco researchers, particularly in Europe, because they are viewed as showing no oral cancer risk for Swedish products. They formed the basis for the Swedish government's decision in 1999 to recommend that the European Union (EU) oral cancer warning labels be removed from ST products. An EU directive in 2001 accomplished that objective and specified a new warning, "This tobacco product can damage your health and is addictive" [80]. Notably, the other five studies contributing to the summary RRs for moist snuff were American, and they reported RRs very similar to those of the Swedish studies.
Summary RRs for dry snuff use are higher, ranging from 4 to 13, although the confidence intervals for these estimates are wide (Table 3). The first study appeared in 1962 [70], followed by studies in 1981 [81], 1988 [73], and 1994 [76], spanning a period of 32 years.
Table 3. Dry Snuff and Cancer of the Mouth and Upper Respiratory Sites
RRs for ST-unspecified range from 1.5 to 2.8, and most are statistically significant. For all sites the summary RR is 1.9 (CI = 1.5–2.3), which is intermediate between the low risks reported for chewing tobacco (1.2, 1.0–1.4) or moist snuff (1.0, 0.8–1.2) and the higher risk for dry snuff (5.9, 1.7–20) (Table 4). The intermediate risks for this ST category probably reflect the use of either the lower- or higher-risk products among different groups within the studies. Eight studies provided RRs for ST-unspecified, five of which appeared between 1957 and 1969 [82-86]. Additional studies appeared in 1992 [87], 1993 [75] and 1998 [88].
Table 4. ST-Unspecified and Cancer of the Mouth and Upper Respiratory Sites
Prior to the 2002 analysis by Rodu and Cole, the distinctive risk profiles of moist snuff and chewing tobacco on one hand, and dry snuff on the other, had gone unnoticed. In fact, the low oral cancer risk associated with chewing tobacco had been discussed briefly in only one article [89]. No distinction in risks had been made previously between dry snuff and moist snuff, even though these products are considerably different with regard to tobacco content and processing, as noted earlier.
The majority of epidemiologic studies regarding ST and oral cancer have limitations, many of which are typical for case-control studies, and some important for understanding unique oral cancer risks. Most of them did not control for confounding by two strong determinants of oral cancer, cigarette smoking and alcohol use. Positive confounding by smoking would occur if ST users smoke more than do nonusers of ST. This would result in artificially high risk estimates for oral cancer among ST users. On the other hand, negative confounding is plausible and would occur if smoking rates are lower among ST users than among nonusers of ST. This would result in artificially low risks for oral cancer among ST users.
Only three studies [78,79,81] controlled for alcohol use, where only positive confounding is likely. Thus, control for alcohol consumption in all studies probably would have reduced somewhat many of the estimates of mouth cancer risk associated with ST use.
However, even with these limitations, the results of these studies are reasonably consistent with regard to mouth cancer risks from long-term use of moist snuff and chewing tobacco. In their review Rodu and Cole concluded that "the abundance of data now available indicates that commonly used ST products increase the risk of oral and upper respiratory tract cancers only minimally."
Since the 2002 review four epidemiologic studies, one from Sweden and three from the U.S., have been published [90-93]. In all of these studies ST use was not associated with a significant increase in mouth cancer risk. In 2004 a group of epidemiologists concluded that the evidence linking ST use and oral cancer was "not decisive" [94]. These investigators commented that many claims in the media "overemphasize the risk of oral cavity cancer [from ST use], reaching beyond the scientific data."
In 2005 the American Cancer Society (ACS) reported that ST users did not have significantly increased risks for oral and pharyngeal cancer in either the first or the second Cancer Prevention Study [92]. Despite this finding, the ACS website continues to focus on ST as a cause of mouth cancer, erroneously stating that "risk of cancer of the cheek and gums may increase nearly 50-fold among long-term snuff users" [95]. A later section of this report will discuss this type of misinformation.
3. Other cancers
As noted above, cigarette smoking is associated with increased risk for several cancers in locations not in contact with cigarette smoke. In comparison, numerous epidemiologic studies have not demonstrated that ST use is associated with risk of cancer at any site outside the mouth. In 2004 Waterbor et al. assessed the epidemiologic research literature and summarized the evidence regarding ST use and cancers in various locations [94]. Table 5 shows the conclusions of Waterbor et al. with respect to cancer risks associated with ST use, compared with the established risks for smoking.
Table 5. Risk of Cancer in Various Sites Associated with ST Use and Smoking
4. Cardiovascular diseases
Over the past 15 years, eight epidemiologic studies have examined the risk of cardiovascular diseases among ST users. Six of the studies found that ST users had no increased risk for heart attacks or strokes [47,90,97-100]. The other two reported modestly positive associations, with ST users having RRs of 1.2 and 1.4 [92,101], which are lower than those of smokers. In 2003, Asplund completed a comprehensive review of the cardiovascular effects of ST use [102]. He concluded that, in distinct contrast to smokers, ST users do not exhibit any significant differences from nonusers of tobacco with regard to the following measures of cardiovascular health: heart rate, blood pressure, cardiac output and maximal working capacity, levels of hemoglobin and hematocrit, leukocytes, antioxidant vitamins, fibrinogen, components of the fibrinolytic system, C-reactive protein and thromboxane A2 production. In addition, ST users did not show important smoking-associated vascular changes, including increased thickness of blood vessels and atherosclerotic plaque development. In summary, most of the medical and epidemiologic evidence documents that ST users do not have elevated risks for cardiovascular diseases.
Two studies based in Sweden have examined the impact of ST use as a risk factor for adult-onset diabetes. One of these studies found that current ST users had a slightly elevated risk (Odds ratio = 1.5, CI = 0.8–30) [103], while the other reported that the risk of diabetes in ST users was not significantly increased [104].
IV. Scientific rationale for harm reduction with ST
A. Nicotine maintenance
1. Nicotine background
Nicotine has been characterized as powerfully addictive. But nicotine itself poses little or no health hazard. For example, it does not cause emphysema or cancer [105,106], and there is no evidence that it plays a direct role in the development of cardiovascular diseases [106,107]. A report from a meeting at the United Nations Focal Point on Tobacco or Health concluded that "long-term nicotine use is not of demonstrated harm, with the possible exception of use during pregnancy" [108].
The U.S. Food and Drug Administration (FDA) has acknowledged the safety of nicotine replacement therapy (NRT) by allowing its sale without prescription. Long-term use of NRT has not been associated with any medical risks and is considered far less hazardous than relapsing to smoking cigarettes [109,110], prompting authorities in the United Kingdom (U.K.) to liberalize NRT regulations there recently. The new guidelines allow NRT use by patients with cardiovascular disease, by confirmed smokers ages 12 to 17, by pregnant smokers, and concurrently by those who continue to smoke [111].
