Dipping tobacco

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Dipping tobacco Smokeless tobacco is no healthier than smoking 130226-M-ZB219-007.jpg
Dipping tobacco

Dipping tobacco is a type of finely ground or shredded, moistened smokeless tobacco product. It is commonly and idiomatically known as dip. Dipping tobacco is used by placing a pinch, or "dip", of tobacco between the lip and the gum (sublabial administration). The act of using it is called dipping. Dipping tobacco is colloquially called chaw, snuff, rub, or fresh leaf among other terms; because of this, it is sometimes confused with other tobacco products—namely dry snuff.

Contents

Using dipping tobacco can cause various harmful effects such as oral cancer, oesophagus cancer, and pancreas cancer, coronary heart disease, as well as negative reproductive effects including stillbirth, premature birth and low birth weight. [1] [2] Dipping tobacco poses a lower health risk than traditional combusted products, [3] however, it is not a healthy alternative to cigarette smoking. [4] The level of risk varies between different types of products and producing regions. [5] [3] There is no safe level of dipping tobacco use. [4] Globally it contributes to 650,000 deaths each year. [6]

Description

Four different cans (or tins) of dipping tobacco (from bottom left, clockwise): Skoal straight, Skoal long cut mint, Copenhagen straight, and Copenhagen long cut. Dipping tobacco, miscellaneous brands.jpg
Four different cans (or tins) of dipping tobacco (from bottom left, clockwise): Skoal straight, Skoal long cut mint, Copenhagen straight, and Copenhagen long cut.
A can of Copenhagen brand American dipping tobacco Theo Cope 121610.jpg
A can of Copenhagen brand American dipping tobacco

Dipping tobacco is packaged in "tins" or "cans", although they are not typically completely metal anymore. Dipping tobacco is also available in "rolls", "logs", or "sleeves", which is a package of 5 tins of tobacco, a similar concept to that of a carton of cigarettes. Ten tin rolls were also available in the past. Another package of dipping tobacco is the "tub", available in only select brands, equivalent to 6, 10, or 12 cans.

Before opening the can/tin of tobacco, users typically "pack" the can, similar to how cigarette smokers pack a pack of cigarettes. This is done by placing one's thumb and middle finger on the sides of the can, and then quickly turning the can and flicking the wrist so that one's index finger taps the top of the can.

Unlike snus, which is most often placed between the upper lip and gum, moist tobacco users or "dippers" tend to use the lower. Dipping in the upper lip is unusual, though when done, it is colloquially termed an "upper decker" or "top lip dip".[ citation needed ] The dip rests on the inside lining of the mouth for a period depending upon the user's preference—often 20–40 minutes.[ citation needed ] Nicotine and other alkaloids found in tobacco are absorbed in saliva sublabially by the inferior or superior labial arteries. Buccal and sublingual absorption may also occur.

Also unlike snus, dip often causes the user to produce excess saliva during the act of dipping. This is typically spat onto the ground or in a container, because swallowing the saliva-tobacco mixture can cause irritation to the esophagus and induce nausea and vomiting. A spittoon can be used, but often users will simply use an empty plastic bottle or a "mudjug," a portable spittoon. Smokeless tobacco is sometimes used in the workplace by employees, especially if the employer does not provide many cigarette breaks or if the employee is consistently using both hands during work (which doesn't provide opportunities for cigarette smoking). Smokeless tobacco is popular in many industrial areas where there is a safety risk in having an open flame, such as oil rigs or refineries.

Etymology and terminology

An example of how dipping tobacco is often placed in the mouth Dipping tobacco in mouth.jpg
An example of how dipping tobacco is often placed in the mouth

Dipping tobacco was first popularized and marketed as moist snuff in the 1800s. The term "snuff" in this context is an English cognate of the aforementioned "snus", from Swedish. Dipping tobacco's Scandinavian roots impart a noticeable legacy on modern American brands such as Copenhagen and Skoal (referring to the interlinguistic term skål, which in Danish, Norwegian, Icelandic, Faroese and Swedish roughly translates to "cheers", implying a toast).

