Many people think using smokeless tobacco is safer than smoking. But even though there is no smoke, that doesn't mean it's safe. Smokeless tobacco has very high levels of nicotine, much more than cigarettes. It's full of harmful chemicals. And it can cause many kinds of health problems.

Smokeless tobacco is a mixture of:

• Tobacco
• Nicotine
• Sweeteners
• Abrasives
• Salts
• More than 3,000 chemicals, including 28 that are known to cause cancer

It is sold in 2 main forms:

• Chew. Chew comes in 2 types. The first is the most popular and usually is simply called chew. This is a leafy form of tobacco. It's often sweetened with molasses or similar substances. It is sold in pouches. Users keep the chew between their cheek and gums for several hours at a time. The second type is called a plug. A plug is tobacco leaves that have been pressed into a brick. Users often bite off or cut a piece of the plug off and place it between the gum and cheek.
• Snuff. Snuff comes in 2 types: moist and nasal (powdered). Moist snuff is often called dip. It's sold in a circular can called a tin. The tobacco is often flavored. Users place the tobacco between their lip and gum. This process is known as dipping. Dry snuff is meant to be breathed in. A user often places the powder on the back of their hand in a natural space that is called the snuff box. The user then snorts the powder up their nose. Using snuff also is called dipping.

A person who uses smokeless tobacco gets 3 to 4 times the amount of nicotine as a smoker. A person who uses 8 to 10 dips or chews a day gets the same amount of nicotine as a heavy smoker who smokes 30 to 40 cigarettes a day.

Smokeless tobacco is addictive. The addiction is mostly caused by the nicotine. The nicotine in smokeless tobacco is absorbed by the body more slowly than in smoking. But it stays in the body longer. And chew tobacco placed inside the mouth gives the user a constant high from the nicotine.

The most harmful chemicals in smokeless tobacco are called tobacco-specific nitrosamines (TSNAs). These chemicals can cause cancer. TSNAs are formed as tobacco is grown, cured, fermented, and aged. The amount of these chemicals in smokeless tobacco can be very high.

Other harmful chemicals in smokeless tobacco include:

• Polonium 210 and lead 210, rare radioactive elements
• Arsenic
• Benzene
• Lead

Like cigarettes, smokeless tobacco affects the cardiovascular system. It can cause:

• Heart disease
• Stroke
• High blood pressure

Smokeless tobacco can cause many mouth problems, such as:

• Cracking and bleeding lips and gums
• Precancer mouth sores called oral leukoplakia
• Tooth abrasion
• Receded gums
• Gum and tooth disease
• Loss of teeth and bone in the jaw
• Long-term (chronic) bad breath
• Teeth staining

Smokeless tobacco can also cause cancer. Cancer can happen in these areas:

• Lips
• Tongue
• Cheek
• Throat
• Stomach
• Esophagus
• Pancreas

Quitting smokeless tobacco is hard. But it can be done. To break the habit:

• Talk with your healthcare provider. Ask them where you can get support in your effort to quit.
• Ask about nicotine replacement. This includes products, such as nicotine gum or a patch.
• Try using substitutes. Try tobacco-free mint-leaf snuff, sugarless gum, hard candy, beef jerky, sunflower seeds, shredded coconut, raisins, or other dried fruit.
• Make a list of the reasons you want to quit. Keep it with you and look at it often.
• Get involved in healthy activities. These may be things like lifting weights, shooting baskets, or swimming.
• Manage your triggers. Find replacements for the things that make you want to use tobacco. Stay away from places or people that make you want to use it.
• Reward yourself. Quitting is hard. Every day you don't use tobacco is a success!
• Use free community resources. For some people, online and in-person support groups can help them stay away from tobacco. Some of these include:
  • CDC: Quitline 800-QUIT-NOW (800-784-8669)
  • American Lung Association: Quit Smoking 800-586-4872
  • American Cancer Society: Great American Smokeout 800-227-2345