Nicotine gum was introduced in the U.S. in 1984 as a prescription product to assist in smoking cessation . The gum is considered to pose no consequential health hazard, and it was granted over-the-counter status by the FDA in 1996. The gum gives the user only a limited degree of control over the amount of nicotine absorbed because its nicotine content is low and only slowly released [112]. Depending on state and local excise taxes and cigarette consumption, the gum may be competitive on a per-unit basis for the smoker. However, it is available only in large quantities, making the purchase price far more expensive than that for cigarettes, a major economic disincentive. In fact, cost is the reason most frequently cited by smokers for never using NRT [113].
The nicotine patch was introduced in the U.S. in 1992 and was available without prescription by 1996. It continuously delivers nicotine through the skin for up to 24 hours. Although the patch is intended to preclude smoking, the rate of nicotine delivery is so low that smoking while wearing the patch is not uncommon. The patch's major limitation is its inadequate nicotine delivery, but it is not a technical problem. A high-dose nicotine patch has been evaluated and may provide complete nicotine replacement even for heavy smokers [114].
Many smokers overestimate the health risks of NRT products. A 2001 survey of 1,046 adult smokers found that 53% incorrectly believed nicotine causes cancer and 14% didn't know [115], and a 2002 survey found that half of all smokers are concerned about negative side effects of using NRT [116]. A similar problem exists in the U.K., where recent research found that 69% of smokers believe NRT is as harmful as cigarettes.
Misconceptions are not limited to persons without medical training. Twenty-two percent of general medical practitioners in the U.K. are concerned that NRT is just as harmful as cigarettes, 40% believe that nicotine may cause cardiovascular disease and stroke, and one-quarter believe it may cause lung cancer [117].
In summary, poor nicotine delivery, high cost and misconceptions about health risks are the principal reasons that the long-term quit rate among users non-prescription nicotine medications is only 7%, according to a recent meta-analysis [118].
2. Long-term use of nicotine medications
The FDA specifies that nicotine medications should not be used for more than 10 to 12 weeks. This restriction is based not on health considerations, but on a concern about prolonging nicotine addiction. Considering the limitations of nicotine medications, it is remarkable that some smokers continue to use the products beyond the 3-month period specified by the FDA. About 20 percent of those who quit smoking with nicotine gum used it for more than one year when it was available only by prescription [112]. A cessation study that provided free gum but encouraged weaning after two months use reported that 37% of smoke-free subjects at one year were still using nicotine gum [119]. Using a liberal definition of continuous use, a recent study found that as many as one-third of current nicotine gum users have used the product for longer than six months [120]. That study also reported that, among persons who start to use nicotine gum, 7% will use it for longer than six months and 1% will continue use for over two years. The equivalent figures for nicotine patch were 1.7% and 0.05% respectively.
3. Nicotine concentration and availability from ST products
ST products contain nicotine at far higher concentrations than nicotine medications, and at levels that are generally acknowledged to be addictive [121,122]. Bioavailability of nicotine from ST products is dependent on the pH of the product, since unprotonated nicotine (in more alkaline products) is absorbed more efficiently and more rapidly across the mucous membranes of the mouth than protonated forms of the drug from more acidic products. The pH-dependent absorption kinetics of nicotine is a very important reason why ST is not consumed like foods. The pH of stomach contents is very acidic, which strongly inhibits the absorption of nicotine [122].
The nicotine absorption profiles of ST products, which have been known for many years [105,123], show both advantages and disadvantages when compared with those from smoking. Nicotine absorption from ST is somewhat slower than that from cigarettes, although the peak nicotine levels obtained in venous blood are similar [105]. In addition, elevated serum nicotine from ST use persists for much longer than that from smoking [105]. This may explain the observation that unit consumption of ST products among former smokers was much lower than prior unit consumption of cigarettes [124,125]. In the end, ST users and smokers consume similar quantities of nicotine daily [126].
B. Comparison of risks from ST use and smoking
The established health risks associated with ST use are vastly lower than those of smoking. In the past 25 years, almost 80 peer-reviewed scientific and medical publications have acknowledged the differential risks between the two tobacco products (see 1).
Additional File 1. Peer-Reviewed Scientific/Medical Articles Acknowledging that Smokeless Tobacco Use Confers Less Risk Than Cigarette Smoking, In Reverse Chronological Order 2006-1980.
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In 1980 Michael A.H. Russell and co-workers proposed that powdered nasal snuff might serve as an effective substitute for cigarettes because it delivers nicotine effectively without the risks of tobacco combustion [4]. This article was cited shortly thereafter in a brief letter in the New England Journal of Medicine [5]. Russell et al. published follow-up studies on nasal snuff in 1981 [6] and on an oral ST product in 1985 [7]. Lynn Kozlowski, a prominent American smoking and nicotine addiction expert at Penn State University, noted in 1984 and 1989 that smokeless forms of tobacco conferred fewer risks to users and therefore might serve as effective substitutes for cigarettes [8,9,127]. Starting in 1994, University of Alabama at Birmingham researchers Brad Rodu and Philip Cole provided a quantitative assessment of the difference in risks for the two products. Using established risk estimates from accepted sources, Rodu and Cole documented that ST use confers only about 2% of the health risks of smoking [10-12]. In addition, they established that the average reduction in life expectancy from long-term ST use was about 15 days, compared with a reduction of about 8 years from smoking [11].
In 1994 Rodu noted that ST use posed a lower risk for mouth cancer than smoking [10]. In 2001 this was confirmed by a comprehensive report on tobacco harm reduction by the Institute of Medicine, which stated that "the overall [oral cancer] risk [for ST use] is lower than for cigarette smoking, and some products such as Swedish snus may have no increased risk" [15].
By the late 1990s some influential organizations acknowledged the differential risks of ST use and smoking. For example, in 1997 experts meeting at the United Nations Focal Point on Tobacco or Health concluded that "it is now evident that the risk of death and disease is related to not only the amount but also the nature of tobacco exposure; for example, daily cigarette smoking is far more dangerous than occasional use of Swedish snuff" [108]. That same year a scientific panel convened by the Swedish National Board of Health and Welfare concluded that "the health risks related to smokeless tobacco are with great probability lower than those related to smoking" [41].
