Many people who chew tobacco or dip snuff think it's safer than smoking. But you don't have to smoke tobacco for it to be dangerous. Chewing or dipping carries risks like

• Cancer of the mouth
• Decay of exposed tooth roots
• Pulling away of the gums from the teeth
• White patches or red sores in the mouth that can turn to cancer

Recent research shows the dangers of smokeless tobacco may go beyond the mouth. It might also play a role in other cancers, heart disease and stroke.

Smokeless tobacco contains more nicotine than cigarettes. Nicotine is a highly addictive drug that makes it hard to stop using tobacco once you start. Having a quit date and a quitting plan can help you stop successfully.

You may have questions about smokeless tobacco products like dip and chew. The more you know about the long and short-term effects of smokeless tobacco, the more you’ll understand the risks.

What Is Smokeless Tobacco?

Smokeless tobacco is tobacco that isn’t burned or inhaled by the user. It’s also known as chewing tobacco, chew, dipping tobacco, dip, oral tobacco, spit, spitting tobacco, and snuff.

Most people chew or suck (dip) the tobacco in their mouth and spit out the tobacco juices that build up. There’s also “spitless” smokeless tobacco.

There are two main types of smokeless tobacco products:

• Chewing tobacco. Chew is available as loose leaves, plugs (bricks), or twists of rope. A piece of tobacco is placed between the cheek and lower lip, typically near the back of the mouth. It’s either chewed or held in place. Saliva is spit out or swallowed.
• Snuff tobacco. Snuff tobacco is finely cut or powdered tobacco. It is packaged moist or dry—most American snuff is moist. It may be sold in different scents and flavors. Dip or dipping tobacco and snus are common forms of moist snuff in the US. It’s available loose or in small pouches similar to tea bags. People take a pinch or pouch of moist snuff and put it between the cheek and gums—or behind the lips.

Are Chew and Dip Addictive?

Yes. Both dip and chewing tobacco contain nicotine, which is addictive. People who use smokeless tobacco and people who smoke have similar levels of nicotine in their blood.

With smokeless tobacco, nicotine is absorbed through the mouth and gets into the blood. Then it goes to the brain.

Even after people take tobacco out of their mouths, nicotine is still being absorbed into their blood. Research shows that nicotine stays in the blood longer for people who use smokeless tobacco than for people who smoke.

Are Chew and Dip Harmful?

Yes—there are many harmful health effects of chewing tobacco and dip, including:

• Cancer. Smokeless tobacco has high levels of chemicals and other substances that can cause cancer, especially mouth and throat cancer. It can also cause leathery white patches in the mouth that can turn into cancer.

• Tooth decay and mouth sores. The sugar in smokeless tobacco can cause tooth decay and painful mouth sores.
• Poor gum health. Dip and chew can cause people’s gums to pull away from their teeth, which can lead to loose teeth.

How Much Do Chew and Dip Cost?

Smokeless tobacco is expensive, and the cost adds up! Each can of dip costs an average of $3. Someone who uses two cans a week could spend about $300 a year. Using a can per day could cost almost $1,100 a year.

Chewing tobacco costs about $2 a pouch. Someone who uses a pouch every day could spend over $700 a year.

How to Quit

Quitting smokeless tobacco is a lot like quitting smoking, but there are some differences. Get tips to help you quit chewing or dipping tobacco.

Smokeless tobacco:

• Is not burned
• Includes tobacco that can be sucked or chewed
• Can be spit or swallowed, depending on the product
• Can be spitless, depending on the product
• Contains nicotine and is addictive
• May appeal to youth because it comes in flavors such as cinnamon, berry, vanilla, and apple

Types of smokeless tobacco:

• Chewing tobacco (loose leaf, plug, or twist and may come in flavors)
• Snuff (moist, dry, or in packets [U.S. snus])
• Dissolvables (lozenges, sticks, strips, orbs)

Smokeless tobacco is not a safe alternative to smoking. Learn more about these products.

