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  • Snus smokeless tobacco: Less harmful than cigarettes, but not safe.

    Mon, Nov 22, 2010

    Oral Cancer News

    Source: WebMD

    By: Daniel J. DeNoon

    If you use snus, do you win or lose?

    Snus — alternately pronounced snoose or snooze — is a smokeless, flavored tobacco product very different from snuff. When placed between cheek and gum, it doesn’t make you spit.

    Even its critics admit that snus is less harmful than other forms of smokeless tobacco. And it is far less harmful than cigarette smoking.

    So is snus a good thing?

    It would be a good thing if everyone who smoked cigarettes or dipped snuff switched to snus instead. It would be a good thing if snus were a way station on the road to quitting all forms of tobacco. It would even be a good thing if kids who would have become smokers became snus users instead.

    But despite all of that, mounting evidence suggests snus isn’t a good thing — and may be far worse than they appear.

    Snus: Less Harmful, But Not Safe

    Cigarettes are the world’s most efficient nicotine delivery device. They are also the most deadly. Many of the most dangerous byproducts of cigarettes are created during the burning process.

    Smokeless tobacco products obviously don’t burn. But smokeless tobacco is a major cause of oral cancer, pancreatic cancer, and esophageal cancer.

    Much of this risk comes from cancer-causing chemicals called nitrosamines and polycyclic aromatic hydrocarbons (PAH). And snuff products actually deliver more cancer-causing nitrosamines than cigarettes do.

    But nitrosamine content is far lower in snus than in snuff, says Stephen S. Hecht, PhD, professor of cancer prevention at the University of Minnesota.

    “Snus are made with a special process to help control nitrosamine levels,” Hecht tells WebMD.

    There’s a catch, of course. Carcinogen levels in snus may be lower — but they are not low.

    “Nitrosamine levels in snus are still 100 times greater than levels of nitrosamines in foods like nitrite-preserved meats,” Hecht says. “This is not a harmless product.”

    And there’s evidence that these nitrosamines — or something else in snus — are causing cancer. In Sweden and Norway, where snus originated, snus users have a significantly higher risk of pancreatic cancer.

    Snus are also linked to mouth sores, dental cavities, heart attack, stroke, and diabetes risk. And they do deliver nicotine — an addictive drug.

    Snus: Harm Reduction or Multiplication?

    OK, so snus isn’t without harm. But if it’s so much safer than cigarettes, wouldn’t it be good for smokers to switch to snus?

    In Scandinavia, there’s some evidence that snus contributed to a decline in smoking. Whether that happens in the U.S. depends on young people, says Michael Eriksen, ScD, director of the Institute of Public Health at Georgia State University and former director of the CDC Office on Smoking and Health.

    “If we see that existing smokers are the primary users of snus and go from smoking to snus, that would be a public health success story,” Eriksen tells WebMD. “But if kids start out on snus and then grow into smoking, that is going to be a disaster.”

    It’s a huge public health experiment — and the results already are plain to see, says Terry Pechacek, PhD, associate director for science at the CDC’s Office on Smoking and Health.

    Pechacek notes that more than a fourth of white, male high school students report having used smokeless tobacco products in the last month. Overall, nearly 7% of all U.S. high school students already use smokeless tobacco.

    And they are not using snus instead of cigarettes.

    “The overwhelming pattern is to smoke cigarettes along with smokeless tobacco — and two-thirds of this is among young adults,” Pechacek tells WebMD. “Over half of teens using smokeless tobacco are also using cigarettes. … It is of great public health concern.”

    This isn’t an accident, says Michael Steinberg, MD, MPH, director of the tobacco dependence program at the University of Medicine and Dentistry of New Jersey.

    Steinberg notes that in 2006, major U.S. cigarette companies bought the major smokeless tobacco brands. And the two major brands of snus? They’re from leading cigarette makers Altria/Philip Morris (Marlboro Snus) and RJ Reynolds (Camel Snus).

    “Snus is being co-marketed with cigarettes,” Steinberg tells WebMD. “The companies are not shy in saying, ‘When you can’t smoke, use snus.’ But when you can smoke, it is clear they want you to smoke cigarettes. They make more money from cigarettes sales than anything else on the planet.”

    Steinberg also notes that U.S. snus deliver less nicotine than do cigarettes.

    “So if people try to get nicotine from snus, they will not get what they are used to. They will go through nicotine withdrawal and so will not use snus alone,” Steinberg says. “My conclusion is that companies do not want to replace cigarettes with snus.”

    Snus: An Aid to Quitting Cigarettes?

    Data from Sweden show that snus users don’t always progress to cigarette use, and that it’s possible to use snus to reduce dependence on cigarettes.

    One Swedish study, for example, found that there were more ex-smokers using snus that there were ex-snus users using cigarettes.

    However, Steinberg notes that this study fails to account for significant anti-smoking efforts taking place in Sweden at the same time, such as indoor health programs and government assistance to smoking cessation programs.

    “Other countries, such as Norway, have not seen the same outcomes in terms of health benefits of snus as in Sweden,” he says.

    Steinberg points to studies showing that snus isn’t any more helpful than nicotine replacement products such as nicotine gum and nicotine nasal spray.

    “The real question is who do you buy your nicotine from?” GSU’s Erickson says. “Do you buy it from a tobacco company that can put anything on the market with no testing … or do you buy it from pharmaceutical companies that have to demonstrate the safety and effectiveness of their products as a drug and demonstrate they actually work?”

    It’s right there in a big black box on the home page of the Camel Snus web site: “WARNING: Smokeless tobacco is addictive.”

    Snus users get hooked on nicotine. This means that if users try to quit, they will go through the unpleasant sick feeling known as withdrawal. Many will find it very difficult, if not impossible, to stop using nicotine in one form or another.

    “Those who sell nicotine would like to keep people hooked on nicotine forever. That is a question, whether lifetime nicotine addiction is acceptable,” Erikson says. “There are 50 million people in the U.S. who are regular nicotine users. The sooner we can get them from relying on smoked nicotine to not-smoked nicotine the better. The sooner we can get them all off nicotine entirely, the better.”

    All of the experts who spoke with WebMD agree: Snus clearly aren’t as deadly as cigarettes, but they pose a significant risk to your health.

    “The bottom line is there is no safe form of tobacco use,” Pechacek says.

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