A user of dipping tobacco will produce an excess amount of saliva which will be disposed of using a "spitter." A spitter can be an empty bottle, cup or commercially produced spittoon.

Dipping tobacco use is often accompanied by first drinking a liquid, in some areas known as a primer, catalyst, and rinser. A primer is used to initially salivate the mouth, usually during a meal, in order to prepare the mouth to use smokeless tobacco. This is important because a dry mouth or one full of food could lead to a less enjoyable experience for the user. A catalyst, like a primer, is used to fix the issues of a dry mouth or dry tobacco; however, the dipping tobacco is already currently in the user's lip. A rinser is used when the user is finished with their tobacco, and it is swished around in the user's mouth, similar to mouthwash, to dispose of any excess tobacco juice or particulates. All three liquids are usually water, but any liquid may be used.[ citation needed ]

Primarily in Texas and other southern US states, terminology is unique.[ citation needed ]Dip or dips refers to a wad of tobacco, whereas snuff refers to any amount of tobacco greater than a dip. For example, a tobacco user may reach for a dip from their can of snuff. Many areas have no such distinction, and may rarely use the word "snuff".

Cut sizes

The difference between cut sizes is the length of the strands of dip.

Common cut sizes

Unique cut sizes

The following cuts are either unique to one brand of dipping tobacco or are extremely rare:

Flavoring

Dipping tobacco is typically flavored. The most common flavors consist of mint, wintergreen, straight, and natural.

Health issues

Even though it is less dangerous than smoking, dipping tobacco is addictive, represents a major health risk, has no safe level use and is not a safe substitute for smoking. [7] [8] [9] [10] Globally it contributes to 650 000 deaths each year with a significant proportion of them in Southeast Asia. [11] [12]

Using dipping tobacco can cause a number of adverse health effects such as dental disease, oral cancer, oesophagus cancer, and pancreatic cancer, cardiovascular disease, asthma, and deformities in the female reproductive system. [13] It also raises the risk of fatal coronary artery disease, fatal stroke and non-fatal ischaemic heart disease [14] [15]

Quitting dipping tobacco use is as challenging as smoking cessation. [16] There is no scientific evidence that using dipping tobacco can help a person quit smoking. [17] [18]

Cancer

Dipping tobacco is a cause of oral cancer, oesophagus cancer, and pancreas cancer. [19] Increased risk of oral cancer caused by dipping tobacco is present in countries such as the United States but particularly prevalent in Southeast Asian countries where the use of smokeless tobacco is common. [20] [21]

All tobacco products, including dipping, contain cancer-causing chemicals. [22] [23] These carcinogenic compounds occurring in dipping tobacco vary widely, and depend upon the kind of product and how it was manufactured. [24] There are 28 known cancer-causing substances in dipping tobacco products. [24]

Cardiovascular disease

Using dipping tobacco increases the risk of fatal coronary heart disease and stroke. [25] [26] In 2010 more than 200 000 people died from coronary heart disease due to smokeless tobacco use. [27] Use of dipping tobacco also seems to greatly raise the risk of non-fatal ischaemic heart disease among users in Asia, although not in Europe. [25]

Effects during pregnancy

Dipping tobacco can cause adverse reproductive effects including stillbirth, premature birth, low birth weight. [25] [28] Nicotine in dipping tobacco products that are used during pregnancy can affect how a baby's brain develops before birth. [28]

List of brands

The following is a partial list of brands of dipping tobacco. Other tobacco products, such as chewing tobacco and snus, are excluded. [29]

Legality

Several countries have banned the sale (and in some cases the import) of dipping tobacco. Sale of dipping tobacco was banned in South Australia in 1986 and across the country in 1991 [30] and in most of the EU nations in 1993. [31] Sweden was exempt from this ban because of the traditionally high usage of snus in that country. Dipping tobacco is also not currently permitted for sale in the UK. It is not yet clear whether this law will be changed now that the UK has left the EU. [32]

