The health impact of smokeless tobacco products: a systematic review
Abstract Introduction The objective was to systematically review studies on health outcomes from smokeless tobacco (SLT) products. Methods We analysed published literature on the health outcomes from SLT use between 01/01/2015 to 01/02/2020, following Preferred Reporting Items for Systematic Reviews...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2021-12-01
|
| Series: | Harm Reduction Journal |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12954-021-00557-6 |
| _version_ | 1818742518854975488 |
|---|---|
| author | C. Hajat E. Stein L. Ramstrom S. Shantikumar R. Polosa |
| author_facet | C. Hajat E. Stein L. Ramstrom S. Shantikumar R. Polosa |
| author_sort | C. Hajat |
| collection | DOAJ |
| description | Abstract Introduction The objective was to systematically review studies on health outcomes from smokeless tobacco (SLT) products. Methods We analysed published literature on the health outcomes from SLT use between 01/01/2015 to 01/02/2020, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol using PubMed, Embase, Scopus, and Google Scholar. Results Of 53 studies included, six were global, 32 from Asia, Middle East and Africa (AMEA), nine from USA and six from Europe. ‘Poor’-rated studies predominated (23;43%), in particular, for global (4;66%) and AMEA (16;50%). Health outcomes differed between SLT-products and regions; those in AMEA were associated with higher mortality (overall, cancer, Coronary heart disease (CHD), respiratory but not cardiovascular disease (CVD)), and morbidity (CVD, oral and head and neck cancers), with odds ratios up to 38.7. European studies showed no excess mortality (overall, CVD, from cancers) or morbidity (ischemic heart disease (IHD), stroke, oral, head and neck, pancreatic or colon cancers) from several meta-analyses; single studies reported elevated risk of rectal cancer and respiratory disorders. Pooled study data showed protection against developing Parkinson’s disease. US studies showed mixed results for mortality (raised overall, CHD, cancer and smoking-related cancer mortality; no excess risk of respiratory or CVD mortality). Morbidity outcomes were also mixed, with some evidence of increased IHD, stroke and cancer risk (oral, head and neck). No studies reported on switching from cigarettes to SLT-products. Conclusion Our review demonstrates stark differences between different SLT-products in different regions, ranging from zero harm from European snus to greatly increased health risks in AMEA. The literature on the safety profile for SLT-products for harm reduction is incomplete and potentially misinforming policy and regulation. |
| first_indexed | 2024-12-18T02:13:48Z |
| format | Article |
| id | doaj.art-be645e14ea304a008f2914ffe16008d7 |
| institution | Directory Open Access Journal |
| issn | 1477-7517 |
| language | English |
| last_indexed | 2024-12-18T02:13:48Z |
| publishDate | 2021-12-01 |
| publisher | BMC |
| record_format | Article |
| series | Harm Reduction Journal |
| spelling | doaj.art-be645e14ea304a008f2914ffe16008d72022-12-21T21:24:25ZengBMCHarm Reduction Journal1477-75172021-12-0118112110.1186/s12954-021-00557-6The health impact of smokeless tobacco products: a systematic reviewC. Hajat0E. Stein1L. Ramstrom2S. Shantikumar3R. Polosa4Public Health Institute, UAE UniversityIndependent ResearcherIndependent Researcher, Institute for Tobacco StudiesWarwick Medical School, University of WarwickCenter of Excellence for the Acceleration of HArm Reduction (CoEHAR), University of CataniaAbstract Introduction The objective was to systematically review studies on health outcomes from smokeless tobacco (SLT) products. Methods We analysed published literature on the health outcomes from SLT use between 01/01/2015 to 01/02/2020, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol using PubMed, Embase, Scopus, and Google Scholar. Results Of 53 studies included, six were global, 32 from Asia, Middle East and Africa (AMEA), nine from USA and six from Europe. ‘Poor’-rated studies predominated (23;43%), in particular, for global (4;66%) and AMEA (16;50%). Health outcomes differed between SLT-products and regions; those in AMEA were associated with higher mortality (overall, cancer, Coronary heart disease (CHD), respiratory but not cardiovascular disease (CVD)), and morbidity (CVD, oral and head and neck cancers), with odds ratios up to 38.7. European studies showed no excess mortality (overall, CVD, from cancers) or morbidity (ischemic heart disease (IHD), stroke, oral, head and neck, pancreatic or colon cancers) from several meta-analyses; single studies reported elevated risk of rectal cancer and respiratory disorders. Pooled study data showed protection against developing Parkinson’s disease. US studies showed mixed results for mortality (raised overall, CHD, cancer and smoking-related cancer mortality; no excess risk of respiratory or CVD mortality). Morbidity outcomes were also mixed, with some evidence of increased IHD, stroke and cancer risk (oral, head and neck). No studies reported on switching from cigarettes to SLT-products. Conclusion Our review demonstrates stark differences between different SLT-products in different regions, ranging from zero harm from European snus to greatly increased health risks in AMEA. The literature on the safety profile for SLT-products for harm reduction is incomplete and potentially misinforming policy and regulation.https://doi.org/10.1186/s12954-021-00557-6Tobacco harm reductionSmokeless tobaccoSnusSnuffMoist snuffSmoking |
| spellingShingle | C. Hajat E. Stein L. Ramstrom S. Shantikumar R. Polosa The health impact of smokeless tobacco products: a systematic review Harm Reduction Journal Tobacco harm reduction Smokeless tobacco Snus Snuff Moist snuff Smoking |
| title | The health impact of smokeless tobacco products: a systematic review |
| title_full | The health impact of smokeless tobacco products: a systematic review |
| title_fullStr | The health impact of smokeless tobacco products: a systematic review |
| title_full_unstemmed | The health impact of smokeless tobacco products: a systematic review |
| title_short | The health impact of smokeless tobacco products: a systematic review |
| title_sort | health impact of smokeless tobacco products a systematic review |
| topic | Tobacco harm reduction Smokeless tobacco Snus Snuff Moist snuff Smoking |
| url | https://doi.org/10.1186/s12954-021-00557-6 |
| work_keys_str_mv | AT chajat thehealthimpactofsmokelesstobaccoproductsasystematicreview AT estein thehealthimpactofsmokelesstobaccoproductsasystematicreview AT lramstrom thehealthimpactofsmokelesstobaccoproductsasystematicreview AT sshantikumar thehealthimpactofsmokelesstobaccoproductsasystematicreview AT rpolosa thehealthimpactofsmokelesstobaccoproductsasystematicreview AT chajat healthimpactofsmokelesstobaccoproductsasystematicreview AT estein healthimpactofsmokelesstobaccoproductsasystematicreview AT lramstrom healthimpactofsmokelesstobaccoproductsasystematicreview AT sshantikumar healthimpactofsmokelesstobaccoproductsasystematicreview AT rpolosa healthimpactofsmokelesstobaccoproductsasystematicreview |