“Snus” consist of loose ground tobacco in a very small tea bag–like pouch, placed behind the upper gum for up to 30 minutes. With a different curing process and in the absence of combustion, several carcinogens are reduced, if not eliminated. Epidemiological studies in Sweden, where snus were developed and adopted by approximately 20% of males, have found few, if any, increases in oral/head cancers or cardiovascular risks. Although snus are considerably safer than cigarettes from the perspective of an individual smoker, from a broader societal perspective, at least three problems suggest the need for regulatory oversight: (1) Snus could serve as a “gateway” product for adolescents; (2) snus could serve as a temporary bridge/replacement product for smokers in situations in which cigarettes cannot be used, thus dampening their motivation to quit smoking; and (3) studies have found potentially heightened risks of pancreatic cancer, premature birth, dental disease, and oral lesions among users.
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