Smokeless tobacco (SLT) products
SLT products present greater opportunity for THR than smoked tobacco because there is no combustion/vaporisation and therefore no risk of respiratory disease, fire or passive smoking. SLT products include traditional chewing tobacco and snuff, and new products such as compressed tobacco lozenges, tobacco chewing gum and dissolvable strips (Hatsukami et al., 2007; Stepanov et al., 2006). Most policy attention has focused on a form of moist oral snuff used in Sweden, known as snus (see box on p. 262). It has much lower levels of tobacco-specific nitrosamines than snuffs marketed in the United States and elsewhere because it is produced by pasteurisation rather than fermentation (Hoffmann et al., 1995; Österdahl et al., 2004; Ramström, 2000). Levels of nitrosamines in Swedish snus have decreased over the past 20 or so years in response to the development of an
industry standard (Hatsukami et al., 2007; Österdahl et al., 2004). The development of portion snus in the 1970s (tea-bag-like sachets of snus) has produced a more user-friendly version that has increased prevalence of snus use among Swedish men. The fact that until recently snus was taxed at a much lower rate than cigarettes may also have contributed to its increased popularity. Increased snus use by Swedish men has been accompanied by decreased cigarette smoking and tobacco-related disease mortality (Foulds et al., 2003; Ramström, 2003).
A major barrier to the adoption of this form of harm reduction is the ban on the sale of the least harmful smokeless tobacco products in many countries. In Australia and New Zealand, for example, oral snuff and chewing tobacco products cannot be sold (Commonwealth of Australia, 1974; Parliament of New Zealand, 1990). With the exception of Sweden, the same is true in all EU Member States, where the sale of these tobacco products is prohibited, although chewing tobacco and nasal snuff can be sold (European Court of Justice, 2004).