Snus and Health: A Review of the Literature on the Impact of Swedish Smokeless Tobacco on the Human Body
DOI:
https://doi.org/10.12775/JEHS.2025.77.57417Keywords
snus, smokeless tabacco, health impact, nicotine pouchAbstract
Introduction: Snus is a tobacco-containing product particularly popular in Scandinavian
countries. It comes in the form of a pouch filled with tobacco, which is typically placed under
the upper lip, allowing nicotine to be absorbed through the mucous membrane. Due to the
absence of combustion during snus use—and consequently the lack of substances produced
by this process—many manufacturers claim that snus is a healthier alternative to cigarettes.
The aim of this article is to review scientific studies examining the effects of snus on the
human body and to objectively summarize its impact on human health.
Materials and Methods: This study was conducted by collecting scientific articles from the
PubMed database and other online scientific databases. The articles were identified using
keywords such as "snus," "smokeless tobacco," and "snus health impact."
Results: Snus cannot be considered a healthier alternative to tobacco use. While it does not
cause many of the diseases associated with smoking and the toxic compounds produced
during combustion, it is still addictive and contributes to other health issues caused by the
substances it contains and the way it is consumed. This product requires more detailed
scientific research.
References
[1]According to the company Swedish Match https://www.swedishmatch.com/Our-business/smokefree/Snus-production/
[2]Luo J, Ye W, Zendehdel K, Adam J, Adami HO, Boffetta P, Nyrén O. Oral use of Swedish moist snuff (snus) and risk for cancer of the mouth, lung, and pancreas in male construction workers: a retrospective cohort study. Lancet. 2007;369:2015–20
[3]Boffetta, Paolo, Bjarte Aagnes, Elisabete Weiderpass, and Aage Andersen. ‘Smokeless Tobacco Use and Risk of Cancer of the Pancreas and Other Organs’. International Journal of Cancer 114, no. 6 (10 May 2005): 992–95. https://doi.org/10.1002/ijc.20811.
[4] Araghi, Marzieh, Maria Rosaria Galanti, Michael Lundberg, Anton Lager, Gunnar Engström, Lars Alfredsson, Anders Knutsson, et al. ‘Use of Moist Oral Snuff (Snus) and Pancreatic Cancer: Pooled Analysis of Nine Prospective Observational Studies’. International Journal of Cancer 141, no. 4 (15 August 2017): 687–93. https://doi.org/10.1002/ijc.30773.
[5] Helserisiko ved snusbruk. Rapport. Oslo: Folkehelseinstituttet, 2019. https://www.fhi.no/publ/2019/helserisiko-ved-snusbruk2/
[6] Németh, Orsolya, Levente Sipos, Péter Mátrai, Noémi Szathmári-Mészáros, Dóra
Iványi, Fanni Simon, Márton Kivovics, Dorottya Pénzes, and Eitan Mijiritsky. ‘Snus Use in Adolescents: A Threat to Oral Health’. Journal of Clinical Medicine 13, no. 14 (19 July 2024): 4235. https://doi.org/10.3390/jcm13144235.
[7]Kopperud, Simen E., Vibeke Ansteinsson, Ibrahimu Mdala, Rune Becher, and Håkon Valen. ‘Oral Lesions Associated with Daily Use of Snus, a Moist Smokeless Tobacco Product. A Cross-Sectional Study among Norwegian Adolescents’. Acta Odontologica Scandinavica, 17 February 2023, 1–6. https://doi.org/10.1080/00016357.2023.2178502.
[8] Frithiof L, Anneroth G, Lasson U, et al. The snuff-induced lesion. A clinical and morphological study of a Swedish material. Acta Odontol Scand. 1983;41(1):53–64.
[9] Monten U, Wennstrom JL, Ramberg P. Periodontal conditions in male adolescents using smokeless tobacco (moist snuff). J Clin Periodontol. 2006;33(12):863–868.
[10] Muthukrishnan, A.; Warnakulasuriya, S. Oral health consequences of smokeless tobacco use. Indian J. Med. Res. 2018, 148, 35–40.
[11] Stockwell HG, Lyman GH. Impact of smoking and smokeless tobacco on the risk of cancer of the head and neck. Head Neck Surg 1986;9: 104 –10.
[12] Winn DM, Blot WJ, Shy CM, Pickle LW, Toledo A, Fraumeni JF Jr. Snuff dipping and oral cancer among women in the southern United States. N Engl J Med 1981;304:745–9.
[13] Sterling TD, Rosenbaum WL, Weinkam JJ. Analysis of the relationship between smokeless tobacco and cancer based on data from the National Mortality Followback Survey. J Clin Epidemiol 1992;45: 223–31.
[14] Lewin F, Norell SE, Johansson H, Gustavsson P, Wennerberg J, Biorklund A, Rutqvist LE. Smoking tobacco, oral snuff, and alcohol in the etiology of squamous cell carcinoma of the head and neck. Cancer 1998;82:1367–75.
[15] Roosaar, Ann, Anna L.V. Johansson, Gunilla Sandborgh‐Englund, Tony Axéll, and Olof Nyrén. ‘Cancer and Mortality among Users and Nonusers of Snus’. International Journal of Cancer 123, no. 1 (July 2008): 168–73. https://doi.org/10.1002/ijc.23469.
[16] Zitterbart, P. A., Marlin, D. C, and Christen, A. G.: Dental and oral effects observed in a long-term tobacco chewer: case report. J Ind Dent Assoc 62: 17-18, July/August 1983
[17] Zendehdel K, Nyren O, Luo J, et al. Risk of gastroesophageal cancer among smokers and users of Scandinavian moist snuff. Int J Cancer. 2008;122:1095-1099.