In 2002 the Royal College of Physicians of London, one of the oldest and most prestigious medical societies in the world, issued a report called "Protecting Smokers, Saving Lives," which stated, "As a way of using nicotine, the consumption of non-combustible [smokeless] tobacco is on the order of 10–1,000 times less hazardous than smoking, depending on the product." The report continued with an even bolder statement, acknowledging that some smokeless tobacco manufacturers may want to market their products "as a 'harm reduction' option for nicotine users, and they may find support for that in the public health community" [128]
In 2004 a study funded by the NCI assembled an international panel of experts (including epidemiologists from the NIH and the ACS) to compare the risks of ST use with those of smoking. The study authors reported that, "In comparison with smoking, experts perceive at least a 90% reduction in the relative risk of low-nitrosamine smokeless tobacco use." The authors concluded that "This finding raises ethical questions concerning whether it is inappropriate and misleading for government officials or public health experts to characterize smokeless tobacco products as comparably dangerous with cigarette smoking" [129].
Phillips et al. have provided perhaps the most detailed and direct comparison of risks from use of Swedish or American ST products and from smoking, using a spectrum of risk estimates for ST use ranging from well-substantiated and plausible to highly speculative and implausible [130]. They estimated that, compared with smoking, ST risks "in the range of 1% or 2%, and possibly less, are most consistent with the epidemiologic evidence. Perhaps most important, our calculation shows that comparative risk estimates as high as 5%, let alone 10% or more, cannot be justified based on the evidence."
C. Evidence that ST is an effective substitute for cigarettes
1. Survey data
There is limited evidence from governmental and other surveys that some smokers have quit by substituting ST products for cigarettes, and most of the published information on this subject is dated. The 1991 NHIS survey revealed that 33.3% (about 1.8 million) of adult current ST users were former cigarette smokers [42].
The 1986 national Adult Use of Tobacco Survey, conducted by the CDC Office on Smoking and Health, found that 7% (1.7 million) of male ex-smokers had used ST to help them quit smoking cigarettes. That same survey found that only 1.7% of male ex-smokers (404,600) had used organized programs to help them quit smoking [131].
The 1998 NHIS survey revealed that 5.8% of daily snuff users reported quitting smoking cigarettes within the past year, that daily snuff users were three times more likely to report being former cigarette smokers than never snuff users, and that daily snuff users were four times more likely to have quit smoking in the past year than never snuff users [132].
According to the 1987 NHIS survey, 23- to 34-year old U.S. men who had smoked cigarettes and subsequently used snuff were twice as likely to have quit smoking (95% CI 1.2 – 3.5) than were cigarette-only users [133].
Cohen-Smith and Severson surveyed 51 female and 59 male ST users in the Northwestern U.S., 98% and 90% of whom respectively were either current or former cigarette smokers. They found that 52% of women and 59% of men used ST in place of cigarettes while quitting smoking [134].
2. Clinical trial data
One clinical trial, an open-label, nonrandomized pilot study, has been conducted assessing the efficacy of an ST product in helping cigarette smokers become smoke-free. The investigators used a low-intensity approach, consisting of a 20-minute lecture about the health effects of all forms of tobacco use, followed by information about and samples of pre-portioned single-dose tobacco packets available throughout the U.S. The investigators used exhaled carbon monoxide levels to validate participant self-reports regarding smoke-free status at the conclusion of the original study after one year [125] and after seven years of follow-up [135].
Of 63 subjects starting the study, 16 had successfully quit smoking by switching to ST after one year, and 12 were still smoke-free after seven years. At enrollment, the average cigarette consumption of the successful participants had been 1.5 packs per day. One year later average consumption of ST was 2.3 packages per week among the 13 successful quitters using ST (3 were tobacco-free). Four additional participants had used ST to reduce their cigarette consumption by at least 50%.
3. The Swedish tobacco experience
For the past 100 years, cigarette smoking has been the dominant form of tobacco consumption in almost all developed countries. One notable exception is Sweden, where smoking rates, especially among men, have been considerably lower than those of comparable countries for decades. (An ACSH article provides historical background on Swedish snus [136]). Over the past 50 years Swedish men have had the lowest rates of smoking-related cancers of the lung, larynx, mouth and bladder in Europe [137], and the lowest percentage of male deaths related to smoking of all developed countries [138,139].
A 2004 study revealed that if men in the (15-country) EU had the smoking prevalence of Sweden, almost 200,000 deaths attributable to smoking would be avoided each year [140]. In contrast, women in Sweden smoke at rates much more similar to women in other European countries, and this is reflected in similar rates of smoking-related illnesses. The 2004 study found that only 1,100 deaths would be avoided in the EU at Swedish women's smoking rates.
As Fagerström pointed out in a recent study, per capita consumption of nicotine from tobacco in Sweden is quite high and on par with other countries such as Denmark, the U.S. and Austria [141]. The difference between Sweden and the other countries is how nicotine is consumed. In Denmark, the U.S. and Austria, almost all nicotine consumption is derived from tobacco combustion. In contrast, ST use, in the form of snus, accounts for almost 50% of all contemporary nicotine consumption in Sweden. Snus use in Sweden is much more common among men than among women; over 60% of nicotine consumption among Swedish men is from snus. This is not a new phenomenon; for over a century, Swedish men have had among the world's highest per capita consumption of ST [142].
Beginning in 2002, an American-Swedish research group used a World Health Organization database to describe in detail the impact of snus use on smoking among the population in northern Sweden during the period 1986–2004 [46,143,144].
Among men, the prevalence of all tobacco use was stable during the study period, at about 40%. However, there were striking, and opposite, changes in prevalence of smoking and snus use. Smoking prevalence was 19% in 1986, and it was lower in all subsequent surveys, reaching 9% in 2004. The prevalence of exclusive snus use increased from 18% in 1986 to 27% by 2004. Snus use was the dominant factor in the higher prevalence of ex-smoking among men compared to women (prevalence ratio 6.18, 95% CI 4.96 – 7.70).
Among women the prevalence of all tobacco use also was steady at 27 to 28%, and women smoked at higher rates than men in all surveys. But these studies showed that snus use was associated with lower smoking rates among women in 1999 and 2004. Smoking prevalence was about 25 to 27% in 1986, 1990 and 1994, but declined to 21% in 1999, and 16% in 2004. The prevalence of snus use was 0.5% in 1986 and increased to 1.9% in 1990, 2.0% in 1994, 5.1% in 1999 and 8.9% in 2004.
In these reports snus use was not associated with smoking initiation, as the prevalence of smoking among former snus users was low in all survey years (3–4%). The evidence showed that among adult men in northern Sweden the dominant transition is from smoking to snus, not vice versa.
