title: Smokeless tobacco use: harm reduction or induction approach?
abstract: BACKGROUND
  Smokeless tobacco (ST) substitution for cigarettes as a method to reduce harm has been actively debated. Use of ST as a smoking cessation method or as a means to reduce cigarettes has been proposed. The impact of using ST in these ways is relatively unknown.
  
  
  METHODS
  A review of the different issues and studies related to using smokeless tobacco as a method to reduce tobacco toxin exposure and harm is presented.
  
  
  RESULTS
  The toxicity of the product itself varies by brand of ST and across countries. Of the existing studies, comparisons of consequences between cigarettes and ST show that cigarette smoking produces more negative health effects, is likely to have a higher addiction potential and more severe withdrawal, and leads to a higher rate of relapse than ST use. On the other hand, ST use facilitates the use of cigarettes, which is a deadly tobacco product. Additionally, ST is not a harmless product, and a less harmful product, medicinal nicotine, is available as an effective treatment approach. Furthermore, ST products are not under the same regulatory scrutiny as medicinal nicotine products.
  
  
  CONCLUSIONS
  Considerably more research and product regulation is necessary prior to considering smokeless tobacco as a harm reduction method.
authors.affiliation: Tobacco Use Research Center, Medical School, University of Minnesota, Minneapolis, MN 55414, USA. hatsu001@umn.edu
authors.forename: Dorothy K
authors.initials: DK
authors.lastname: Hatsukami
authors.forename: Charlotte
authors.initials: C
authors.lastname: Lemmonds
authors.forename: Scott L
authors.initials: SL
authors.lastname: Tomar
mesh_terms: D006801:Humans; D009062:Mouth Neoplasms / Q000209:etiology*; D009538:Nicotine / Q000009:adverse effects / Q000493:pharmacokinetics; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology; D016540:Smoking Cessation / Q000379:methods* / Q000523:psychology; D014030:Tobacco, Smokeless / Q000009:adverse effects*
chemical_list: D009538:Nicotine