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1
Calculating the comparative mortality risk from
smokeless tobacco versus smoking Carl V
Phillips, Dunsi Rabiu, Brad Rodu University of
Alberta School of Public Health Alberta Smokeless
Tobacco Education and Research Group
(ASTER) University of Louisville

• Background and Motivation
• Smoking is bad for your health. We assume we do
  not have to expand on that.
• The use of smokeless tobacco (ST), which includes
  moist snuff (dip), chewing tobacco, and various
  new sachet and lozenge-type products, is much
  less risky than smoking, and provides a dose of
  nicotine similar to that from smoking.
• There is overwhelming epidemiologic evidence to
  support the claim that the risk of
  life-threatening disease from ST use is much
  lower than that from smoking.
• This observation has led some public health
  advocates, ourselves included, to suggest that
  smokeless tobacco might be a promising substitute
  for smoking and that this harm reduction
  strategy could benefit the large number of
  smokers who are never going to quit nicotine
  entirely.
• Such substitution has worked very well in
  Sweden, where a large portion of male smokers
  switched to ST, resulting in the lowest smoking
  rate for any comparable population.
• New smokeless tobacco products are easy to use
  in particular, they do not require spitting.
  This makes the harm reduction option socially
  feasible.
• Unfortunately, for reasons that are not entirely
  obvious, a large, well-financed cadre of
  anti-tobacco abolitionists opposed the harm
  reduction strategy. Sometimes their arguments
  imply that the total risk reduction would be too
  modest to be sufficient.
• How much would substitution of smokeless tobacco
  for cigarettes change health risks?

.
Table 1 Annual smoking-attributed and
other-cause mortality, US males, age 35
Table 2 Smoking status, U.S. males, age 35
(percent of population)