SLT: Difference between revisions

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* New research on the relative safety of American dip/chew products indicates that smokeless users who had never smoked showed no significant risks for numerous diseases.

* In summary, American dip/chew and Swedish snus are indistinguishable with respect to health impact. Smokers who switch to any of these products can make smoking history.

In a press release 16 March 2023 [https://www.fda.gov/news-events/press-announcements/fda-authorizes-copenhagen-classic-snuff-be-marketed-modified-risk-tobacco-product FDA Authorizes Copenhagen Classic Snuff to be Marketed as a Modified Risk Tobacco Product]

Please note that other products listed in the table below may be significantly more risky, information on the relative risks and those compared to smoking are not easily available.

* FDA authorized U.S. Smokeless Tobacco Company (USSTC) to market its Copenhagen Classic Snuff, a loose moist smokeless tobacco product, as a modified risk tobacco product (MRTP).

* This product is a pre-existing tobacco product that has been marketed in the U.S. for years without modified risk information.

* This action now allows the product to be marketed as a modified risk tobacco product with the claim: “IF YOU SMOKE, CONSIDER THIS: Switching completely to this product from cigarettes reduces risk of lung cancer.”

Please note that other products listed in the table below may be significantly more risky, information on the relative risks and those compared to smoking are not easily available.

==== Possible advantages ====

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==== Chewing tobacco (“chew”) ====

Chewing tobacco is available in loose leaves, plugs, or twists of tobacco, and is placed between the cheek and gum or teeth. Examples of chewing tobacco include Red Man and Levi Garrett.

This opinion piece is interesting as it looks at the risk and how to reduce it:

[https://theprint.in/opinion/no-gutkha-zarda-or-khaini-is-safe-but-heres-how-their-cancer-causing-risk-can-be-reduced/1966957/ No gutkha, zarda, or khaini is ‘safe’. But here’s how their cancer-causing risk can be reduced] (The Print India article)

* Many of the cancer causing chemicals are produced by curing or bacterial growth and fermentation of the product, either intentional or during transit or storage.

* It may allow local products to be made with a much lower risk, by eliminating the fermentation and curing processes that result in carcinogens.

==== Snuff ====

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== Scientific studies and papers ==

[https://pubmed.ncbi.nlm.nih.gov/36738817/ Sudanese smokeless tobacco (Toombak) users harbour significantly altered long-term cortisol body production.]

=== 2023: [https://pubmed.ncbi.nlm.nih.gov/38051542/ Heterogeneity of Harmful Constituent Profiles in Smokeless Tobacco Products from Five African Countries] ===

* Chem Res Toxicol. 2023 Dec 5. doi: 10.1021/acs.chemrestox.3c00181. Online ahead of print.

* Francisco Gomez, Olalekan Ayo-Yusuf, Katrina Yershova, Vipin Jain, Aleksandra Alcheva, Dorothy K Hatsukami, Mark Parascandola , Irina Stepanov

* Manufactured and custom-made SLT products were purchased from five African countries (South Africa, Uganda, Mauritania, Nigeria, and Zambia) using a standard approach for sample collection, labeling, and storage. Moisture content, pH, total and unprotonated (biologically available) nicotine, five tobacco-specific ''N''-nitrosamines (TSNA), 10 polycyclic aromatic hydrocarbons (PAH), five metals and metalloids (As, Cd, Cr, Ni, and Pb), nitrate, and nitrite were analyzed.

=== 2023: [https://pubmed.ncbi.nlm.nih.gov/37560082/ Death, Disability, and Premature Life Years Lost Due to Cigarettes, Bidis, and Smokeless Tobacco in India: A Comparative Assessment.] ===

* A total of 33 studies were included. PAF [population attributable fraction] was calculated for oral and lung cancer as well as ischemic heart disease (IHD) due to cigarettes, oral and lung cancer, IHD, and chronic obstructive pulmonary disease due to bidi, and oral and stomach cancer and IHD due to SLT.

* Cigarettes resulted in 8.4 million DALYs, 8.26 million YLLs, and 341 thousand deaths; Bidis led to 11.7 million DALYs, 10.7 million YLLs, and 478 thousand deaths (83 million users combined)

* SLTs accounted for 4.38 million DALYs, 4.3 million YLLs, and 171 thousand deaths annually (191 million smokeless users)

* I would be very time consuming to assess if they have properly attributed death and disease to these tobacco-use risks. It is complicated by the wide range of other risks that afflict, especially the poor and rural populations. Thus their number will be used as is, further analysis welcome:

** Some normalising for population and user numbers would be helpful in giving a rough proxy for relative risk. In 2020, India had 274 million adult tobacco users, of which 83 million were smokers (cigarettes and bidis) and the (rest (191 m) were smokeless users (WHO data for 2020). Just using simple division: smoking = 242 DALY/100,000 users SLT = 23 DALY/100,000 users.