Chewing Tobacco

Chewing tobacco comes in the form of loose leaf, plug, or twist

Market Share of Types of Chewing Tobacco

Snuff

Snuff is finely ground tobacco that can be dry, moist, or packaged in pouches or packets (dip, U.S. snus).

• Some types of snuff are sniffed or inhaled into the nose; other types are placed in the mouth.
• Snus is a newer form of moist snuff used in the United States.

Market Share of Types of Snuff

Other Tobacco Products That Are Not Burned

Dissolvables are finely ground tobacco pressed into shapes such as tablets, sticks, or strips.

• Dissolvable tobacco products slowly dissolve in the mouth.
• These products may appeal to youth because they come in attractive packaging, look like candy or small mints, and can be easily hidden from view.

Market Share of Other Types of Tobacco

Marketing Information

Some cigarette companies make and sell smokeless tobacco products.

• In 2019, $576.1 million was spent on advertising and promotion of smokeless tobacco products, a decrease from 2018. Price discounts comprised nearly 65.3% of all advertising and promotion expenditures in 2019. Smokeless tobacco products include dry snuff, moist snuff, plug/twist, loose-leaf chewing tobacco, snus, and dissolvable products.
• Some cigarette companies advertise that smokeless tobacco can be used in places where tobacco smoking is not allowed.
• Additional research is needed to examine long-term effects of newer smokeless tobacco products, such as dissolvables and U.S. snus.

It’s a common misconception that smokeless tobacco is a safe alternative to smoking. Chew, dip, snuff, and other forms of smokeless tobacco contain the addictive chemical nicotine, and dozens of other cancer-causing chemicals such as arsenic, lead and formaldehyde. Some chemicals are present in smokeless tobacco at levels as much as 100 times higher than in cigarettes.

A Mouthful of Problems

Smokeless tobacco can cause oral, esophageal and pancreatic cancer. This is in addition to an increase in risk for other health problems, such as heart disease and stroke. And the impact on oral health can be severe:

• Chew and dip wear down teeth, which can lead to cavities and decay in exposed tooth roots.
• The gums can darken and pull away from the teeth, causing teeth to become loose. Since gums don’t grow back this can lead to tooth loss.
• Using dip or chew causes dry mouth, halitosis (bad breath) and stained teeth.
• Smokeless tobacco weakens sense of taste.

Remain Vigilant: Know the Signs of Oral Cancer

Smokeless tobacco can lead to painful sores that can turn into cancer. See a doctor right away for early signs such as:

• Mouth sores that bleed easily and don’t heal.
• A lump in the mouth or on the neck.
• Soreness or swelling that doesn’t go away.
• A white patch that doesn’t go away.
• Trouble chewing, swallowing, or moving your tongue or jaw.

Going From Smokeless to Tobacco-less

Veterans are especially at risk as they’re more than twice as likely to use smokeless tobacco than the general population. An average-sized dip held in the mouth for 30 minutes releases three cigarette’s worth of nicotine into the body. Nicotine remains in the blood longer for smokeless tobacco users, increasing the potential for addiction.

But there’s hope, even for heavy users. After stopping smokeless tobacco use, mouth sores begin to heal, breath will smell better, sense of taste and smell recover, and the rate of gum loss will reduce. After being tobacco free for five years, the risk of oral cancer is cut in half.

You’ve Got Backup

It’s tough quitting on your own. But there are resources that can help Veterans double their chances of quitting chew and dip for good.

• 1-855-QUIT-VET (1-855-784-8838): Free quitline that provides ongoing, individualized support with help from trained counselors.
• Personalized quit plan: Helps you strategize, stay on track, and quit for good.
• Quit medications: Medications can help you double or even triple your chance of quitting for good. Learn about the different types of medications and how they help, or explore different nicotine replacement therapies like the nicotine patch, gum, and lozenge.

Quitting smokeless tobacco is hard. But it helps if you have a plan. Here are some tips for quitting chew and dip.

Pick a Quit Date

Every day is a good day to stop chewing tobacco or dipping. Try to pick a date within the next two weeks so you can prepare. A time with low stress works well for many people.

