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Snus (pron.: //; Swedish pronunciation: [snʉːs]), also known as snuff, naswar (Pashto: نسوار) in Afghanistan, Iran, Pakistan and India, and nasway (Cyrillic: Насвай) in Central Asia, is a moist powder tobacco product originating from a variant of dry snuff in the early 19th century in Sweden. It is consumed by placing it under the lip for extended periods of time. The precursor of snus, the dry form of snuff inhaled through the nose, was introduced in Europe much earlier. Although used in a manner similar to American dipping tobacco, it does not typically result in the need for spitting. Snus is also unique in that it is steam-pasteurized rather than fire-cured, is not fermented and contains no added sugar. Its sale is illegal in the European Union, but due to special exemptions, it is still manufactured and consumed primarily in Norway and Sweden. Its popularity is growing in the United States as an alternative to smoking and traditional "chewing" tobacco.
In the 16th century, snuff (pulverized tobacco), the precursor of snus (moist snuff), was introduced to France by Jean Nicot, who worked at the court of King Henry II of France. He recommended snuff to Catherine de' Medici as a migraine remedy. As she became a regular user of snuff it became a fashion amongst the court and upper class citizens of France, especially amongst females, as it was deemed more socially acceptable than other forms of tobacco.
This trend of inhaling snuff through the nose also spread to Sweden at the beginning of the 17th century. Later in the 19th century, Swedish producers began to manufacture local brands of moist snuff placed under the upper lip which did not require spitting, and became known as snus. As of today, Ettan, registered since 1822, remains the oldest snus still sold.
A widespread urban legend holds that snus and other forms of smokeless tobacco contain fragments or particles of glass as an aid to absorbing nicotine into the user's blood. However, mucous membranes readily absorb free nicotine. The key to absorbing nicotine is having it in an unprotonated form in which it is freely available. Thus, the prick or burning sensation in the palate is a result of food additives, such as table salt, and/or sodium carbonate (E500), a food additive which is used to increase the pH of the tobacco, and the bioavailability of the nicotine, thereby decreasing the amount of time for nicotine to enter the bloodstream. The burning sensation occurs often because the tobacco is much higher in pH than the mouth and saliva. The greater the difference in pH between the user's mouth and the snus, the more vigorously the tissues respond to the more alkaline snus, precipitating an exothermic acid-base reaction, in a manner similar to pouring hydrogen peroxide on a wound, or baking soda into vinegar and observing the fizzing. This causes inflammation of the tissues, and sometimes can be perceived by the user as painful.
Confusingly, the English word "snuff" is translated to snus in Swedish and the word snuff is, often incorrectly and outside Sweden, used to refer to both the inhaled form and the placed under the lip form of snus/snuff.
However, snuff intended to be inhaled through the nose is referred to as torrsnus (dry snus) or more correctly as luktsnus (smelling-snus) in Swedish. The moist form of snuff placed under the upper lip is just called snus in Swedish, and the correct word for referring to this form would be snus in English as well.
What may add to the confusion is that the word snuff may also refer to dipping tobacco (also known as moist snuff, which may confuse even more), which is applied to the lower lip and the gums rather than inhaled or placed under the upper lip. Thus all three forms are different products.
Some forms of tobacco consumed in the mouth may be categorized as:
Many types of snus are on the market:
Portioned snus is available in three different sizes: mini, normal/large (most common) and maxi. The weights may vary, but most snus labels share their weight. Mini portions typically weigh close to 0.5 g, normal (large) portions weigh around 1 g, and Maxi portions weigh up to 1.7 g, depending on brand. Some brands also offer the choice of "regular" and "long" versions of the normal size sachet, which are similar in content weight. These long portions differ from traditional sachets by being slimmer but longer, to fit against the gums more comfortably.
The nicotine content of snus varies between brands, with the most common strength being 8 mg of nicotine per gram of tobacco. In recent years, snus manufacturers have released stark (strong or sterk) and extra stark (extra strong or extra sterk) varieties with greater nicotine content. Stark varieties contain, on average, 11 mg of nicotine per gram of tobacco, while extra stark varieties may contain up to 22 mg of nicotine per gram of tobacco.
Swedish snus is made from air-dried tobacco from various parts of the world. In earlier times, tobacco for making snus was laid out for drying in Scania and Mälardalen. Later, Kentucky tobaccos were used. The ground tobacco is mixed with water, salt, and an alkylizing agent (today this is sodium carbonate) and aroma and is prepared through heating. In Sweden, snus is regulated as a food product, and for this reason, all ingredients are listed on the label of each individual package (can) of snus. Moist snus contains more than 50% water, and the average use of snus in Sweden is approximately 800 grams (16 units) per person each year. About 12% (1.1 million people) of the population in Sweden use snus . Unlike dipping tobacco and chew, most snus today does not undergo the fermentation process, but is instead steam-pasteurized. Although steam-pasteurization is remarkably complex, it has the advantages of inhibiting the growth of bacteria that facilitate the formation of tobacco-specific nitrosamines, while preserving the desired texture and mouthfeel of the snus.