In 2003 Foulds et al. reviewed the evidence relating to the effects of snus use on smoking and concluded, "Snus availability in Sweden appears to have contributed to the unusually low rates of smoking among Swedish men by helping them transfer to a notably less harmful form of nicotine dependence." The investigators noted that "in Sweden we have a concrete example in which availability of a less harmful tobacco product has probably worked to produce a net improvement in health in that country" [145].
In 2005 Furberg et al examined tobacco use data from the Swedish Twin Registry, finding that regular snus use was associated with smoking cessation, not initiation, among almost 15,000 male participants. Both regular and occasional snus use were protective against having ever smoked [146].
In 2006 Ramstrom and Foulds examined data from a 2001–02 nationally representative Swedish social survey. They found that snus use among men was significantly protective against smoking initiation (OR = 0.3, CI 0.2–0.4). They also found that snus was the most commonly used cessation aid among men (used by 24% of men on their most recent quit attempt). Men who used snus as a quit-smoking aid were more likely to quit successfully than those using nicotine gum (OR = 2.2, CI = 1.3–3.7) or the patch (OR = 4.2, CI = 2.1–8.6), which was also true for women [147].
V. Policy issues
A. ST use: gateway to smoking cessation, not smoking initiation
Data from research studies in Sweden and the U.S. do not support the allegation that widespread use of ST serves as a gateway to smoking, especially among youth. A 2003 policy statement published in Tobacco Control, coauthored by Clive Bates, former director of Action on Smoking and Health (U.K.) and five other eminent tobacco research and policy experts, dismissed the notion that ST use led to smoking in Sweden: "To the extent there is a 'gateway' it appears not to lead to smoking, but away from it and is an important reason why Sweden has the lowest rates of tobacco related disease in Europe" [148]. Foulds reached a similar conclusion: "This review suggests...that in Sweden snus has served as a pathway from smoking, rather than a gateway to smoking among Swedish men" [145].
A 2005 study examined tobacco use among 15- to 16-year old schoolchildren over a 15-year period, from 1989 to 2003 [149]. The investigators found that the prevalence of regular snus use among Swedish boys increased from about 10% to 13% from 1989 to 2003, but the prevalence of regular smoking was very low and declined, from about 10% to under 4%. The prevalence of snus use among girls was very low, and the prevalence of smoking was about double that of boys over the entire period. The authors concluded that snus use did not appear to be a gateway to smoking among Swedish youth but instead was associated with low smoking prevalence among boys.
In the U.S. investigators have not found credible evidence that ST use is a gateway to smoking among American youth. In 2003 Kozlowski et al analyzed data from the 1987 NHIS survey and concluded that there was little evidence that ST use was a gateway to smoking, because the majority of ST users had never smoked or had smoked cigarettes prior to using ST [133]. The investigators noted that their results coincided with earlier work from Sweden and with a tobacco industry-sponsored survey from 1984 [150].
In 2003 O'Connor et al. examined data from the 2000 National Household Survey on Drug Abuse [151]. They described the impact of ST use on subsequent cigarette smoking initiation as "minimal at best." O'Connor et al. also examined data from the CDC's Teenage Attitudes and Practices Survey for evidence that ST use served as a gateway to smoking among youth [152]. They concluded that ST use was not associated with smoking initiation after appropriate control for confounding by well-recognized psychosocial predictors of smoking. This is in contrast to an earlier report that did not control for confounding and found a positive association [153].
Claims of a gateway effect persist, even with lack of credible evidence, prompting O'Connor et al. to note in 2005, "Continued evasion of the [harm reduction] issue based on claims that ST can cause smoking seems, to us, to be an unethical violation of the human right to honest, health-relevant information" [154]. That quote introduces the next topic, information and misinformation about ST and tobacco harm reduction.
B. Information and misinformation about ST and tobacco harm reduction
Kozlowski et al. have argued persuasively that smokers have a fundamental right to accurate information about safer forms of tobacco use [155-157]. The research group established the underlying rationale for the provision of this information, citing principles of the Universal Declaration of Human Rights, the doctrine of informed consent, and business ethics contract theory, under which companies have a moral obligation to inform customers about important information regarding their products.
In 2001 the U.S. Supreme Court may have provided a legal basis for holding tobacco manufacturers responsible for providing truthful information about the differential risks of ST use and smoking. Writing the majority opinion in Lorillard v. Reilly, in which a 5–4 majority of the Court ruled that broad advertising restrictions by the Commonwealth of Massachusetts violated the commercial free-speech rights of tobacco manufacturers, Justice Sandra Day O'Connor wrote that "the State's interest in preventing underage tobacco use is substantial, and even compelling, but it is no less true that the sale and use of tobacco products by adults is a legal activity. We must consider that tobacco retailers and manufacturers have an interest in conveying truthful information about their products to adults, and adults have a corresponding interest in receiving truthful information about tobacco products" [158].
1. Fundamental right to information
Over the past 20 years, many public health and tobacco policy experts have argued that smokers have a fundamental right to accurate information about less hazardous products so that they can make informed choices if they are unable or unwilling to quit tobacco altogether. In 1984 Kozlowski commented on both the challenges and the potential of tobacco harm reduction, writing that "the use of less-hazardous tobacco, if prohibitionist impulses can be put aside, may have an important role in the treatment of the smoking and health problem..." [9].
In 1994 Rodu proposed that a "public health policy that recognizes ST as an alternative to smoking would benefit individuals confronted with the unsatisfactory options of abstinence or continuing to smoke" [10]. In a 1995 book, Rodu told smokers that "ST products allow you, the hard-core and long-term smoker, to take back a measure of control over your health by indulging in a far safer form of tobacco use" [13].
One concern about tobacco harm reduction is that dissemination of information about less hazardous tobacco products might adversely affect public health if it creates new users. However, the risk/use equilibrium addresses this issue [159]. If ST use is 50 to 100 times less hazardous than smoking, it would require 50 to 100 more ST users to reach the level of public harm produced by smoking. In other words, it would take 2.3 to 4.5 billion ST users to have the same death toll as 45 million American smokers do today, an impossible scenario in the U.S. population of 290 million people.