Understand Nicotine Withdrawal

After you quit, you may feel uncomfortable and crave a chew or dip. This is withdrawal. Your body is getting used to not having nicotine. During withdrawal, you may:

• Feel a little depressed.
• Be unable to sleep.
• Become cranky, frustrated, or mad.
• Feel anxious, nervous, or restless.
• Have trouble thinking clearly.

The timeline for withdrawal symptoms can vary, but for most people, the worst symptoms last a few days to a few weeks. You may be tempted to chew or dip when these feelings hit. Remember that they are temporary, no matter how powerful they feel at the time.

Learn How to Handle Triggers and Cravings

Triggers are specific people, places, or activities that make you want to chew or dip. Knowing your triggers can help you find ways to deal with them. Different people have different triggers. Some common ones are:

• Waking up during the night or having nightmares
• After meals or during breaks
• Driving
• Stress or pain
• Feeling anxious, angry, impatient, or bored
• Seeing someone else smoke, chew, or dip
• Drinking coffee or alcohol
• After sex
• Before bedtime
• Watching TV or a live game
• Playing a sport

Triggers can cause cravings. Cravings are short but intense urges to chew or dip. All cravings are temporary and will pass with time. 

Use Nicotine Replacement Therapy

One way to deal with nicotine withdrawal is to try nicotine replacement therapy (NRT) like nicotine gum and patches. NRT can reduce withdrawal symptoms and double your chances of quitting smokeless tobacco for good. Explore the different types of NRT that can help you quit smokeless tobacco.

NRT comes in several different forms, including patch, gum, and lozenge. The nicotine patch is a long-acting form of NRT that releases a small, steady amount of nicotine through the skin. This small amount of nicotine helps satisfy your craving for nicotine. But you may still have cravings while on the patch. Doctors recommend using the patch along with a short-acting form of NRT, like nicotine gum or lozenges. This will help you fight these strong cravings for dip or chew. That’s because using the patch with either the gum or lozenge will work better than using any of these on their own. If you have a severe medical condition or are pregnant, talk to your doctor about using NRT.

A lot of research has been done on NRT. It has been shown to be safe and effective for almost all adult tobacco users who want to quit. NRT is available from your VA provider at a low cost or at your neighborhood drugstore without a prescription. If you plan to use NRT, have it available on your quit day.

NRT will give you the most benefit if you use it as recommended.

Try Other Medications

There are also other medications that can help you quit. Medications such as the prescriptions varenicline or bupropion, can double your chances of quitting for good. Using medication can help you keep committed to quitting for yourself and others.

Remember that quitting “cold turkey” is not your only choice. Talk to your VA health care provider about medications to help you quit chewing or dipping

Get Support

It is hard to quit chewing or dipping on your own, but there are lots of resources to help you quit.

Celebrate Successes

An hour, a day, or any time without dipping or chewing tobacco is something to celebrate. Get together with the people who’ve supported your quit journey. Take time to feel proud of yourself. Check out tobacco-free ways to celebrate your successes.

Be Prepared For the Unique Challenges of Quitting

People who use smokeless tobacco face unique challenges when they are trying to quit. It is not the same as quitting cigarettes. There is more nicotine in smokeless tobacco and stressors are can be different. 

Smokeless tobacco is not a safe alternative to smoking. Learn more about who uses it and what measures are in place to protect the public’s health.

Adult Smokeless Product Tobacco Use (National)

Characteristics of Adults Who Currently Used Smokeless Tobacco in 2021

• About 2 in every 100 (2.1%) adults aged 18 or older reported current use of smokeless tobacco products. This represents 5.2 million adults.
  • About 4 in every 100 (4.2%) men currently used smokeless tobacco.
  • Less than 1 in every 100 (0.2%) women currently used smokeless tobacco.
• Among racial/ethnic groups, non-Hispanic White adults had the highest prevalence of smokeless tobacco use. Nearly 3 of every 100 (2.9%) non-Hispanic White adults currently used smokeless tobacco.