Snus is sold mainly in Sweden and Norway, and has more recently been introduced to South Africa and the US. It can be found in places frequented by Scandinavian tourists, such as Murmansk in Russia (with the notable exception of countries in the EU; see below). It is sold in small tins, which in the earlier years were made of porcelain, wood, silver or gold. At the time of writing, portioned snus usually comes in plastic tins of 24 portions, containing about a gram of snus each, while loose snus is mostly sold in compressed paper tins with plastic lids, at 45 g (50 g before 2008). Mini-portion and medium-portion snus are increasingly popular formats. Most of these products come in tins containing 20 portions, of either 0.65 or 0.5 grams each for a total of just under 13 or 10 grams, particularly with those for whom concealing their use of smokeless tobacco in places is of utmost importance.
Despite weight, the price of 10-, 13-, 24-, and 45-g tins is approximately -5 in Sweden and -10 in Norway as Norwegian consumption taxes are considerably higher. Prices in the US vary per tin, depending on brand and source. Local or state taxes may also add considerably to this price, and vary widely across states.
Previously[when?], Swedish snus was only available by mail order in the US; an increasing number of tobacco retailers have now begun to stock it. R. J. Reynolds Tobacco Company, Philip Morris USA, and U.S. Smokeless Tobacco Company now produce similar products called Camel Snus, Marlboro Snus, and Skoal Snus, respectively. While it is packaged in much the same way (moist tobacco in a small pouch), production methods vary considerably from traditional Scandinavian methods. Additionally, differences in the way American snus is formulated may diminish some of its possible health benefits over other tobacco products. Swedish Match, the leading manufacturer of Swedish snus, is currently[when?] test-marketing snus in Canada, Russia, and several regions throughout the US.
In October 2012, the European Union's commissioner for health and consumer policy, John Dalli, resigned, following an investigation by OLAF, the European Anti-fraud Office, into a complaint made in by tobacco producer Swedish Match. OLAF found that an unnamed Maltese entrepreneur approached Swedish Match using his contacts with Mr. Dalli, and seeking payments in exchange for influence over possible snus legislation. The new EU's Tobacco Products Directive was expected to be appointed during autumn 2012.
Swedish Match has commented that they expect, given the proven scientific facts regarding snus, it should considered in a fair legal process for the proposal of a new Tobacco Products Directive.
Since snus is not intended nor recommended for inhalation, it does not affect the lungs as cigarettes do. Because it is steam-cured, rather than fire-cured like smoking tobacco or other chewing tobacco, it contains lower concentrations of nitrosamines and other carcinogens that form from the partially anaerobic heating of proteins - 2.8 parts per million for Ettan brand compared to as high as 127.9 parts per million in some American brands, according to a study by the Commonwealth of Massachusetts Department of Health. The World Health Organization (WHO) acknowledges Swedish men have the lowest rate of lung cancer in Europe, partly due to the low tobacco smoking rate, but does not argue for substituting snus for smoking, citing the effects of snus still remain unclear. Around 2005, several reports, partially funded by the snus industry, pointed to the fact that no carcinogenic effects could be attributed to Nordic snus and this resulted in the removal of the warning label that claimed snus could cause cancer. It was replaced with the more vague label "May affect your health negatively". Research is still going on, but no conclusive reports have been made regarding the health effects of snus.
Many cardiologists believe nicotine products (oral) contribute to the potentiation of sympathetic nerve tone, and may aggravate hypertension due to the effects of nicotine on cholinergic and dopaminergic neurotransmission. At higher doses, tachycardia and reflex bradycardia can also occur, triggering serious arrhythmias or even cardiac arrest in sensitive individuals. Further studies are needed in this regard.
A large study of almost 10,000 Swedish men published in the International Journal of Cancer in 2008 found snus use to be associated with an increase in the rate of oral and pharyngeal cancers, and a slightly increased mortality rate. Other studies and opinion pieces in renowned journals such as the British Medical Journal and the Lancet also suggest the probable risk of oral, pharyngeal and oesophageal cancers as a result of snus use.
The European Union banned the sale of snus in 1992, after a 1985 WHO study concluded "oral use of snuffs of the types used in North America and western Europe is carcinogenic to humans", but a WHO committee on tobacco has also acknowledged the evidence is inconclusive regarding health consequences for snus consumers. Only Sweden and EFTA-member Norway are exempt from this ban. A popular movement during the run-up to the 1994 referendum for Sweden's EU membership made exemption from the EU sale ban of snus a condition of the membership treaty.