Kozlowski's message in 2002 was clear: "Cigarettes kill about half of those who smoke them...It is urgent to inform smokers about options they have to reduce risk...public health policy in this instance lacks compelling justification to override the human rights of the individual. Individuals have the right to such relevant information [on tobacco risks]" [155]. That same year, the prestigious Royal College of Physicians of London made its hopeful statement that "some manufacturers may want to market ST as a 'harm reduction' option for nicotine users, and they may find support for that in the public health community" [128].
Since then a growing number of experts have weighed in on the case for providing smokers relevant risk information and safer tobacco options. In 2002 Cummings argued for a market approach involving risk information: "Until smokers are given enough information to allow them to choose products because of lower health risks, then the status quo will remain. Capitalism, and not government regulation, has the greatest potential to alter the world-wide epidemic of tobacco-related disease" [160].
In 2003 Kozlowski et al expanded on the rationale that smokers are entitled to information about safer products, addressing concerns that provision of risk information might adversely affect public health: "Public health concerns should trump individual rights only when there is clear and convincing evidence of harm to society. Lacking that evidence, individual rights should prevail" [161].
2. Misinformation from governmental and other organizations
Americans are badly misinformed about the risks of ST use, especially in comparison with smoking. In 2005 a survey of 2,028 adult U.S. smokers found that only 10.7% correctly believed that ST products are less hazardous than cigarettes [154]. In another survey, 82% of U.S. smokers incorrectly believed that chewing tobacco is just as likely to cause cancer as smoking cigarettes [162].
A 1999–2000 survey of 36,012 young adults entering the U.S. Air Force found that 75% of males and 81% of females incorrectly believed that switching from cigarettes to ST would not result in any risk reduction, while another 16% of males and 13% of females incorrectly believed that only a small risk reduction would occur. Only 2% of males and 1% of females correctly understood that a large risk reduction would occur by switching from cigarettes to ST [163]. That survey also found that the overwhelming majority of subjects believed that switching from regular to low-tar cigarettes conferred greater reduction in risks than switching from cigarettes to ST.
It is not clear how Americans have become so confused about tobacco risks. But it is clear that misinformation about ST products is available in copious quantities from ostensibly reputable sources, including governmental health agencies and health-oriented organizations. Phillips et al have made some of the most pointed comments about this phenomenon:
"Certain health advocates believe it is acceptable to mislead people into making choices they would not otherwise make...Through the use of various tactics, advocates who oppose the use of ST as a harm reduction tool have managed to convince most people that the health risk from ST is several orders of magnitude greater than it really is. The primary tactic they use is making false or misleading scientific claims that suggest that all tobacco use is the same. . . . Apparently motivated by their hatred of all things tobacco, they are trying to convince people to not switch from an extremely unhealthy behavior to an alternative behavior that eliminates almost all of their risk" [164].
The tactic has worked in the U.S., as Americans, almost without exception and regardless of general and health education levels, believe that the risks from ST are similar to those from smoking. In particular, Americans incorrectly believe that switching from smoking to ST use will create a large increased risk for oral cancer. Phillips has characterized this popular misinformation as the "you might as well smoke" message, since it tells people that if they are using ST, they could switch to smoking with no increase in risk, while smokers considering switching to ST should not bother [165].
Phillips et al. systematically reviewed content about ST use on the web in 2003 and found that the risks of ST use are almost always conflated with those of smoking [165]. Roughly one-third of the time, there are explicit claims that ST is as bad as or worse than smoking. Most of the rest of the time the information is arranged to imply similar risks, though there is no such explicit statement. There are also a variety of specific claims that are not supported by the literature.
Government agencies, other organizations and members of the public health community have a moral obligation not to misinform smokers about products that have fewer risks than cigarettes. Nevertheless, researchers have exposed numerous cases of misinformation from governmental sources. For example, in 2003 Kozlowski and O'Connor criticized websites of the CDC and the Substance Abuse and Mental Health Services Administration for erroneously reporting that ST products were not safer than cigarettes, pointing out that "the misleading health information on ST fails to meet the government criteria against deception in research" [156].
At a 2003 U.S. House subcommittee hearing, U.S. Surgeon General Richard Carmona testified: "I cannot conclude that the use of any tobacco product is a safer alternative to smoking...There is no significant evidence that suggests ST is a safer alternative to cigarettes" [166]. Scott Leischow, Chief of the Tobacco Control Research Branch at the NCI, presented similar testimony at a concurrent hearing [167]. Carmona's statement prompted Rodu, who also presented testimony at that hearing [168], to comment that the Surgeon General was "sadly ill-informed about the nation's No. 1 health problem, cigarette smoking." Rodu strongly criticized Carmona, writing that he should be compelled to "tell American smokers the truth about all available options for quitting. After all, the 10 million smokers who will die over the next two decades are, in a very tangible way, his responsibility and his legacy" [169].
In March 2004, Ken Boehm of the National Legal & Policy Center (NLPC), a non-profit organization committed to promoting open, accountable and ethical practices in government, filed a request under the Data Quality Act (DQA) for correction of a document from the National Institute of Aging (NIA) that contained misinformation regarding the relative risks of ST versus cigarettes. (This other DQA requests on ST can be seen at the U.S. Department of Health and Human Services website [170]) The request resulted in a change of wording from the original text:
"Some people think ST (chewing tobacco and snuff), pipes, and cigars are safer than cigarettes. They are not."
The revised wording from NIA was:
"Some people think ST (chewing tobacco and snuff), pipes, and cigars are safe. They are not."
The claim that ST products are not "safe" is a tactic that can be traced back to the 1986 Comprehensive Smokeless Tobacco Education Act, which required as one of three warnings on all ST products: "This product is not a safe alternative to cigarettes."
In 1995 Rodu criticized this warning as ludicrous and suggested that other consumer products like automobiles, lawnmowers, aspirin and red meat don't meet absolute criteria for safety [13]. A decade later, Kozlowski and Edwards criticized this type of uninformative warning in a study entitled, "'Not safe' is not enough: smokers have a right to know more than there is no safe tobacco product" [157]. These authors believe that smokers deserve more information: "The 'not safe' or 'not harmless' messages don't address the reality that some tobacco products are substantially safer than others... Saying tobacco 'isn't safe' isn't incorrect, but it isn't saying enough. Going beyond the no safe tobacco message to provide better information on the nature of risks from tobacco products and nicotine delivery systems is necessary to respect individual rights to health relevant information."
