Smokeless tobacco: a gateway to smoking or a way away from smoking.

Recently, tobacco companies have been marketing moist smokeless tobacco products that are 'spitless'. These products have lower concentrations of tobacco-specific nitrosamines and of other harmful chemicals than other tobacco products, but can deliver relatively high doses of nicotine. They are packaged in small sachets, similar to tea bags that are placed between cheek and gum. Global promotion of smokeless tobacco products is hotly debated among tobacco control and public health experts. Proponents point to the Swedish experience where snus (Swedish moist snuff) is widely used as an alternative to cigarette smoking among men. Meanwhile, Sweden has low rates of smoking and a lower rate of respiratory diseases and lung cancers by comparison to other developed countries. The opponents argue that snus has its own risks, that no form of tobacco should ever be promoted; and that 'snus is culture-bound and not transferable to other settings'. Critics also suspect that the tobacco industry will use snus marketing as a 'gateway' to promote cigarettes among young people. Research on the effects of marketing snus to smokers is too limited to support using snus as a harm-reduction tool, and the epidemiological data are not conclusive.