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References: THR, Snus

A page of listings for THR (Tobacco Harm Reduction), Snus (Swedish oral tobacco) and assorted ST (smokeless tobacco) references or resources.

Snus & ST

1. Lee, Hamling 2009
Systematic review of the relation between smokeless tobacco and cancer in Europe and North America.
(Large-scale meta analysis of 89 ST studies; Snus has no demonstrated elevation of risk for oral cancer, but obsolete US products were implicated)
Short form:
Full study:

2. B Rodu
2009 article - an analysis of Lee, Hamling's work

3. Lee 2011
Summary of the epidemiological evidence relating Snus to health.
(No association with cancer, heart disease),f1000m,isrctn

4. Lee & Hamling 2010
Powerpoint slides from a presentation on Snus

5. Ingeborg, Scheffels 2012
The Relative Risk to Health From Snus and Cigarettes
(Good explanation of ST vs smoking risks; useful list of refs)

6. Timberlake, Zell 2009
...smokeless tobacco's role in harm reduction
(A commentary from CDC personnel; some obfuscation of the facts discussed, e.g. an incorrect report of Lee, Hamling's conclusions)

7. Phillips, Rodu
Health Effects of ST
(Good Q&A on ST & health, esp. myths)

8.a. Foulds, Ramstrom, Burke, Fagerström 2003
Effect of Snus on smoking and public health in Sweden.

8.b. Full text:
An exhaustive dissertative analysis of multiple Snus studies - the effects on health and the difference in findings between studies and how unadjusted confounders might affect results.
Above all this study shows that by 2003 it was widely known that Snus consumption was not just safer than smoking but that it had barely-measurable risks; and that smoking, drinking (and likely diet) were substantially more important risk factors.
Studies examined included sample sizes of up to 98,000 subjects, which allowed for cohorts of significant size and statistical power, along with longitudinal capability. These were not just small-scale cross-sectional studies, but about as powerful as you can get. The results are fascinating if an evidence source is required as a means to understanding the facts (Sweden's unique national health statistics).
About 30% of ex-smokers in the studies they examined used Snus to quit, which is by far the largest successful ex-smoker group behind the unassisted group.

9. Environ 2010
Review of the Scientific Literature on Snus.
(An evidence review for Swedish Match, the Snus manufacturers)
[join up this link to repair it]

10. Snus consumption not associated with heart disease:
This study reports that long-term nicotine consumption has no association with CVD.
Commentary by Rodu:

11. Snus consumption dies not increase risk for stroke:
This study reports that long-term Snus consumption does not elevate risk for stroke; but there is a small increase in worse outcomes for stroke victims.
Commentary by Rodu:

12. Snus consumption and risk of stroke:
Hansson et al 2014 (16 co-authors)
Zero risk for stroke is demonstrated by this meta study of 8 Snus studies of never-smokers: "Use of snus was not associated with the risk of stroke. Hence, nicotine is unlikely to contribute importantly to the pathophysiology of stroke."

13. Snus - lifespan reduction about 10 weeks:
[NB: numerous citations exist for lifespan reductions attributable to Snus consumption of between 6 and 10 weeks]

14. TSNA content of ST:

15. How Many Americans Use Smokeless Tobacco?
Rodu with the US stats for ST, and a commentary on ST issues.


EU and Snus
1. Bates, Ramstrom 2013
Proposed revision to the Tobacco Products Directive.

2. Rodu 2013
What the EU Snus Ban Means: 290,865 Casualties Per Year
(Brad Rodu kindly updated his estimates for EU mortality due to regulatory policy; a useful guide to the cost in human life)
We now know that the EU Snus ban costs between 70,000 lives (current absolute minimum [i]) and 291,000 lives (probable maximum) per year

[i] The EU Snus ban is 21 years old @2013. To suggest that less than 10% (70,000) of the reported annual 700,000 smoking deaths in the EU could not have been prevented by allowing free access to Snus would be a fantasy (Sweden is the world leader in reducing smoking mortality, due to free access to Snus, and has the lowest smoking-related mortality by a wide margin).

UK and Snus
1. Snus letter to Jeremy Hunt from public health experts:



1. A fresh look at tobacco harm reduction: the case for the electronic cigarette
R Polosa, B Rodu, P Caponnetto, M Maglia, C Raciti 2013

2. Estimating the Harms of Nicotine-Containing Products Using the MCDA Approach
Nutt et al, 2014
Eur Addict Res 2014;20:218-225 (DOI:10.1159/000360220)
A report that attempts to estimate values for harm caused by a range of nicotine-containing products, using the full spectrum of possible harms including financial and social harm.
The main criticism is that a scale of 100 is insufficient to measure these factors: there is no possible way the NRT patch can be placed at a 1% harm mark compared to smoking since it is at least 10,000 times less harmful than smoking by any conceivable measurement. Other products are poorly represented according to experts. The report is probably an attempt to show that THR is a good idea, but looks more like an attack on it as the science is so poor; risk-reduction is massively underestimated and harm is hugely over-represented. Any scale that places nicotine patches, one of the world's safest medicines, at a position representing greater than than 1000th of the harm from cigarette smoking is clearly ludicrous and it is of no consequence what measure is used.


THR blogs & resources

Carl Phillips
Ex-Prof of Public Health at Alberta. Authority on the science base for THR and principal scientist curating the evidence.
- A blog that mainly examines anti-THR junk science and propaganda, and the liars (often named) who protect smoking to benefit pharma.

CV Phillips (see above)
- A blog on the 'ep-' sciences, especially as related to THR and associated public health issues.

Brad Rodu
Prof of Medicine at Louisville, KY. Specialist in oral pathology, leading authority on the oral pathology of tobacco consumption. Authority on the science base for THR.
- Blog that examines public health and THR issues, with a speciality in smokeless tobacco (e.g. Snus).

Michael Siegel
Prof of Public Health at Boston Uni. Tobacco control practitioner though supportive of e-cigarettes.
- 'The Rest of the Story...' blog - looks at the full story behind news items in the public health / tobacco area. Although a tobacco control industry member, Siegel struggles with the evidence of fraud within his own profession, frequently commenting on the poor standard of published research, or the obvious misuse of parts of it by anti-THR propagandists.

Phillips, Rodu, plus other contributors.
- A site featuring various resources related to the THR area. Now essentially an archive, since the authors have moved to other sites for their main work in this area.

Paul Bergen
Tobacco Harm Reduction: News & Opinions
- A blog on public health / THR issues by a well-known Canadian researcher. Originally an Alberta product and including posts by others such as CV Phillips, the authors have moved on, and PB now concentrates on the CAN vapers / ECTA blog below. Essentially an archive now, like THR org.

Rodu, Cole
- A blog for smokers, examining THR alternatives and similar issues.

Murray Laugesen
- A resource site run by the veteran NZ researcher who has the honour of having carried out the first research on ecigs, many years ago.

- Paul Bergen's new home.

10. THR blog list:

THR RSS feeds

The first consumer association in the world for ecigs, also covers all THR substitution products such as Snus and dissolvables (less thoroughly).