Smokeless tobacco products should not be used as an alternative to cigarettes or for smoking cessation due to the risk of addiction and return to smoking, according to an American Heart Association policy statement.

Smokeless tobacco products such as dry and moist snuff as well as chewing tobacco may also increase the risk of fatal heart attack, fatal stroke and certain cancers, according to the statement published online in Circulation: Journal of the American Heart Association.

“No tobacco product is safe to consume,” said Mariann Piano, Ph.D., lead writer of the statement and a professor in the Department of Biobehavioral Health Science at the University of Illinois at Chicago.

The statement also addresses a controversy over whether smokeless tobacco product use is a “safer” alternative to smoking. The idea that smokeless tobacco products are preferable to cigarettes is based in part on the Swedish experience where there was a significant decrease in smoking among Swedish men between 1976 and 2002 which corresponded to an increase in the use of smokeless tobacco.

However, the opposite was true in a recent United States study which found no reduction in smoking rates among people using smokeless tobacco products. For people trying to quit smoking, nicotine replacement therapy (nicotine gum or a nicotine-releasing patch placed on the skin) is a safer alternative compared to using smokeless tobacco products. Clinical studies have found no increased risk of heart attack or stroke with either type of nicotine replacement therapy.

As smoke-free air laws become common in the U.S., smokeless tobacco products have been marketed as a situational substitute (“pleasure for whenever”) for cigarette smoking when smoking is prohibited.

“Smokeless tobacco products are harmful and addictive – that does not translate to a better alternative,” Piano said.

Smokeless tobacco also is being used more by teenage boys, according to the statement. The Food and Drug Administration issued a final regulation related to the Tobacco Control Act that became effective June 22 that prohibits the sale of tobacco products to anyone younger than 18 years.

“Scientists and policy makers need to assess the effect of “reduced risk” messages related to smokeless tobacco use on public perception, especially among smokers who might be trying to quit,” said Piano.

Co-authors are Neal L. Benowitz, M.D.; Garret A. FitzGerald, M.D.; Susan Corbridge, Ph.D., A.P.N., ACNP; Janie Heath, Ph.D.; Ellen Hahn, Ph.D.; Terry F. Pechacek, Ph.D.; George Howard, D.P.H. Author disclosures are on the manuscript.

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The American Heart Association/American Stroke Association receives funding mostly from individuals. Foundations and corporations donate as well, and fund specific programs and events. Strict policies are enforced to prevent these relationships from influencing the association’s science content. Financial information for the American Heart Association, including a list of contributions from pharmaceutical companies and device manufacturers, is available at http://www.heart.org/corporatefunding.

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Statement highlights:

  * The American Heart Association advises against smokeless tobacco products for smoking cessation – they are not a “safe” alternative to smoking.
  * Long-term use of smokeless tobacco products increases the odds of suffering a fatal heart attack or fatal stroke, according to analysis of several studies.

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American Heart Association, Inc