NOTE:
In the list above, “current smokeless tobacco product use” means using chewing tobacco, snuff, dip, snus, or dissolvable tobacco at least once during their lifetime and, at the time of the survey, using at least one of these products “every day” or “some days.” The survey was conducted among persons aged 18 and older.

Adult Smokeless Tobacco Product Use (By Region)

• In 2021, the percentage of adults who reported current use of smokeless tobacco was highest among people living in the Midwest (3.2%) and the South (2.3%).
• In 2021, the percentage of adults who reported current use of smokeless tobacco was lowest among people living in the Northeast (1.2%) and the West (1.6%).

Adult Smokeless Tobacco Product Use (State-Specific)

• In 2018, the percentage of adults who reported current smokeless tobacco use was highest in:
  • Wyoming: nearly 9 in every 100 people (8.8%)
  • West Virginia: about 8 in every 100 people (8.3%)
  • Mississippi: about 7 in every 100 people (7.4%)
  • Kentucky: 7 in every 100 people (7.0%)
• In 2018, the percentage of adults who reported current smokeless tobacco use was lowest in:
  • New Jersey: about 1 in every 100 people (1.4%)
  • District of Columbia: nearly 2 in every 100 people (1.7%)
  • Rhode Island, Connecticut, California: nearly 2 in every 100 people (1.8%)

NOTE:
In the list above, “current smokeless tobacco” means using chewing tobacco, snuff, or snus every day or some days at the time of the survey.

Youth Smokeless Tobacco Product Use

The table below shows the percentage of high school students who were current users of smokeless tobacco in 2022.

Smokeless Tobacco Product Use Among High School Students

NOTE:
In the table above—

• Percentages represent approximately how many people in every 100 people use smokeless tobacco products. For example, 7.7% represents nearly 8 in every 100 people.
• “Current use of smokeless tobacco” means using chewing tobacco, snuff, dip, snus, or dissolvable tobacco on 1 or more of the 30 days before participation in a survey about this topic.
• A statistically reliable estimate of percent of Black non-Hispanic high school students who currently used smokeless tobacco in 2019 could not be calculated.

Multiple Product Use

• In 2021, nearly 2 of every 25 (7.9%) adults who reported using two or more tobacco products reported currently smoking cigarettes and using smokeless tobacco. Nearly 1 of every 10 (9.3%) of young adults (ages 18-24) who currently smoked cigarettes also reported current use of smokeless tobacco.
• In 2022, among high school students who used any tobacco product, 5% (760,000) indicated that they used two or more types of tobacco products.
• According to a 2016 report, use of both cigarettes and smokeless tobacco (dual use) was associated with switching to smokeless tobacco in an attempt to quit smoking cigarettes.
  • Using smokeless tobacco products instead of cigarettes is not healthy, as smokeless tobacco can cause many negative health effects.
  • Using other tobacco products in addition to cigarettes (dual use) is not an effective way to safeguard your health.

Cessation

• According to the 2017 National Health Interview Survey, 8.0% of adults were former users of smokeless tobacco.
• People who used only smokeless tobacco were less likely to try to quit than people who only smoked cigarettes.

Measures to Protect the Public’s Health

Family Smoking Prevention and Tobacco Control Act

In 2009, the Family Smoking Prevention and Tobacco Control Act (FSPTCA) gave the U.S. Food and Drug Administration (FDA) the authority to regulate the manufacture, distribution, and marketing of tobacco products, including smokeless tobacco. Among other restrictions, the FSPTCA:

• Requires smokeless tobacco packages and advertisements to have larger and more visible labels that warn of health effects. Every package must include the following warning:
  • This product can cause mouth cancer.
  • This product can cause gum disease and tooth loss.
  • This product is not a safe alternative to cigarettes.
  • Smokeless tobacco is addictive.
• Prohibits the sale of smokeless tobacco in vending machines, except in adult-only facilities.
• Restricts tobacco marketing and sales to youth.
• Prohibits tobacco companies from making reduced-harm claims like “light,” “low,” or “mild” without approval from FDA.
• Requires tobacco companies to provide detailed information to FDA about the ingredients in their products.