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Health Effects of Smokeless Tobacco Products

Smokeless tobacco has many health risks and is not a safe alternative to smoking. Smokeless tobacco contains the same addictive chemical, nicotine, that is in other tobacco products.

Key Facts about Smokeless Tobacco

  • Smokeless tobacco is linked to several different types of cancer, including cancer of the mouth, esophagus and pancreas.1
  • Smokeless tobacco contains at least 28 cancer-causing chemicals (carcinogens).2
  • Smokeless tobacco use can cause gum disease, tooth decay, tooth loss and the formation of white or gray patches inside the mouth called leukoplakia that can lead to cancer.1
  • Smokeless tobacco use during pregnancy increases the risk for early delivery and stillbirth.1

There are two main types of smokeless tobacco used in the U.S., chewing tobacco and snuff.

  • Chewing tobacco comes in loose leaf, plug and twist.
  • Snuff is finely ground tobacco that comes dry, moist or in bag-like pouches.

Most smokeless tobacco users place the product in the cheek or between their gum and cheek, suck on the tobacco and spit out or swallow the juices. Smokeless tobacco is often called spit tobacco.3 Some tobacco companies are now selling smokeless tobacco products such as snus, that do not require the user to spit, or that dissolve when put into the mouth. A U.S. Food and Drug Administration report concluded that dissolvable tobacco products could increase overall tobacco use by encouraging kids to start using tobacco or discouraging current smokers from quitting.3

In 2016 the five major smokeless tobacco manufacturers spent more than $759 million on advertising and promotion. The largest single category of promotional expenses reported was price discounts to smokeless tobacco retailers or wholesalers to reduce the price to consumers, accounting for close to $468 million or 62 percent of total advertising and promotional spending.4

Smokeless Tobacco Use in the U.S.

Even though cigarette smoking has decreased in recent years, smokeless tobacco has not.

  • In the U.S., an estimated 3.8 percent of adults are current smokeless tobacco users; use is much higher among men than women (6.8 percent vs. 1.0 percent).5
  • Among specific populations, American Indian/Alaska Natives and whites have the highest use at (2.8 percent).5
  • An estimated 4.1 percent of high school students are current smokeless tobacco users. Smokeless tobacco use is much more common among male than female high school students (6.8 percent versus 1.3 percent). 
  • Among high school students, smokeless tobacco use is highest among American Indian or Alaska Natives (9.2 percent), followed by whites (5.7 percent), Native Hawaiian or Pacific Islanders (5.3 percent), Hispanics (2.2 percent), blacks (0.9 percent), and Asians (0.7 percent).6
  • An estimated 2.2 percent of middle school students are current smokeless tobacco users.8

Dual Use

Dual use of smokeless tobacco with other tobacco products like cigarettes or e-cigarettes is concerning. Users can face greater health impacts with dual use.

  • An estimated 9.6 percent of high school students and 3.1 percent of middle school students used two or more tobacco products, including smokeless tobacco, in the past 30 days.8

Learn about the American Lung Association's programs to help you or a loved one quit smoking, and join our advocacy efforts to reduce tobacco use and exposure to secondhand smoke. Visit or call the Lung HelpLine at 1-800-LUNGUSA (1-800-586-4872).

  • Sources
    1. Centers for Disease Control and Prevention. Factsheet: Smokeless Tobacco: Health Effects. December 2016.
    2. National Cancer Institute. Smokeless Tobacco and Cancer: Questions and Answers. October, 2010.
    3. Centers for Disease Control and Prevention. Factsheet: Smokeless Tobacco: Products and Marketing. July 2018.
    4. Federal Trade Commission. Smokeless Tobacco Report for 2016; Issued March 2018.
    5. Centers for Disease Control and Prevention. National Center for Health Statistics. National Health Interview Survey, 2017. Analysis performed by the American Lung Association Epidemiology and Statistics Unit using SPSS software.
    6. Centers for Disease Control and Prevention. National Youth Tobacco Survey, 2017. Analysis by the American Lung Association Epidemiology and Statistics Unit using SPSS software.

    Reviewed and approved by the American Lung Association Scientific and Medical Editorial Review Panel. Last reviewed March 13, 2019.

    Page Last Updated: August 7, 2019

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