Ever heard of SNUS?

If not, you will soon enough. But let me be the first to introduce you. Snus is a smokeless tobacco product that is new to the U.S. The two biggest cigarette makers - Philip Morris and R.J. Reynolds - began test-marketing it here in 2006. Snus is the Swedish form of smokeless tobacco and has been manufactured there for over a century. It is different from regular American smokeless tobacco because it is SPITLESS and comes in small, flavored pouches that users place behind their upper lip while the product delivers nicotine to their body. It is also manufactured differently which leads to some interesting consequences.

One of those consequences is that using snus is MUCH SAFER than smoking but it is still NOT SAFE. However, many people in the tobacco control community (called reduced-harm proponents) argue that the tobacco control community should actually PROMOTE the use of snus as a safer alternative to smoking.

So why am I talking about snus? Well it just so happens that last semester I took a Tobacco Control Seminar and ended up writing a 43 page paper talking about how the public health community should respond now that snus is being introduced in the U.S. It's going to be published in the law school's Journal of Heath Care Law & Policy in May! My article argues against the "harm-reduction" strategy of promoting snus use to those who can't quit smoking and those who otherwise may begin to smoke. Why? Because to do so would be to play right into the tobacco industry's hands.

It is difficult to give you a brief taste of what I say in 43 pages, but I do want you to know that this stuff is dangerous! I especially can't get into the science of the uncertain health effects of American vs. Swedish snus, snus vs. other forms of smokless tobacco, etc. But let me give you just a few reasons why any health professional promoting snus is a bad idea.

1. One of the reasons the tobacco control community has had success in reducing smoking rates is through labelling smoking as an "aberrant social behavior," because of smell, spitting, etc. Snus, however, isn't susceptible to those defects - no smell, no spitting, and it can be used discreetly. While most middle class youth are no longer interested in cigarettes, "snusing" could easily become the new thing - all we need to do is look to Sweden to see how that may happen.

2. Snus can only be a "reduced-harm" product if current smokers who wouldn't quit actually switch to using snus. This is unlikely because snus doesn't provide a good substitute for cigarettes in terms of nicotine delivery (getting that "fix"). What is likely to happen is that smokers will use snus when they can't smoke. This will undermine the beneficial effect of clean-air laws of encouraging smokers to quit. This, in fact, is precisely how snus is being marketed: to current smokers, for "pleasure for wherever." If all snus does is help smokers sustain their nicotine addiction, and encourage new users to start using tobacco, there can be no public health benefit.

3. It is unclear what advantages snus would provide as a replacement for cigarettes over nicotine replacement therapy (NRT) which unlike snus has been deemed "safe" for long-term use. Currently, NRT is expensive and formulated for short-term use in quitting. But surely the tobacco control industry should focus on developing and promoting forms of NRT that are effective and attractive to consumers before it helps the tobacco industry promote its latest product.

I hope that gives you just a taste of what we are up against. In my article, I argue that the U.S. should ban the sale of snus (as has been done in the European Union and Australia). Since this is unlikely to happen, I argue that congress must pass the bill currently before it which would give the FDA authority to regulate tobacco. As it stands, a major federal agency charged with protecting the public health still lacks authority to regulate a product that is one of the leading causes of death among Americans. I also discuss other actions states can independently take to counteract the negative consequences of snus marketing by Big Tobacco. At a minimum, the public health community should not team up with Big Tobacco by promoting snus. Tobacco manufacturers have brought snus to the U.S. to respond to falling profits and declining cigarette consumption - they hope to widen their consumer base and increase their bottom line, and so far it seems that it may be working. The public health community must take another approach, before snus creates a new tobacco crisis in the U.S.

Anyway, thanks for listening to me talk about snus. It was fun to write a law school paper that is actually on something I care about - tobacco control - although I hadn't ever heard of snus either until I took the class. And I figured since I wrote all about it I might as well blog a little bit about it, too. :) I am interested to see if any of you have heard of it! (By the way, it is coming to Baltimore ...)