Skip to main content

Advertisement

Log in

Two large prospective studies of mortality among men who use snuff or chewing tobacco (United States)

  • Published:
Cancer Causes & Control Aims and scope Submit manuscript

Abstract

Background: Few prospective studies have examined the health risks associated with use of snuff and chewing tobacco.

Methods: We studied the association between the use of spit tobacco (snuff or chewing tobacco) and mortality among men enrolled in Cancer Prevention Study I (CPS-I) in 1959 or Cancer Prevention Study II (CPS-II) in 1982. Analyses were based on men who reported exclusive use of snuff or chewing tobacco (7745 in CPS-I, 3327 in CPS-II) or no previous use of any tobacco product (69,662 in CPS-I, 111,482 in CPS-II) at baseline. Twelve-year follow-up of CPS-I, and 18-year follow-up of CPS-II identified 11,871 and 19,588 deaths, respectively. Cox proportional hazards models were used to control for age and other covariates.

Results: Men who currently used snuff or chewing tobacco at baseline had higher death rates from all causes than men who did not in both CPS-I (hazard ratio [HR]=1.17, 95% CI=1.11–1.23) and CPS-II (HR=1.18, 95% CI=1.08–1.29). In CPS-I, current use of spit tobacco was statistically significantly associated with death from coronary heart disease (CHD), stroke, and diseases of the respiratory, digestive, and genitourinary systems, but not with death from cancer. In CPS-II, use of these products was significantly associated with death from CHD, stroke, all cancers combined, lung cancer, and cirrhosis. The associations with cardiovascular and other non-malignant endpoints were attenuated, but not eliminated, by controlling for measured covariates. Former use of spit tobacco was not associated with any endpoint in CPS-II. No clear dose response was observed with either the frequency or duration of usage for any endpoint.

Conclusions: These two prospective studies provide limited evidence that current use of chewing tobacco or snuff may increase mortality from heart disease and stroke.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Substance Abuse and Mental Health Services Administration (2004) Results from the 2003 National Survey on Drug Use and Health: National Findings. Rockville, MD: Office of Applied Studies, NSDUH Series H-25, DHHS Publication No. SMA 04–3964.

  2. U.S. Department of Health and Human Services (1986) The Health Consequences of Using Smokeless Tobacco: A Report of the Advisory Committee to the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services,National Institutes of Health, National Cancer Institute.

  3. SL Tomar (2003) ArticleTitleTrends and patterns of tobacco use in the United States Am J Med Sci 326 248–254 Occurrence Handle14557744

    PubMed  Google Scholar 

  4. RA Bell JG Spangler SA Quandt (2000) ArticleTitleSmokeless tobacco use among adults in the Southeast South Med J 93 456–462 Occurrence Handle1:STN:280:DC%2BD3c3ptVGgtQ%3D%3D Occurrence Handle10832940

    CAS  PubMed  Google Scholar 

  5. U.S. Department of Health and Human Services (2002) 10′th Report on Carcinogens: U.S. Department of Health and Human Services, Public Health Service, National Toxicology Program.

  6. JA Critchley B Unal (2003) ArticleTitleHealth effects associated with smokeless tobacco: a systematic review Thorax 58 435–443 Occurrence Handle1:STN:280:DC%2BD3s3gslajuw%3D%3D Occurrence Handle12728167

    CAS  PubMed  Google Scholar 

  7. F Huhtasaari K Asplund V Lundberg B Stegmayr PO Wester (1992) ArticleTitleTobacco and myocardial infarction: is snuff less dangerous than cigarettes? BMJ Med J 305 1252–1256 Occurrence Handle1:STN:280:ByyC38%2FptlE%3D

    CAS  Google Scholar 

  8. G Bolinder L Alfredsson A Englund U Faire Particlede (1994) ArticleTitleSmokeless tobacco use and increased cardiovascular mortality among Swedish construction workers Am J Public Health 84 399–404 Occurrence Handle1:STN:280:ByuC2srhvVc%3D Occurrence Handle8129055

    CAS  PubMed  Google Scholar 

  9. F Huhtasaari V Lundberg M Eliasson U Janlert K Asplund (1999) ArticleTitleSmokeless tobacco as a possible risk factor for myocardial infarction: a population-based study in middle-aged men J Am Coll Cardiol 34 1784–1790 Occurrence Handle1:STN:280:DC%2BD3c%2FktlGjsA%3D%3D Occurrence Handle10577570

    CAS  PubMed  Google Scholar 

  10. K Asplund S Nasic U Janlert B Stegmayr (2003) ArticleTitleSmokeless tobacco as a possible risk factor for stroke in men: a nested case-control study Stroke 34 1754–1759 Occurrence Handle12775887

    PubMed  Google Scholar 

  11. K Wallenfeldt J Hulthe L Bokemark J Wikstrand B Fagerberg (2001) ArticleTitleCarotid and femoral atherosclerosis, cardiovascular risk factors and C-reactive protein in relation to smokeless tobacco use or smoking in 58-year-old men J Int Med 250 492–501 Occurrence Handle1:CAS:528:DC%2BD38XivV2qtA%3D%3D