** Obviously, massive caveats apply to this. But a crude first approximation suggests an '''order of magnitude''' difference in risks between Indian smoking and smokeless use. It would be better for smokers to switch to smokeless, even the toxic traditional South Asian recipes.

=== 2023: [https://pubmed.ncbi.nlm.nih.gov/37264008/ Physical and chemical characterization of smokeless tobacco products in India.] ===

* The products in question are better described as traditional recipes that contain tobacco (and much else). That doesn't inhibit the authors from drawing conclusions that range far beyond the products and geography of their study and chiming in with something about flavours, as that is the happening thing now.

* Needs reading as it may help differentiate the risk of some Indian SLT

=== 2023: [https://pubmed.ncbi.nlm.nih.gov/36738817/ Sudanese smokeless tobacco (Toombak) users harbour significantly altered long-term cortisol body production.] ===

* The effect on body cortisol response over a retrospective period in users of this product has not been previously explored. In addition, the psycho-dependency level distributed amongst users of Toombak has also not been analysed to date.

* FTND - ST scores ranged from 4-9, with 85% of Toombak users reflecting high levels of psycho-dependency (score>5) and nicotine tolerance.

* Cortisol body release in Sudanese smokeless tobacco users was found to be significantly altered. While low cortisol levels do lead to anxiolytic effects, long-term, this can allow for an increased susceptibility to low cortisol associated diseases. (Unfortunately there is no discussion on the possibility that this might be an overall positive regarding anxiety, and no information on what these diseases might be. ed.)

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# https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9685874/

[[Category:THR product]]

[[:Category:THR product]]

[[Category:Smoking cessation]]

[[:Category:Smoking cessation]]

[[Category:Smoking]]

[[:Category:Smoking]]