Ken Boehm from NLPC summarized the arguments against misinformation:
"This is the kind of evidence Americans should be able to review and make their own decisions. Despite the best efforts of the largest government bureaucracy in the history of the republic, Americans still prefer to do their own thinking. And as we do our own thinking on the merits of reduced-risk products such as ST, none of us needs misinformation supplied by our own government" [171].
With regard to a policy as "credible, logical and eminently do-able" as tobacco harm reduction [172], it is unfortunate that arguments against deception are actually necessary.
VI. Conclusion and recommendations
The past 40 years have brought ever more assertive public health campaigns against cigarette smoking. A coalition of well-funded public and private agencies has as its goal a reduction in the prevalence of cigarette smoking. The coalition's influence has resulted in pervasive health warnings, ever more intensive quit-smoking programs, and recently the social ostracism of smokers and the industry that supplies them. Yet 45 million Americans continue to smoke, and far too many die from smoking-related diseases.
The American Council on Science and Health has been part of this anti-smoking coalition for several decades. Throughout its history ACSH has published many articles about the health risks of smoking. And it has held the tobacco industry accountable for its part of the devastating toll from tobacco. ACSH founder Elizabeth Whelan published a landmark anti-smoking book, A Smoking Gun?: How the Tobacco Industry Gets Away with Murder [173].
ACSH was founded in 1978 by a group of scientists who had become concerned that many important public policies related to health and the environment did not have a sound scientific basis. These scientists created the organization to add reason and balance to debates about public health issues and bring common-sense views to the public.
The mission of the ACSH is to promote sound science in regulation, in public policy, and in the courtroom and to assist consumers, via the media, in distinguishing real health threats from purely hypothetical ones. ACSH believes that strong support of tobacco harm reduction is fully consistent with this mission; as this report documents, there is a strong scientific and medical foundation for tobacco harm reduction, and it shows great potential as a public health strategy to help millions of smokers.
Tobacco harm reduction empowers smokers to gain control over the consequences of their nicotine addiction. At its simplest it is nonintrusive and solely educational, and therefore has a strong moral rationale. The strategy is cost-effective and accessible today to almost all smokers. But its implementation will require rethinking of conventional tobacco control policies and their premises.
The ACSH believes that the following actions will benefit smokers:
1. Agencies of the federal government (most notably the Office of the Surgeon General) and health promotion organizations (such as the American Cancer Society and the Mayo Clinic) should discontinue the campaign of misinformation that irresponsibly misrepresents the scientific information about and use of ST products. They endanger their reputations as sources of trusted health information by providing messages about ST products that are neither accurate nor credible. The campaign of misinformation should be replaced with an educational program that emphasizes the differential risks of all forms of tobacco use.
2. Regulatory restrictions on the manufacture and sale of nicotine replacement medications should be revised. Nicotine is addictive, but it plays little or no role in the development of most smoking-related diseases. Manufacturers of nicotine replacement medications should be permitted to sell higher doses of the drug within flavor/delivery systems that are satisfying and enjoyable for smokers at costs that are competitive with cigarettes. In addition, smokers should be informed that permanent use of NRT is vastly safer than continuing to smoke. This could be accomplished by new labels on NRT packaging and additional labels on cigarette packs: "Notice: Nicotine does not cause cancer, heart diseases or emphysema."
3. Manufacturers of tobacco products should follow the lead of British American Tobacco (BAT) and acknowledge that ST use is vastly safer than smoking. BAT has openly admitted that oral ST products are safer than cigarettes, and this company is actively engaged in test-marketing Swedish snus in Sweden, Norway and South Africa [174]. At the press date of this report, cigarette manufacturers in the U.S. have introduced ST products in limited test markets, but they have made no statements regarding differential health risks. This is unacceptable, given the state of the science documented in this report.
4. Any federal legislation that addresses the regulation of tobacco should include provisions that adequately reflect the differences in risks between combustible tobacco products and ST products or NRT. This includes careful review of current proposals before Congress to ensure that the legislation is written to regulate the labeling and marketing of products based on their risks. The goal should be to give users of tobacco the necessary information they need to understand the differences between various tobacco and nicotine products so they can make the appropriate health choices and decisions.
5. Pending enactment of more comprehensive regulation, the U.S. Congress should repeal the federally-mandated warning that now appears on ST products: "This product is not a safe alternative to cigarettes." This warning not only misleads smokers; it may send a message to ST users that they might as well smoke. The warning should be replaced with the following, which would appear as an onsert with cigarette packages – "Warning: Smokeless tobacco use has risks, but cigarette smoking is far more dangerous. Quitting tobacco entirely is ideal, but switching from cigarettes to ST can reduce greatly the health risks to smokers and those around them." Placement of this warning with cigarettes ensures that it reaches the target audience, continuing smokers.
6. State legislatures should follow the lead of Kentucky and establish rational risk-based tax policies for tobacco products. In 2005 the Commonwealth of Kentucky enacted an excise tax structure for cigarettes and ST products that was based on differential risks. The final bill stated: "The General Assembly recognizes that increasing taxes on tobacco products should reduce consumption, and therefore result in healthier lifestyles for Kentuckians. The relative taxes on tobacco products proposed in this section reflect the growing data from scientific studies suggesting that although smokeless tobacco poses some risks, those health risks are significantly less than the risks posed by other forms of tobacco products. Moreover, the General Assembly acknowledges that some in the public health community recognize that tobacco harm reduction should be a complementary public health strategy regarding tobacco products. Taxing tobacco products according to relative risk is a rational tax policy and may well serve the public health goal of reducing smoking-related mortality and morbidity and lowering health care costs associated with tobacco-related disease."