Recent actions by many European governments to limit the use of cigarettes has led to calls to lift the ban on snus, as it is generally considered to be less harmful than cigarette smoke, both to the user and to others.
There is some debate among public health researchers over the use of "safer" tobacco or nicotine delivery systems, generally dividing along two lines of thought. A minority (primarily in the European Union and Canada) believes in "harm reduction", where the belief is generally that, while it should remain a goal to reduce addiction to nicotine in the population as a whole, the reduction of harm to the health of those who choose to use nicotine is more pragmatic, than the desire to reduce overall nicotine addiction. A proponent with this view is Karl Fagerström, Swedish PhD in psychology and regarded as a leading researcher in smoking cessation in Sweden. For example, some research available today shows snus use reduces or eliminates the risk of cancers associated with the use of other tobacco products such as chewing tobacco (the type primarily used in the US and Canada, created in a process similar to cigarette tobacco) and cigarettes. The widespread use of snus by Swedish men (estimated at 30% of Swedish male ex-smokers), displacing tobacco smoking and other varieties of snuff, is thought to be responsible for the incidence of tobacco-related mortality in men being significantly lower in Sweden than any other European country. In contrast, since women traditionally are less likely to use snus, their rate of tobacco-related deaths in Sweden can be compared to that of other European countries.
Snus may be less harmful than other tobacco products; according to Kenneth Warner, director of the University of Michigan Tobacco Research Network,
Ongoing discussion and debates among primary scientific researchers of the effects of snus use on life expectancy appears to indicate a significant increase in life expectancy among persons who previously smoked tobacco and switch to snus, depending on the age of the persons who switch, even when it is assumed that 100% of the risk of cardiovascular diseases among smokers transfers to snus users. It is also noted, in the correspondence seen in the previous citation that concerns about the effect of marketing by the tobacco industry, as influenced by the results of these scientific studies, is of primary concern to many researchers in the field, including the risk of emboldening the industry to attempt to increase snus sales among young people and promote dual-use of snus and smoked tobacco, and the use of medical nicotine, rather than snus, can better target at-risk populations, given better access and pricing. However, a growing consensus among researchers of smoking cessation have found nicotine replacement therapy (NRT) products to be minimally effective because tobacco users are often seeking the combination of MAO inhibitors (which are found in tobacco) and nicotine. MAO inhibitors in tobacco act to amplify the rewarding effects of nicotine, but may also act as a form of self-medication for people with depression. This would explain the association between mental illness and smoking, the minimal efficacy of NRT and the findings from numerous studies that smokers will choose a denicotinized cigarette over a dose of nicotine. These denicotinized cigarettes can also reduce subjective measures of craving in abstinent smokers. It has been hypothesized that Snus' success when compared with conventional NRT as a cigarette substitute could be attributed to its MAO inhibiting properties with snus being a tobacco product, however it has been shown that it fails to inhibit MAO-b and there is scant literature regarding MAO-a inhibition. Studies seem to suggest that for MAO inhibition tobacco has to be pyrolysized i.e. ignited as in cigarettes, cigars and pipes.
Opponents of snus sales maintain, nevertheless, even the low nitrosamine levels in snus cannot be completely risk-free, but snus proponents point out that inasmuch as snus is used as a substitute for smoking or a means to quit smoking, the net overall effect is positive, similar to the effect of nicotine patches.
In addition, this eliminates any exposure to second-hand smoke, further reducing possible harm to other tobacco nonusers. This is seen by public health advocates who believe in "harm reduction" as a reason for recommending snus, as well as other NRTs rather than continued use of cancer-causing nicotine delivery systems.
This does not, however, eliminate any harm to health caused by the nicotine itself. Current research focuses on possible long-term side effects of nicotine on blood pressure, hypertension and possible risk of pancreatic cancer due to tobacco-specific nitrosamines (TSNAs). TSNAs are the only component of tobacco shown to induce pancreatic cancer in laboratory animals. Nicotine may also exacerbate pancreatic illness, because nicotine stimulates the gastrointestinal tract's production of cholecystokinin, which stimulates pancreatic growth and may be implicated in pancreatic cancer. Thus far, the evidence specifically implicating snus in pancreatic cancer is only suggestive. Notably, the probability of developing pancreatic cancer from cigarettes is higher than the suggested chance of developing pancreatic cancer from snus.
The effects of Swedish snus on blood pressure has been studied at Umeå University in a randomly selected population sample of 4,305 Swedish men between 25 and 74 years of age. In the study, published in November 2008, the researchers found no elevation of blood pressure in snus users who had never been smokers compared to tobacco nonusers. In fact, snus users had lower systolic blood pressure than tobacco nonusers in the unadjusted data.
A number of peer-reviewed studies of snus use have been published:
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