@@ Line 26: / Line 26: @@
 * New research on the relative safety of American dip/chew products indicates that smokeless users who had never smoked showed no significant risks for numerous diseases.
 * In summary, American dip/chew and Swedish snus are indistinguishable with respect to health impact.  Smokers who switch to any of these products can make smoking history.
+In a press release 16 March 2023 [https://www.fda.gov/news-events/press-announcements/fda-authorizes-copenhagen-classic-snuff-be-marketed-modified-risk-tobacco-product FDA Authorizes Copenhagen Classic Snuff to be Marketed as a Modified Risk Tobacco Product]
-Please note that other products listed in the table below may be significantly more risky, information on the relative risks and those compared to smoking are not easily available.
+* FDA authorized U.S. Smokeless Tobacco Company (USSTC) to market its Copenhagen Classic Snuff, a loose moist smokeless tobacco product, as a modified risk tobacco product (MRTP).
+* This product is a pre-existing tobacco product that has been marketed in the U.S. for years without modified risk information.
+* This action now allows the product to be marketed as a modified risk tobacco product with the claim: “IF YOU SMOKE, CONSIDER THIS: Switching completely to this product from cigarettes reduces risk of lung cancer.”
+Please note that other products listed in the table below may be significantly more risky, information on the relative risks and those compared to smoking are not easily available.
 ==== Possible advantages ====
@@ Line 54: / Line 59: @@
 ==== Chewing tobacco (“chew”) ====
 Chewing tobacco is available in loose leaves, plugs, or twists of tobacco, and is placed between the cheek and gum or teeth. Examples of chewing tobacco include Red Man and Levi Garrett.
+This opinion piece is interesting as it looks at the risk and how to reduce it:
+[https://theprint.in/opinion/no-gutkha-zarda-or-khaini-is-safe-but-heres-how-their-cancer-causing-risk-can-be-reduced/1966957/ No gutkha, zarda, or khaini is ‘safe’. But here’s how their cancer-causing risk can be reduced] (The Print India article)
+* Many of the cancer causing chemicals are produced by curing or bacterial growth and fermentation of the product, either intentional or during transit or storage.
+* It may allow local products to be made with a much lower risk, by eliminating the fermentation and curing processes that result in carcinogens.
 ==== Snuff ====
@@ Line 388: / Line 400: @@
 == Scientific studies and papers ==
-[https://pubmed.ncbi.nlm.nih.gov/36738817/ Sudanese smokeless tobacco (Toombak) users harbour significantly altered long-term cortisol body production.]
+=== 2023: [https://pubmed.ncbi.nlm.nih.gov/38051542/ Heterogeneity of Harmful Constituent Profiles in Smokeless Tobacco Products from Five African Countries] ===
+* Chem Res Toxicol. 2023 Dec 5. doi: 10.1021/acs.chemrestox.3c00181. Online ahead of print.
+* Francisco Gomez, Olalekan Ayo-Yusuf, Katrina Yershova, Vipin Jain, Aleksandra Alcheva, Dorothy K Hatsukami, Mark Parascandola , Irina Stepanov
+* Manufactured and custom-made SLT products were purchased from five African countries (South Africa, Uganda, Mauritania, Nigeria, and Zambia) using a standard approach for sample collection, labeling, and storage. Moisture content, pH, total and unprotonated (biologically available) nicotine, five tobacco-specific ''N''-nitrosamines (TSNA), 10 polycyclic aromatic hydrocarbons (PAH), five metals and metalloids (As, Cd, Cr, Ni, and Pb), nitrate, and nitrite were analyzed.
+=== 2023: [https://pubmed.ncbi.nlm.nih.gov/37560082/ Death, Disability, and Premature Life Years Lost Due to Cigarettes, Bidis, and Smokeless Tobacco in India: A Comparative Assessment.] ===
+* A total of 33 studies were included. PAF [population attributable fraction] was calculated for oral and lung cancer as well as ischemic heart disease (IHD) due to cigarettes, oral and lung cancer, IHD, and chronic obstructive pulmonary disease due to bidi, and oral and stomach cancer and IHD due to SLT.
+* Cigarettes resulted in 8.4 million DALYs, 8.26 million YLLs, and 341 thousand deaths; Bidis led to 11.7 million DALYs, 10.7 million YLLs, and 478 thousand deaths (83 million users combined)
+* SLTs accounted for 4.38 million DALYs, 4.3 million YLLs, and 171 thousand deaths annually (191 million smokeless users)
+* I would be very time consuming to assess if they have properly attributed death and disease to these tobacco-use risks.  It is complicated by the wide range of other risks that afflict, especially the poor and rural populations. Thus their number will be used as is, further analysis welcome:
+** Some normalising for population and user numbers would be helpful in giving a rough proxy for relative risk. In 2020, India had 274 million adult tobacco users, of which 83 million were smokers (cigarettes and bidis) and the (rest (191 m) were smokeless users (WHO data for 2020). Just using simple division: smoking = 242 DALY/100,000 users SLT = 23 DALY/100,000 users.
+** Obviously, massive caveats apply to this.  But a crude first approximation suggests an '''order of magnitude''' difference in risks between Indian smoking and smokeless use. It would be better for smokers to switch to smokeless, even the toxic traditional South Asian recipes.
+=== 2023: [https://pubmed.ncbi.nlm.nih.gov/37264008/ Physical and chemical characterization of smokeless tobacco products in India.] ===
+* The products in question are better described as traditional recipes that contain tobacco (and much else).  That doesn't inhibit the authors from drawing conclusions that range far beyond the products and geography of their study and chiming in with something about flavours, as that is the happening thing now.
+* Needs reading as it may help differentiate the risk of some Indian SLT
+=== 2023: [https://pubmed.ncbi.nlm.nih.gov/36738817/ Sudanese smokeless tobacco (Toombak) users harbour significantly altered long-term cortisol body production.] ===
 * The effect on body cortisol response over a retrospective period in users of this product has not been previously explored. In addition, the psycho-dependency level distributed amongst users of Toombak has also not been analysed to date.
 * FTND - ST scores ranged from 4-9, with 85% of Toombak users reflecting high levels of psycho-dependency (score>5) and nicotine tolerance.
 * Cortisol body release in Sudanese smokeless tobacco users was found to be significantly altered. While low cortisol levels do lead to anxiolytic effects, long-term, this can allow for an increased susceptibility to low cortisol associated diseases. (Unfortunately there is no discussion on the possibility that this might be an overall positive regarding anxiety, and no information on what these diseases might be. ed.)
@@ Line 401: / Line 436: @@
 # https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9685874/
-[[Category:THR product]]
+[[:Category:THR product]]
-[[Category:Smoking cessation]]
+[[:Category:Smoking cessation]]
-[[Category:Smoking]]
+[[:Category:Smoking]]