History of Snuff

2008-10-24T07:58:00.001-07:00

The parent species of Nicotiana Rustica and Nicotiana Tabacum are believed to originate in South America. According to genetic studies they have been cultivated as far back as 8,000 years ago, and maybe the first cultivated plant of the Americas.

Pre 15th Century
It is documented that the Mayas were the first to use snuff and smoke Nicotiana Rustica as far back as 200 BC, which they may have called Petun. The using of tobacco would have slowly spread throughout the Americas by trading with neighboring tribes. The Mexican Aztecs, who created the mighty Aztec Empire, may well have been introduced to tobacco by the Mayas and three types of tobacco users emerged. The first group was in the Court of Montezuma, who mingled the leaves of Nicotiana Rustica with the resin of other leaves. This mixture was smoked in pipes with great ceremony after their evening meal. The second group was one of lesser Indians, who rolled the leaves together to form a crude cigar and the third group were the snuff users. The archaeologist, Peter T. Furst uncovered in Colima, Mexico some unique snuffing implements dating form 1600-1800 BC that he theorized were used for snuffing N. Rustica.

As in Southern America, a complex system of religious and political rites was developed around the burning and smoking of the leaves of these plants. No one really knows how long American Indians had been smoking, chewing and snuffing before the 15th century. A best guess puts it around 2000 years before Columbus.

There is little credence given to the idea that Vikings were the first Europeans to experience smoking however it is possible, as there is evidence that they beat Columbus to America by many centuries.

15th Century
In October 1492 Christopher Columbus and his men stepped ashore on an unknown island in the Bahamas and were greeted by the Taino (Nobel) Indians. They were given many gifts; among them some dried leaves which the Taino called Cohiba (tobacco) these they conveyed to the Spanish explorers were extremely precious.
Columbus was to later name the plant Nicotiana Tabacum after the Taino.

Tobacco by name, but not by nature. In 1497 Christopher Columbus returned to America bringing with him the monk Ramon Pane whom he had commissioned to document their discoveries. In one entry in Panes, Relación acerca de las antigüedades de los indios (Report about the antiquities of the Indians) he describes witnessing the drinking of smoke through a “Y” shaped hollow stick which the natives called a “Tobacco”. We can only suppose that when Pane asked “what’s that” pointing at the person smoking, his hosts presumed he was asking about the “Y” shaped stick and answered “Tobacco”.

16th Century
The tobacco plant was brought to Europe through Spanish and Portuguese sailors. In Lisbon in the middle of the 16th century snuff was used as medicine by doctors, who believed that the herb could cure both syphilis and cancer. They grew the tobacco in their own gardens and ground their own snuff.

Jean Nicot, the French ambassador to Lisbon is recognized as the father of snuff usage. Carl von Linné even used Nicot’s name to give the tobacco plant the Latin name, Nicotiana tabacum.