In the United States, the Family Smoking Prevention and Tobacco Control Act gives the Food and Drug Administration the power to regulate the tobacco industry. [33] This law prohibits the sale of dipping tobacco to anyone under the age of 21, restricts tobacco product advertising and marketing directed to younger audiences, and requires bigger, more prominent warning labels for dipping tobacco products. [34]

Taxation

In the United States, the federal government taxes dipping tobacco at $0.5033 per pound ($1.11/kg), equivalent to 3.15¢ per one-ounce (28 g) package. [35] Excise taxes are also levied at the state level (Pennsylvania being the only exception), and in some instances, at the local level. Sales tax is also applied to the full retail price of dipping tobacco in most jurisdictions. The price of a tin of tobacco can range anywhere from under $1 per tin to more than $8. Price is affected by factors such as brand and especially the varying excise taxes from state to state.

History

Dipping tobacco evolved from the use of dry snuff in early American history. Up until the late 1700s, dry snuff was taken nasally, but then early Americans would take snuff orally by chewing the end of a twig until it resembled a brush, and then "dipping" the twig in the snuff and placing it in their mouths until the snuff dissolved. [36] Using dry snuff orally eventually evolved into modern day moist snuff, which Copenhagen introduced in 1822 and then Skoal started producing in 1934. Most varieties of dipping tobacco are much more recent inventions.

Moist snuff is available throughout the United States. Dipping tobacco is predominantly used by males. [37] Also, dipping tobacco has a similar presence in Canada. Smokeless tobacco use by professional baseball players was widespread throughout the 20th century until more recent years with the MLB cracking down on tobacco consumption, although a 1999 survey reported that "31 percent of the league's rookies used smokeless tobacco". [38] According to recent reports from NFL players, many professional football players chew tobacco in locker rooms, with some teams reporting that up to 75% of players admit to dipping. [39]

See also

Related Research Articles

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Gutka, ghutka, guṭkha is a type of betel quid and chewing tobacco preparation made of crushed areca nut, tobacco, catechu, paraffin wax, slaked lime and sweet or savory flavourings, in India, Pakistan, other Asian countries, and North America.

<span class="mw-page-title-main">Smoking cessation</span> Process of discontinuing tobacco smoking

Smoking cessation, usually called quitting smoking or stopping smoking, is the process of discontinuing tobacco smoking. Tobacco smoke contains nicotine, which is addictive and can cause dependence. As a result, nicotine withdrawal often makes the process of quitting difficult.

<span class="mw-page-title-main">Snus</span> Moist tobacco product placed under the upper lip

Snus is a Swedish tobacco product and non-tobacco nicotine product consumed by placing a pouch of powdered tobacco leaves or powdered non-tobacco plant fibers under the lip for nicotine to be absorbed through the oral mucosa. Whereas the nicotine in tobacco-based snus derives from tobacco leaves, the nicotine in non-tobacco snus can be either naturally or synthetically synthesized.

<span class="mw-page-title-main">Nicotine replacement therapy</span> Treatment for tobacco use disorder

Nicotine replacement therapy (NRT) is a medically approved way to treat people with tobacco use disorder by taking nicotine through means other than tobacco. It is used to help with quitting smoking or stopping chewing tobacco. It increases the chance of quitting tobacco smoking by about 55%. Often it is used along with other behavioral techniques. NRT has also been used to treat ulcerative colitis. Types of NRT include the adhesive patch, chewing gum, lozenges, nose spray, and inhaler. The use of multiple types of NRT at a time may increase effectiveness.

<span class="mw-page-title-main">Chewing tobacco</span> Type of smokeless tobacco product

Chewing tobacco is a type of smokeless tobacco product that is placed between the cheek and lower gum to draw out its flavor. It consists of coarsely chopped aged tobacco that is flavored and often sweetened; it is not ground fine like dipping tobacco. Unwanted juices are spat while chewing.

