February 28, 1986

Health Effects of Smokeless Tobacco

Author Affiliations

From the Council on Scientific Affairs, American Medical Association, Chicago.

JAMA. 1986;255(8):1038-1044. doi:10.1001/jama.1986.03370080060027

Tobacco in various forms has been used for centuries. Using snuff and chewing tobacco was popular in the United States during the 18th and 19th centuries, but current data on their use are limited. Pharmacologic and physiologic effects of snuff and chewing tobacco include the gamut of cardiovascular, endocrinologic, neurologic, and psychological effects that are associated with nicotine. A review of studies appearing in the scientific literature involving various populations and approaches indicates that the use of snuff or chewing tobacco is associated with a variety of serious adverse effects and especially with oral cancer. The studies suggest that snuff and chewing tobacco also may affect reproduction, longevity, the cardiovascular system, and oral health. One group estimated that the relative risk of oral cancer in longtime users of snuff varied from 1.8 to 48 times that of its occurrence in nonusers. But few of the studies have fully utilized accepted scientific and epidemiologic methods. The Council on Scientific Affairs concludes there is evidence demonstrating that the use of snuff or chewing tobacco is associated with adverse health effects such as oral cancer, urges the implementation of well-planned and long-term studies that will further define the risks of using snuff and chewing tobacco, and recommends that the restrictions applying to the advertising of cigarettes also be applied to the advertising of snuff and chewing tobacco.

(JAMA 1986;255:1038-1044)