Nicot was friendly with the scholar and botanist Damião de Goes, who showed him a tobacco plant growing in his garden and told him of its marvelous healing properties. The application of the tobacco plant to a cancerous tumor allegedly worked wonders. Nicot tried treating an acquaintance's face wound for 10 days with the plant with excellent results. He became convinced of the healing powers of tobacco. Nicot obtained cuttings, which he planted in the garden of the French Embassy. In 1560 he wrote of tobacco's medicinal properties. He described tobacco as a panacea and in the same year sent tobacco plants and snuff to Catherine de Medici, the Queen of France. He recommended the snuff to treat her migraine headaches. Nicot had applied it to his nose and forehead and found it had relieved his headaches. Catherine de Medici used it to cure her migraines and was so impressed that she decreed that tobacco was henceforth to be called Herba Regina ("the queen's herb"). With the Queen's blessing it was not long before snuff became the fashion item of the French court.

17th Century
Paris served as a model for all the European courts and it was not long before snuff had spread across mainland Europe and to Scotland through ‘The Auld Alliance’. Despite the fact that visiting Scottish nobles were seen using snuff, it remained relatively unknown in England until 1660. It was then that the court of Charles II returned to London from exile in Paris, bringing with them the French court’s snuffing practice. Snuff became the aristocratic form of tobacco use, replacing the common practice of “huffing” or taking the vapours.

Unfortunately for users, snuff underwent a period of prohibition across Europe in the late 17th and early 18th century. Tsar Michael I of Russia ordered that persons caught taking snuff should be whipped for the first offence, have their noses cut off for the second and be executed for the third (there are no records of anyone ever being executed, probably due to it being difficult to snuff without a nose). Around the same time the Florentine Pope Urban VIII ordered that anyone found guilty of taking snuff in church should be excommunicated. This was because he believed it led to sneezing, which too closely resembled sexual ecstasy.

Portuguese tradesmen and Jesuit missionaries, the same priests who would have been excommunicated for using snuff back home, first introduced Snuff to China in the 17th Century. Tobacco had been seen in China, in the form of pipe smoking before the turn of the century. There is a strong possibility that Vasco de Gama had started trading Tobacco in 1560 with India, Persia and China.

In 1612, the Wan-Li Emperor of China banned smoking, but not snuff, due to its therapeutic significance. By the time of the Qing Dynasty in 1644 snuff had become very popular and to many it was regarded as a medicine. This partly accounts for snuff being kept in Chinese medicine bottles. However, a more likely reason lay in China's humid climate. Snuff boxes were found impractical and this led to the adaption of Chinese medicine bottles for storing snuff. The Chinese, following Jean Nicot’s example, claimed that snuff could be used to dispel colds, cure migraines, sinusitis, tooth pain, asthma, constipation and that it was beneficial for those with poor memories. (Today scientists are discovering that nicotine is helpful in the treatment of Alzheimer's, Dementia and Parkinson's disease).

18th Century
Snuff became much more popular with ordinary British citizens, due to a battle that took place off the coast of Vigo in Spain in 1702. The French and Spanish fleet were harboured at Vigo and a detachment of fifteen English and ten Dutch man of war were ordered to enter and attempt to destroy the enemy’s fleet. Vice-Admiral Hopson "of the Torbay" led the attack; his cannon fire was incredibly accurate and most of the enemy vessels were destroyed. One of the Spanish ships, which were on fire, came perilously close to their own ship. Hobson was about to blow it out of the water when an English cabin boy, who had been captured by the Spanish and later rescued by Hobson, informed him of the cargo. This makeshift warship had been hastily prepared and was actually a merchant ship full of snuff. The fire was quickly extinguished and Hobson claimed the lot as booty. To top it all, Hobson was knighted and awarded a pension of £500 a year for his part in this battle. The bounty of snuff was sold in London, the profits of which bought him an estate fit for a Knighted Admiral. Hobson’s snuff was referred to as Spanish, which soon became abbreviated to ‘SP’ one of the best known and most popular of snuffs.

The French revolution led to the end of the French upper class's love of traditional snuff: No upper class, no snuff sales. Under Napoleon, who was a heavy snuffer, snuff sales temporarily increased but after his exile it became unfashionable and even a little politically risky to continue using snuff.

This century also saw the first warnings about the use of tobacco. After an argument with his tobacconist about his bill, John Hill, an 18th Century poet and writer of farces, released a public notice. Under the guise of a Doctor, he proclaimed that the overuse of snuff could lead to nasal cancers, which has since been (fortunately) disproved by the Royal College of Physicians. The likely cause of the rise in nasal cancer at this time has been attributed to the period’s smokers blowing smoke through their noses. This was done to cover the horrendous smells caused by the build up of rubbish in the streets of cities and towns all over Britain. Interestingly with better sewage systems smokers stopped blowing smoke through their noses and nasal cancer ceased to be.

19th Century
In the 19th century snuff was still popular in many parts of society across Europe, although Victorian England became less tolerant of the habit and snuff started to be frowned upon in some quarters. Snuff was, however, popular amongst the professions where it wasn’t possible to smoke or to be seen to smoke such as Doctors, Lawyers, Judges, Clergymen and of course Miners.

During the nineteenth century snuff was so popular in the Chinese community that millions of Chinese snuff bottles were made, which makes collecting them and snuff boxes in general an affordable hobby for the snuff enthusiast.

20th Century
The beginning of the end for snuff-taking was the invention of the automatic cigarette rolling machine in 1881. Up to that point, manufacturers rolled cigarettes by hand at considerable expense.

The First World War saw the virtual death knell for snuff, as cigarette companies literally flooded the trenches with free cigarettes and returning soldiers made smoking fashionable.
After the 1949 communist revolution in China, Moa outlawed snuff as a decadent habit of the previous Qing dynasty. Although Moa’s ban was lifted in 1967 The 1612 ban on smoking has never been lifted and smoking in China is still officially banned, though no one has informed the Chinese people who smoke more than any other nation.

21st Century
Today snuff is undergoing some thing of a renaissance and Toque now sells snuff all over the world including China. Could the smoking bans of the twenty-first century result in the decline of cigarettes and make snuff once more fashionable? Today many smokers are switching to Toque snuff not only because of the bans but also because the medical fraternities are now informing smokers that snuff is a dramatically less harmful alternative to cigarettes