<span class="mw-page-title-main">Skoal (tobacco)</span> Brand of smokeless tobacco

Skoal is an American brand of smokeless tobacco. First produced by the U.S. Smokeless Tobacco Company (USSTC) in 1934 as the first wintergreen flavored dipping tobacco, Skoal is considered a high-priced product within the dipping tobacco market. "Skoal" is an Anglicization of skål, a term used often in Scandinavia to announce a toast of friendship, with connotations of well-wishing.

<span class="mw-page-title-main">U.S. Smokeless Tobacco Company</span> American company responsible for making smokeless tobacco

U.S. Smokeless Tobacco Company is an American company that manufactures smokeless tobacco products, notably dipping tobacco, as well as chewing tobacco, snus, and dry snuff. The company is a subsidiary of Altria.

<span class="mw-page-title-main">Health effects of tobacco</span> Circumstances, mechanisms, and factors of tobacco consumption on human health

Tobacco products, especially when smoked or used orally, have serious negative effects on human health. Smoking and smokeless tobacco use is the single greatest cause of preventable death globally. As many as half of people who smoke tobacco or use it orally die from complications related to such use. It has been estimated that each year, in total about 6 million people die from tobacco-related causes, with 600,000 of these occurring in non-smokers due to secondhand smoke. It is further estimated to have caused 100 million deaths in the 20th century.

<span class="mw-page-title-main">Smokeless tobacco</span> Tobacco product used by means other than smoking

Smokeless tobacco is a tobacco product that is used by means other than smoking. Their use involves chewing, sniffing, or placing the product between gum and the cheek or lip. Smokeless tobacco products are produced in various forms, such as chewing tobacco, snuff, snus, and dissolvable tobacco products. Smokeless tobacco is widely used in South Asia and this accounts for about 80% of global consumption. All smokeless tobacco products contain nicotine and are therefore highly addictive. Quitting smokeless tobacco use is as challenging as smoking cessation.

<span class="mw-page-title-main">Nicotine withdrawal</span> Process of withdrawing from nicotine addiction

Nicotine withdrawal is a group of symptoms that occur in the first few weeks after stopping or decreasing use of nicotine. Symptoms include intense cravings for nicotine, anger or irritability, anxiety, depression, impatience, trouble sleeping, restlessness, hunger, weight gain, and difficulty concentrating. Withdrawal symptoms make it harder to quit nicotine products, and most methods for quitting smoking involve reducing nicotine withdrawal. Quit smoking programs can make it easier to quit. Nicotine withdrawal is recognized in both the American Psychiatric Association Diagnostic and Statistical Manual and the WHO International Classification of Diseases.

<span class="mw-page-title-main">Snuff (tobacco)</span> Smokeless tobacco type

Snuff is a type of smokeless tobacco product made from finely ground or pulverized tobacco leaves. It is snorted or "sniffed" into the nasal cavity, delivering nicotine and a flavored scent to the user. Traditionally, it is sniffed or inhaled lightly after a pinch of snuff is either placed onto the back surface of the hand, held pinched between thumb and index finger, or held by a specially made "snuffing" device.

Tobacco harm reduction (THR) is a public health strategy to lower the health risks to individuals and wider society associated with using tobacco products. It is an example of the concept of harm reduction, a strategy for dealing with the use of drugs. Tobacco smoking is widely acknowledged as a leading cause of illness and death, and reducing smoking is vital to public health.

<span class="mw-page-title-main">Flavored tobacco</span> Tobacco product with added flavorings

Flavored tobacco products — tobacco products with added flavorings — include types of cigarettes, cigarillos and cigars, hookahs and hookah tobacco, various types of smokeless tobacco, and more recently electronic cigarettes. Flavored tobacco products are especially popular with youth and have therefore become targets of regulation in several countries.

