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Health Effects of Smokeless Tobacco Products

Smokeless tobacco carries significant health risks and is not a safe alternative to smoking cigarettes. Smokeless tobacco contains the same addictive chemical (nicotine) that is in cigarettes, which can lead to dependence.1  Smokeless tobacco use has been linked to several different types of cancer, including cancer of the mouth, esophagus and pancreas.3

Key Facts about Smokeless Tobacco

  • Smokeless tobacco contains at least 28 cancer-causing agents (carcinogens).3
  • Smokeless tobacco use has been linked to gum disease, tooth decay and tooth loss as well as the formation of white or gray patches inside the mouth called leukoplakia that can lead to cancer.3
  • Smokeless tobacco use during pregnancy increases the risk for early delivery and stillbirth.1
  • There are two main types of smokeless tobacco used in the U.S., chewing tobacco and snuff. Chewing tobacco comes in loose leaf, plug and twist form. Snuff is finely ground tobacco that comes dry, moist or in bag-like pouches. Most smokeless tobacco users place the product in the cheek or between their gum and cheek, suck on the tobacco and spit out or swallow the juices. Smokeless tobacco often is referred to as spit tobacco.4
  • Some tobacco companies are now selling smokeless tobacco products such as snus, that do not require the user to spit, or that dissolve when put into the mouth. A U.S. Food and Drug Administration report concluded that dissolvable tobacco products could increase overall tobacco use by encouraging kids to start using tobacco or discouraging current smokers from quitting.5
  • In 2015 the five largest smokeless tobacco manufacturers spent close to $685 million on advertising and promotion. The largest single category of promotional expenses reported was price discounts to smokeless tobacco retailers or wholesalers to reduce the price to consumers, accounting for close to 429 million or 63 percent of total advertising and promotional spending.6

Smokeless Tobacco Use in the U.S.

  • In the U.S., an estimated 3.3 percent of adults are current smokeless tobacco users; use is much higher among men than women (6.2 percent vs. 0.5 percent). Among specific populations, American Indian/Alaska Natives have the highest use (7.9 percent) followed by non-Hispanic Whites (4.3 percent).7
  • An estimated 5.8 percent of high school students are current smokeless tobacco users. Smokeless tobacco use is much more common among male then female high school students (8.3 percent versus 3.3 percent). White high school students use smokeless tobacco at the highest rate (7.4 percent).8
  • An estimated 2.2 percent of middle school students are current smokeless tobacco users.8
  • An estimated 9.6 percent of high school students and 3.1 percent of middle school students used two or more tobacco products, including smokeless tobacco, in the past 30 days.8

Learn about the American Lung Association's programs to help you or a loved one quit smoking, and join our advocacy efforts to reduce tobacco use and exposure to secondhand smoke. Visit or call the Lung HelpLine at 1-800-LUNGUSA (1-800-586-4872).

    Page Last Updated: May 7, 2018

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