    CAS  Google Scholar 

  12. A Ahlbom UA Olsson G Pershagen (1997) Halsorisker med snus (Health risks by snuff). Position paper Swedish National Board of Health and Welfare Stockholm

    Google Scholar 

  13. NA Accortt JW Waterbor C Beall G Howard (2002) ArticleTitleChronic disease mortality in a cohort of smokeless tobacco users Am J Epidemiol 156 730–737 Occurrence Handle12370161

    PubMed  Google Scholar 

  14. Thun M, Day-Lally C, Meyers D, et al. (1992) Trends in tobacco smoking and mortality from cigarette use in Cancer Prevention Studies I (1959 through 1965) and II (1982 through 1988). In: Shopland D, Burns D, Garfinkel L, Samet J, eds. National Cancer Institute. Changes in Cigarette-related Disease Risks and Their Implication for Prevention and Control. Smoking and Tobacco Control Monograph No. 8. Bethesda, MD: U.S. Department of Health and Human Services, National Institutes of Health, National Cancer Institute, NIH Pub No. 97-4213, pp. 305–382.

  15. E Hammond (1966) Smoking in relation to the death rates of one million men and women W Haenszel (Eds) Epidemiologic Approaches to the Study of Cancer and Other Chronic Diseases. Natl Cancer Inst Monogr 19. US Department of health, Education, and Welfare Rockville, MD 127–204

    Google Scholar 

  16. L Garfinkel (1985) ArticleTitleSelection, follow-up and analysis in the American Cancer Society prospective studies Monogr Natl Cancer Inst 67 49–52 Occurrence Handle1:STN:280:BimD3Mvjt1A%3D

    CAS  Google Scholar 

  17. SD Stellman L Garfinkel (1986) ArticleTitleSmoking habits and tar levels in a new American Cancer Society prospective study of 1.2 million men and women J Natl Cancer Inst 76 1057–1063 Occurrence Handle1:STN:280:BimB38fkvVI%3D Occurrence Handle3458944

    CAS  PubMed  Google Scholar 

  18. M Thun E Calle C Rodriguez P Wingo (2000) ArticleTitleEpidemiological research at the American Cancer Society Cancer Epidemiol Biomark Prev 9 861–868 Occurrence Handle1:STN:280:DC%2BD3cvlt1Ghsg%3D%3D

    CAS  Google Scholar 

  19. E Calle D Terrell (1993) ArticleTitleUtility of the National Death Index for ascertainment of mortality among Cancer Prevention Study II particpants Am J Epidemiol 137 235–241 Occurrence Handle1:STN:280:ByyC1Mfos1A%3D Occurrence Handle8452128

    CAS  PubMed  Google Scholar 

  20. World Health Organization. International Classification of Diseases (1957) Manual of the International Statistical Classification of Diseases, Injuries, and Causes of Death. 7th rev. Vol. 1. Geneva: World Health Organization.

  21. World Health Organization (1977). International Classification of Diseases, Manual of the International Statistical Classification of Diseases, Injuries, and Causes of Death. 9th rev. Vol. 1. Geneva: World Health Organization.

  22. InstitutionalAuthorNameIARC (2004) Tobacco Smoke and Involuntary Smoking International Agency for Research on Cancer Lyon

    Google Scholar 

  23. U.S. Department of Health and Human Services (2004) The Health Consequences of Smoking: A Report of the Surgeon General. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health.

  24. D Cox (1972) ArticleTitleRegression models and life tables J R Stat Soc 34 187–220

    Google Scholar 

  25. N Breslow N Day (1980) Statistical Methods in Cancer Research. The Analysis of Case-Control Studies International Agency for Research on Cancer Lyon, France

    Google Scholar 

  26. H Stockwell G Lyman (1986) ArticleTitleImpact of smoking and smokeless tobacco on the risk of cancer of the head and neck Head Neck Surg 9 104–110 Occurrence Handle1:STN:280:BiiA3cjjvVc%3D Occurrence Handle3623935

    CAS  PubMed  Google Scholar 

  27. DM Winn WJ Blot CM Shy LW Pickle A Toledo JF Fraumeni SuffixJr (1981) ArticleTitleSnuff dipping and oral cancer among women in the southern United States New Engl J Med 304 745–749 Occurrence Handle1:STN:280:Bi6C383pvV0%3D Occurrence Handle7193288

    CAS  PubMed  Google Scholar 

  28. R Sankaranarayanan S Duffy N Day M Nair G Padmakumary (1989) ArticleTitleA case-control investigation of cancer of the oral tongue and the floor of the mouth in southern india Int J Cancer 60 617–621

    Google Scholar 

  29. R Sankaranarayanan S Duffy G Padmakumary N Day T Padmanabhan (1969) ArticleTitleTobacco chewing, alcohol and nasal snuff in cancer of the gingiva in Kerala, India Brit J Cancer 60 638–643