Herbal smokeless tobacco is any product that imitates types of smokeless tobacco but does not contain tobacco and nicotine, or may contain nicotine without tobacco. Like herbal cigarettes and electronic cigarettes, they are often used as a tobacco cessation aid. Herbal smokeless tobacco use is an alternative to using smokeless tobacco that may help users quit.

<span class="mw-page-title-main">Naswar</span> Dipping tobacco

Naswār, also called nās, nāsor or nasvay, is a moist, powdered tobacco dip consumed mostly in Afghanistan, and surrounding countries, including Pakistan, India and neighboring Central Asian republics. Naswar is stuffed in the floor of the mouth under the lower lip, or inside the cheek, known as butt style stuffing, for extended periods of time, usually for 15 to 30 minutes. It is similar to dipping tobacco and snus. Swabi, Bannu, Dera Ismail Khan, Charsadda, Mohmand and Herat are renowned for their production of some of the highest quality Naswar.

<span class="mw-page-title-main">Youth smoking</span> Overview article

Smokingamong youth and adolescents is an issue that affects countries worldwide. While the extent to which smoking is viewed as a negative health behavior may vary across different nations, it remains an issue regardless of how it is perceived by different societies. The United States has taken numerous measures, ranging from changes in national policy surrounding youth cigarette access to changes in media campaigns, in attempts to eliminate the use of tobacco products among teenagers. Approximately 90% of smokers begin smoking prior to the age of 18.

The scientific community in the United States and Europe are primarily concerned with the possible effect of electronic cigarette use on public health. There is concern among public health experts that e-cigarettes could renormalize smoking, weaken measures to control tobacco, and serve as a gateway for smoking among youth. The public health community is divided over whether to support e-cigarettes, because their safety and efficacy for quitting smoking is unclear. Many in the public health community acknowledge the potential for their quitting smoking and decreasing harm benefits, but there remains a concern over their long-term safety and potential for a new era of users to get addicted to nicotine and then tobacco. There is concern among tobacco control academics and advocates that prevalent universal vaping "will bring its own distinct but as yet unknown health risks in the same way tobacco smoking did, as a result of chronic exposure", among other things.

Smokeless tobacco keratosis (STK) is a condition which develops on the oral mucosa in response to smokeless tobacco use. Generally it appears as a white patch, located at the point where the tobacco is held in the mouth. The condition usually disappears once the tobacco habit is stopped. It is associated with slightly increased risk of mouth cancer.

The chemical constituents of different types of snus vary, and population-level studies suggest that the disease risks vary as well. Using snus is harmful to health, although much less than smoking tobacco.