[18] Araghi M, Galanti MR, Lundberg M, et al. Smokeless tobacco (snus) use and colorectal cancer incidence and survival: results from nine pooled cohorts. Scand J Public Health. 2017;45:741-748
[19] ‘Intl Journal of Cancer - 2023 - Valen - A Systematic Review of Cancer Risk among Users of Smokeless Tobacco Swedish Snus’.
[20] Antoniewicz, L., Novo, M., Bosson, J., & Lundbäck, M. (2018). Brief exposure to Swedish snus causes divergent vascular responses in healthy male and female volunteers. PLOS ONE, 13(4), e0195493. doi:10.1371/journal.pone.0195493
[21] Ozga, J. E., Felicione, N. J., Elswick, D., & Blank, M. D. (2016). Acute effects of snus in never-tobacco users: a pilot study. The American Journal of Drug and Alcohol Abuse, 44(1), 113–119. doi:10.1080/00952990.2016.1260581
[22] Titova, O. E., Baron, J. A., Michaëlsson, K., & Larsson, S. C. (2021). Swedish snuff (snus) and risk of cardiovascular disease and mortality: prospective cohort study of middle-aged and older individuals. BMC Medicine, 19(1). doi:10.1186/s12916-021-01979-6
[23] Huhtasaari F, Asplund K, Lundberg V, Stegmayr B, Wester PO. Tobacco and myocardial infarction: is snuff less dangerous than cigarettes? BMJ. 1992;305: 1252–6.
[24] Bolinder G, Alfredsson L, Englund A, de Faire U. Smokeless tobacco use and increased cardiovascular mortality among Swedish construction workers. Am J Public Health. 1994;84:399–404
[25] Hergens MP, Alfredsson L, Bolinder G, Lambe M, Pershagen G, Ye W. Longterm use of Swedish moist snuff and the risk of myocardial infarction amongst men. J Intern Med. 2007;262:351–9
[26] Lee PN. Summary of the epidemiological evidence relating snus to health. Regul Toxicol Pharmacol. 2011;59:197–214.
[27] Hansson J, Galanti MR, Hergens MP, Fredlund P, Ahlbom A, Alfredsson L, Bellocco R, Engström G, Eriksson M, Hallqvist J, Hedblad B, Jansson JH, Pedersen NL, Trolle Lagerros Y, Ostergren PO, Magnusson C. Snus (Swedish smokeless tobacco) use and risk of stroke: pooled analyses of incidence and survival. J Intern Med. 2014;276:87–95.
[28] Haglund B, Eliasson M, Stenbeck M, Rosén M. Is moist snuff use associated with excess risk of IHD or stroke? A longitudinal follow-up of snuff users in Sweden. Scand J Public Health. 2007;35:618–22.
[29] Asplund K, Nasic S, Janlert U, Stegmayr B. Smokeless tobacco as a possible risk factor for stroke in men – a nested case-control study. Stroke. 2003;34:1754–9
[30] Persson PG, Carlsson S, Svanström L, Ostenson CG, Efendic S, Grill V. Cigarette smoking, oral moist snuff use and glucose intolerance. J Intern Med. 2000;248:103–10.
[31] Eliasson M, Asplund K, Nasic S, Rodu B. Influence of smoking and snus on the prevalence and incidence of type 2 diabetes amongst men: the northern Sweden MONICA study. J Intern Med. 2004;256:101–10.
[32] Wändell PE, Bolinder G, de Faire U, Hellénius ML. Association between metabolic effects and tobacco use in 60-year-old Swedish men. Eur J Epidemiol. 2008;23:431–4.
[33] Rasouli B, Andersson T, Carlsson PO, Grill V, Groop L, Martinell M, Midthjell K, Storm P, Tuomi T, Carlsson S. Use of Swedish smokeless tobacco (snus) and the risk of Type 2 diabetes and latent autoimmune diabetes of adulthood (LADA). Diabet Med. 2017;34:514–21.
[34] Östenson CG, Hilding A, Grill V, Efendic S. High consumption of smokeless tobacco ("snus") predicts increased risk of type 2 diabetes in a 10-year prospective study of middle-aged Swedish men. Scand J Public Health. 2012;40:730–7.
[35] Brinchmann, B. C., Vist, G. E., Becher, R., Grimsrud, T. K., Elvsaas, I.-K. Ø., Underland, V., Holme, J. A., Lødrup Carlsen, K. C., Kreyberg, I., Nordhagen, L. S., Stensby Bains, K. E., Carlsen, K.-H., Alexander, J., & Valen, H. (2023). Use of Swedish smokeless tobacco during pregnancy: A systematic review of pregnancy and early life health risk. Addiction, 118(1), 133–146. https://doi.org/10.1111/add.16114
[36] “Association of maternal snuff use and smoking with Sudden Infant Death Syndrome – a register cohort study”. Anna Gunnerbeck, Cecilia Lundholm, Samuel Rhedin, Ayoub Mitha, Ruoqing Chen, Brian M. D’Onofrio, Catarina Almqvist. Pediatric Research, online 9 February 2023, doi: 10.1038/s41390-022-02463-4.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Marta Jajczak, Jakub Parys, Agnieszka Mikosińska , Martyna Kaźmierczak , Aleksandra Witek, Maciej Mossakowski, Patrycja Kałuziak, Mateusz Litwin, Stanisław Jesionek
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
The periodical offers access to content in the Open Access system under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0
Stats
Number of views and downloads: 305
Number of citations: 0