    Google Scholar 

  30. R Sankaranarayanan SW Duffy NE Day MK Nair G Padmakumary (1989) ArticleTitleA case-control investigation of cancer of the oral tongue and the floor of the mouth in southern India Int. J. Cancer 44 617–621 Occurrence Handle1:STN:280:By%2BD3cjnsVM%3D Occurrence Handle2793234

    CAS  PubMed  Google Scholar 

  31. R Sankaranarayanan S Duffy G Padmakumary N Day M Nair (1990) ArticleTitleRisk factors for cancer of the buccal and labial mucosa in Kerala, southern India J Epidemiol Commun Health 44 286–292 Occurrence Handle1:STN:280:By6C3MnisFQ%3D

    CAS  Google Scholar 

  32. RK Dikshit JG Buch SM Mansuri (1987) ArticleTitleEffect of tobacco consumption on semen quality of a population of hypofertile males Fertil Steril 48 334–336 Occurrence Handle1:STN:280:BiiB2snmsFQ%3D Occurrence Handle3609347

    CAS  PubMed  Google Scholar 

  33. DN Rao B Ganesh RS Rao PB Desai (1994) ArticleTitleRisk assessment of tobacco, alcohol and diet in oral cancer–a case-control study Int J Cancer 58 469–473 Occurrence Handle1:STN:280:ByuA3szptlM%3D Occurrence Handle8056441

    CAS  PubMed  Google Scholar 

  34. PC Gupta FS Mehta RR Irani (1980) ArticleTitleComparison of mortality rates among bidi smokers and tobacco chewers Indian J Cancer 17 149–151 Occurrence Handle1:STN:280:Bi6C3Mngtlc%3D Occurrence Handle7461689

    CAS  PubMed  Google Scholar 

  35. PC Gupta FS Mehta DK Daftary et al. (1980) ArticleTitleIncidence rates of oral cancer and natural history of oral precancerous lesions in a 10-year follow-up study of Indian villagers Commun Dent Oral Epidemiol 8 283–333 Occurrence Handle1:STN:280:Bi6C3snotFw%3D

    CAS  Google Scholar 

  36. AM Idris HM Ahmed MO Malik (1995) ArticleTitleToombak dipping and cancer of the oral cavity in the Sudan: a case-control study Int J Cancer 63 477–480 Occurrence Handle1:STN:280:BymD2svntlQ%3D Occurrence Handle7591252

    CAS  PubMed  Google Scholar 

  37. F Lewin SE Norell H Johansson et al. (1998) ArticleTitleSmoking tobacco, oral snuff, and alcohol in the etiology of squamous cell carcinoma of the head and neck: a population-based case-referent study in Sweden Cancer 82 1367–1375 Occurrence Handle1:STN:280:DyaK1c7oslykuw%3D%3D Occurrence Handle9529030

    CAS  PubMed  Google Scholar 

  38. EB Schildt M Eriksson L Hardell A Magnuson (1998) ArticleTitleOral snuff, smoking habits and alcohol consumption in relation to oral cancer in a Swedish case-control study Int J Cancer 77 341–346 Occurrence Handle1:STN:280:DyaK1czis1OhtA%3D%3D Occurrence Handle9663593

    CAS  PubMed  Google Scholar 

  39. InstitutionalAuthorNameIARC (1985) Tobacco Habits Other than Smoking; Betel-Quid and Areca Nut Chewing; and Some Related Nitrosamines International Agency for Reseach on Cancer Lyon

    Google Scholar 

  40. InstitutionalAuthorNameNational Cancer Institute (2004) SEER Cancer Statistics Review, 1975–2001 US Department of Health and Human Services, Public Health Service Bethesda, MD

    Google Scholar 

  41. B Rodu P Cole (2002) ArticleTitleSmokeless tobacco use and cancer of the upper respiratory tract Oral Surg Oral Med Oral Pathol Oral Radiol Endod 93 511–515 Occurrence Handle12075196

    PubMed  Google Scholar 

  42. J Foulds L Ramstrom M Burke K Fagerstrom (2003) ArticleTitleEffect of smokeless tobacco (snus) on smoking and public health in Sweden Tob Control 12 349–359 Occurrence Handle1:STN:280:DC%2BD2c%2Flslemsw%3D%3D Occurrence Handle14660766

    CAS  PubMed  Google Scholar 

  43. U.S. Smokeless Tobacco Company Request for Advisory Opinion (2002) http://www.ftc.gov/os/comments/smokelesscomments/ reqadvisoryop.pdf http://www.ftc.gov/os/comments/smokelesscomments/reqadvisoryop.pdf (accessed September 13, 2002).

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Michael J. Thun.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Henley, S.J., Thun, M.J., Connell, C. et al. Two large prospective studies of mortality among men who use snuff or chewing tobacco (United States). Cancer Causes Control 16, 347–358 (2005). https://doi.org/10.1007/s10552-004-5519-6

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10552-004-5519-6

Keywords

Navigation