References

  1. Vidyasagaran, A. L.; Siddiqi, K.; Kanaan, M. (2016). "Use of smokeless tobacco and risk of cardiovascular disease: A systematic review and meta-analysis" (PDF). European Journal of Preventive Cardiology. 23 (18): 1970–1981. doi:10.1177/2047487316654026. ISSN   2047-4873. PMID   27256827. S2CID   206820997.
  2. Gupta, Ruchika; Gupta, Sanjay; Sharma, Shashi; Sinha, Dhirendra N; Mehrotra, Ravi (1 January 2019). "Risk of Coronary Heart Disease Among Smokeless Tobacco Users: Results of Systematic Review and Meta-Analysis of Global Data". Nicotine & Tobacco Research. 21 (1): 25–31. doi:10.1093/ntr/nty002. ISSN   1469-994X. PMC   6941711 . PMID   29325111.
  3. 1 2 Hajat, C.; Stein, E.; Ramstrom, L.; Shantikumar, S.; Polosa, R. (4 December 2021). "The health impact of smokeless tobacco products: a systematic review". Harm Reduction Journal. 18 (1): 123. doi: 10.1186/s12954-021-00557-6 . ISSN   1477-7517. PMC   8643012 . PMID   34863207.
  4. 1 2 Lipari, R. N; Van Horn, S. L (31 May 2017). "Trends in Smokeless Tobacco Use and Initiation: 2002 to 2014". Substance Abuse and Mental Health Services Administration. PMID   28636307.{{cite journal}}: Cite journal requires |journal= (help)PD-icon.svg This article incorporates text from this source, which is in the public domain .
  5. Abrams, David B.; Glasser, Allison M.; Pearson, Jennifer L.; Villanti, Andrea C.; Collins, Lauren K.; Niaura, Raymond S. (2018). "Harm Minimization and Tobacco Control: Reframing Societal Views of Nicotine Use to Rapidly Save Lives". Annual Review of Public Health. 39 (1): 193–213. doi: 10.1146/annurev-publhealth-040617-013849 . ISSN   0163-7525. PMC   6942997 . PMID   29323611. Creative Commons by small.svg  This article incorporates text by David B. Abrams, Allison M. Glasser, Jennifer L. Pearson, Andrea C. Villanti, Lauren K. Collins, and Raymond S. Niaura available under the CC BY 4.0 license.
  6. Chugh, Aastha; Arora, Monika; Jain, Neha; Vidyasagaran, Aishwarya; Readshaw, Anne; Sheikh, Aziz; Eckhardt, Jappe; Siddiqi, Kamran; Chopra, Mansi; Mishu, Masuma Pervin; Kanaan, Mona; Rahman, Muhammad Aziz; Mehrotra, Ravi; Huque, Rumana; Forberger, Sarah (June 2023). "The global impact of tobacco control policies on smokeless tobacco use: a systematic review". The Lancet Global Health. 11 (6): e953–e968. doi:10.1016/S2214-109X(23)00205-X. PMID   37202029.
  7. "Recommendation on smokeless tobacco products" (PDF). World Health Organization. 2017. pp. 1–9.
  8. "Health Risks of Smokeless Tobacco". American Cancer Society. 13 November 2015.
  9. "Smokeless Tobacco and Cancer". United States Department of Health and Human Services. National Cancer Institute at the National Institutes of Health. 25 October 2010.PD-icon.svg This article incorporates text from this source, which is in the public domain .
  10. Royal College of Physicians of London. Tobacco Advisory Group (2002). Protecting Smokers, Saving Lives: The Case for a Tobacco and Nicotine Regulatory Authority. Royal College of Physicians. pp. 5–. ISBN   978-1-86016-177-3.
  11. Sinha, Dhirendra N; Suliankatchi, Rizwan A; Gupta, Prakash C; Thamarangsi, Thaksaphon; Agarwal, Naveen; Parascandola, Mark; Mehrotra, Ravi (2016). "Global burden of all-cause and cause-specific mortality due to smokeless tobacco use: systematic review and meta-analysis". Tobacco Control. 27 (1): tobaccocontrol–2016–053302. doi:10.1136/tobaccocontrol-2016-053302. ISSN   0964-4563. PMID   27903956. S2CID   10968200.
