Self Care Pharmacy Blog


Chew or Dip, Time to Quit

November 5th, 2014

By Tyler Michael, PharmD Student

Smokeless tobacco use is on the decline in adults and children.1 This is not necessarily a time to celebrate for healthcare providers though. As the focus has been shifted away from the dangers of smokeless tobacco, some professionals have wrongfully started encouraging smokeless tobacco as a safer alternative to smoking.1,2 Someone seeking to quit smoking or using any tobacco products should seek nicotine replacement therapy, Chantix, or a combination with education if they wish to quit smoking.3

An article recently published by the American Heart Association discusses the heart health effects of discontinuing smokeless tobacco use. The goal of the cohort study, which followed the patients for 4 years, was to track how cessation of smokeless tobacco affects heart health after a myocardial infarction (heart attack). According to the article the mortality rate per 1000 people is 9.7 for those who stopped using smokeless tobacco and 18.7 for those who continued using it.4 These numbers show that people who continue using smokeless tobacco after a heart attack are almost twice as likely to die within the next 4 years. Not only did stopping smokeless tobacco use lower cardiovascular disease risk, but also cancer mortality risk as well. This shows that quitting is very important to the health of those already at risk, and in no way could its use be a safer alternative to cigarette smoking.

Some limitations of this study are that it only followed those who already had a heart attack, so it cannot be applied to the risks of those who have not previously had a heart attack.4 There were no exclusion criteria for this study so a patient could have had a terminal illness or another reason for death that would influence this data. There was a selection bias that did not allow patients over the age of 75 into the study, meaning it cannot be applied to anyone over that age.4

This article agrees with the current standard that smokeless tobacco poses a health risk. Siddiqui et al. shows in there research that those who use smokeless tobacco have higher blood pressure and cholesterol than those who do not use smokeless tobacco.5 Smokeless tobacco may have lower mortality risk than those who smoke over 15 cigarettes a day, but still a much greater mortality rate than those who do not use tobacco at all.6

Based on this article and the other articles on the topic, it is evident that smokeless tobacco is not healthy, and should not be viewed as a healthy alternative to smoking cigarettes. This article shows that smokeless tobacco use increases mortality risk and this research shows that it nearly doubles mortality risk in those who have already had a heart attack. I believe stopping use of all tobacco products is the safest route and nicotine replacement therapy can be used to help patients’ quit.3 Further research is needed to determine the best nicotine replacement therapy or smoking cessation medication in this population of patients with previous heart attack.

Stopping tobacco use is one of the best health decisions someone can make for themselves.  What method would you use to quit? If you have successfully quit, what worked for you?


References List


  1. Nelson D, Mowery P, Tomar S, Marcus S, Giovino G, Zhao L. Trends in Smokeless Tobacco Use  Among Adults and Adolescents in the United States. American Journal Of Public    Health [serial online]. May 2006;96(5):897-905. Available from: SPORTDiscus with  Full Text, Ipswich, MA.             Accessed October 1, 2014.
  2. Digard H, Proctor C, Kulasekaran A, Malmqvist U, Richter A. Determination of Nicotine Absorption  from Multiple Tobacco Products and Nicotine Gum. Nicotine & Tobacco Research [serial online]. January 2013;15(1):255-261. Available from: Consumer Health Complete – EBSCOhost,       Ipswich, MA. Accessed October 1, 2014.
  3. Heydari G, Masjedi M, Fadaizadeh L, et al. A Comparative Study on Tobacco Cessation Methods: A  Quantitative Systematic Review. International Journal Of Preventive Medicine [serial online]. June 2014;5(6):673-678. Available from: Academic Search Complete, Ipswich, MA. Accessed    November 2, 2014.
  4. Arefalk G, Hambreaus K, Lind L, Michaëlsson K, Lindahl B, Sundström J. Discontinuation of  Smokeless Tobacco and Mortality Risk after Myocardial Infarction. Circulation AHA. May 2014.  doi: 10.1161/CIRCULATIONAHA.113.007252
  5. Siddiqui S, Rana A, Singal S, Pandey D, Khan S. Assessment of Cardiovascular Risks of  Tobacco Chewers by Comparing it with Normal Human Beings. National Journal Of Physiology, Pharmacy & Pharmacology [serial online]. January 2014;4(1):76-79.   Available from: Academic Search Complete, Ipswich, MA. Accessed October 2, 2014.
  6. Bolinder G, Alfredsson L, Englund A, De Faire U. Smokeless Tobacco Use and Increased Cardiovascular Mortality among Swedish Construction Workers. American Journal Of Public Health [serial online]. March 1994;84(3):399-404. Available from: Business Source Complete, Ipswich, MA. Accessed October 2, 2014.

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4 Responses to “Chew or Dip, Time to Quit”

  1. Ruth Choi Says:

    Quitting smoking is really hard, so it’s important for a smoker who wants to quit to get the best and most appropriate help. I am not familiar with all of the methods available to quit smoking; however, from reading your blog, I think nicotine replacement therapy is a great method in quitting especially if counseling is added as well because I feel like gradual changes are the most effective in making permanent lifestyle changes.

  2. Kristin Lessig Says:

    Your blog was very interesting to read. While I knew that smokeless tobacco is still not a good alternative to smoking cigarettes, I did not realize that the mortality rate was doubled for those using smokeless tobacco. I think this information is a great source to use when counseling patients on smoking cessation. Quitting is hard, but I believe that equipped with the right information, a pharmacist is a great resource for a patient who is interested in quitting smoking. The educational aspect is just as important as the medication therapy for smoking cessation.

  3. Rachel Wilcox Says:

    I really had no idea that smokeless tobacco was that harmful. I do not personally know anyone who uses smokeless tobacco so it was interesting to read your article to learn more about it. From what I know, I think using drug therapy and making small changes in reducing the amount of smokeless tobacco you use is the best way to quit. When I worked in a pharmacy, I saw many prescriptions for Chantix or nicotine patches. I think it is really encouraging to see people who are trying to quit because they realize the impact tobacco has on their health.

    You mentioned that smokeless tobacco use is declining in adults as well as children. It would be interesting to investigate why this is. Are people moving towards cigarettes? Are they ditching tobacco for other drugs?

  4. Stephen Yeboah Says:

    Tyler, your blog is revealing something I did not know of that people use smokeless tobacco in place of smoking tobacco like cigarette. Since there are new discoveries in medicine every now and then and with the recent discovery that marijuana has a medical benefits with some state even legalizing the use of marijuana, will there be a time where we will have “medical tobacco” as we have “medical marijuana.” Until we have that discovery I believe that the use of tobacco in all forms should be discouraged and I agree with you that those who engage in tobacco use must be educated, counseled and offered current treatment like Chantix and nicotine patches.

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