  12. Chugh, Aastha; Arora, Monika; Jain, Neha; Vidyasagaran, Aishwarya; Readshaw, Anne; Sheikh, Aziz; Eckhardt, Jappe; Siddiqi, Kamran; Chopra, Mansi; Mishu, Masuma Pervin; Kanaan, Mona; Rahman, Muhammad Aziz; Mehrotra, Ravi; Huque, Rumana; Forberger, Sarah (June 2023). "The global impact of tobacco control policies on smokeless tobacco use: a systematic review". The Lancet Global Health. 11 (6): e953–e968. doi:10.1016/S2214-109X(23)00205-X. PMID   37202029.
  13. Niaz, Kamal; Maqbool, Faheem; Khan, Fazlullah; Bahadar, Haji; Ismail Hassan, Fatima; Abdollahi, Mohammad (2017). "Smokeless tobacco (paan and gutkha) consumption, prevalence, and contribution to oral cancer". Epidemiology and Health. 39: e2017009. doi:10.4178/epih.e2017009. ISSN   2092-7193. PMC   5543298 . PMID   28292008. Creative Commons by small.svg  This article incorporates text by Kamal Niaz, Faheem Maqbool, Fazlullah Khan, Haji Bahadar, Fatima Ismail Hassan, Mohammad Abdollahi available under the CC BY 4.0 license.
  14. Vidyasagaran, A. L.; Siddiqi, K.; Kanaan, M. (2016). "Use of smokeless tobacco and risk of cardiovascular disease: A systematic review and meta-analysis" (PDF). European Journal of Preventive Cardiology. 23 (18): 1970–1981. doi:10.1177/2047487316654026. ISSN   2047-4873. PMID   27256827. S2CID   206820997.
  15. Gupta, Ruchika; Gupta, Sanjay; Sharma, Shashi; Sinha, Dhirendra N; Mehrotra, Ravi (1 January 2019). "Risk of Coronary Heart Disease Among Smokeless Tobacco Users: Results of Systematic Review and Meta-Analysis of Global Data". Nicotine & Tobacco Research. 21 (1): 25–31. doi:10.1093/ntr/nty002. ISSN   1469-994X. PMC   6941711 . PMID   29325111.
  16. Lipari, R. N; Van Horn, S. L (31 May 2017). "Trends in Smokeless Tobacco Use and Initiation: 2002 to 2014". Substance Abuse and Mental Health Services Administration. PMID   28636307.{{cite journal}}: Cite journal requires |journal= (help)PD-icon.svg This article incorporates text from this source, which is in the public domain .
  17. "Smokeless Tobacco and Cancer". United States Department of Health and Human Services. National Cancer Institute at the National Institutes of Health. 25 October 2010.PD-icon.svg This article incorporates text from this source, which is in the public domain .
  18. ERS (29 May 2019). "ERS Position Paper on Tobacco Harm Reduction". ERS - European Respiratory Society. Retrieved 30 May 2024.
  19. Vidyasagaran, A. L.; Siddiqi, K.; Kanaan, M. (2016). "Use of smokeless tobacco and risk of cardiovascular disease: A systematic review and meta-analysis" (PDF). European Journal of Preventive Cardiology. 23 (18): 1970–1981. doi:10.1177/2047487316654026. ISSN   2047-4873. PMID   27256827. S2CID   206820997.
  20. Aupérin A (May 2020). "Epidemiology of head and neck cancers: an update". Current Opinion in Oncology. 32 (3): 178–186. doi:10.1097/CCO.0000000000000629. PMID   32209823. S2CID   214644380.
  21. Wyss AB, Hashibe M, Lee YA, Chuang SC, Muscat J, Chen C, et al. (November 2016). "Smokeless Tobacco Use and the Risk of Head and Neck Cancer: Pooled Analysis of US Studies in the INHANCE Consortium". American Journal of Epidemiology. 184 (10): 703–716. doi:10.1093/aje/kww075. PMC   5141945 . PMID   27744388.
  22. Lipari, R. N; Van Horn, S. L (31 May 2017). "Trends in Smokeless Tobacco Use and Initiation: 2002 to 2014". Substance Abuse and Mental Health Services Administration. PMID   28636307.{{cite journal}}: Cite journal requires |journal= (help)PD-icon.svg This article incorporates text from this source, which is in the public domain .
  23. Niaz, Kamal; Maqbool, Faheem; Khan, Fazlullah; Bahadar, Haji; Ismail Hassan, Fatima; Abdollahi, Mohammad (2017). "Smokeless tobacco (paan and gutkha) consumption, prevalence, and contribution to oral cancer". Epidemiology and Health. 39: e2017009. doi:10.4178/epih.e2017009. ISSN   2092-7193. PMC   5543298 . PMID   28292008. Creative Commons by small.svg  This article incorporates text by Kamal Niaz, Faheem Maqbool, Fazlullah Khan, Haji Bahadar, Fatima Ismail Hassan, Mohammad Abdollahi available under the CC BY 4.0 license.
  24. 1 2 Drope, Jeffrey; Cahn, Zachary; Kennedy, Rosemary; Liber, Alex C.; Stoklosa, Michal; Henson, Rosemarie; Douglas, Clifford E.; Drope, Jacqui (2017). "Key issues surrounding the health impacts of electronic nicotine delivery systems (ENDS) and other sources of nicotine". CA: A Cancer Journal for Clinicians. 67 (6): 449–471. doi: 10.3322/caac.21413 . ISSN   0007-9235. PMID   28961314.
  25. 1 2 3 Vidyasagaran, A. L.; Siddiqi, K.; Kanaan, M. (2016). "Use of smokeless tobacco and risk of cardiovascular disease: A systematic review and meta-analysis" (PDF). European Journal of Preventive Cardiology. 23 (18): 1970–1981. doi:10.1177/2047487316654026. ISSN   2047-4873. PMID   27256827. S2CID   206820997.
  26. Gupta, Ruchika; Gupta, Sanjay; Sharma, Shashi; Sinha, Dhirendra N; Mehrotra, Ravi (1 January 2019). "Risk of Coronary Heart Disease Among Smokeless Tobacco Users: Results of Systematic Review and Meta-Analysis of Global Data". Nicotine & Tobacco Research. 21 (1): 25–31. doi:10.1093/ntr/nty002. ISSN   1469-994X. PMC   6941711 . PMID   29325111.
  27. Chugh, Aastha; Arora, Monika; Jain, Neha; Vidyasagaran, Aishwarya; Readshaw, Anne; Sheikh, Aziz; Eckhardt, Jappe; Siddiqi, Kamran; Chopra, Mansi; Mishu, Masuma Pervin; Kanaan, Mona; Rahman, Muhammad Aziz; Mehrotra, Ravi; Huque, Rumana; Forberger, Sarah (June 2023). "The global impact of tobacco control policies on smokeless tobacco use: a systematic review". The Lancet Global Health. 11 (6): e953–e968. doi:10.1016/S2214-109X(23)00205-X. PMID   37202029.
  28. 1 2 "Smokeless Tobacco: Health Effects". Centers for Disease Control and Prevention. 1 December 2016.PD-icon.svg This article incorporates text from this source, which is in the public domain .
  29. http://www.doj.state.or.us/tobacco/pdf/smokeless_tobacco_directory.pdf%5B%5D
  30. Sachdev, Preeti; Chapman, Simon (September 2005). "Availability of smokeless tobacco products in South Asian grocery shops in Sydney, 2004". Medical Journal of Australia. 183 (6): 334. doi:10.5694/j.1326-5377.2005.tb07070.x. PMID   16167879. S2CID   45284231.
  31. "British American Tobacco – EU Social Reporting – Issues". Batresponsibility.eu. Retrieved 26 January 2012.
  32. Sharrow Mills, "The Encyclopaedia of Tobacco", Sharrow Mills, 2018
  33. "The Family Smoking Prevention and Tobacco Control Act" (PDF).
  34. "Overview of the Family Smoking Prevention and Tobacco Control Act: Consumer Fact Sheet". Food and Drug Administration .
  35. "TTBGov Tax and Fee Rates". Ttb.gov. Archived from the original on 26 February 2016. Retrieved 26 January 2012.
  36. "American Snuff Company - Est. 1900 - Timeline". Archived from the original on 1 December 2011. Retrieved 19 September 2014.
  37. Cornelius, Monica E. (2020). "Tobacco Product Use Among Adults — United States, 2019". MMWR. Morbidity and Mortality Weekly Report. 69 (46): 1736–1742. doi:10.15585/mmwr.mm6946a4. ISSN   0149-2195. PMC   7676638 . PMID   33211681.
  38. Palmer, Brian (2 November 2009). "Why Do So Many Baseball Players Chew Tobacco?". Slate. ISSN   1091-2339 . Retrieved 16 February 2018.
  39. "Fowler: NFL has a smokeless tobacco habit, too". ESPN.com. Retrieved 16 February 2018.