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Our current research programme on smokeless tobacco focuses on snus, a product which is placed between the gum and upper lip allowing nicotine, tobacco extract and flavours to be absorbed through the oral mucosa. It has been popular with Swedish men for over a century.

Epidemiological evidence, particularly from Sweden, suggests that snus use is substantially less hazardous than cigarette smoking because it is not associated with increased risks of lung cancer, oral cancer and chronic obstructive pulmonary disease (COPD).  Some public health bodies have concluded that snus use is associated with increased risks of pancreatic cancer and other diseases [ 1,2 ]. However, a recent study by the Karolinska Institute in Sweden appears to suggest otherwise. This research indicates that it is tobacco smoke constituents - other than nicotine or its metabolites – that may account for the link between smoking and pancreatic cancer [ 3 ]. It concluded that Swedish snus use does not appear to be implicated in the development of pancreatic cancer in men [ 3 ].

There is currently an active public health debate over whether snus could play a role in harm reduction for tobacco users.

Our research programme on snus broadly focuses in two areas:

  • laboratory studies on the chemical and toxicological characterisation of snus; and
  • consumer studies on dependence, use and risk perception.

Chemical characterisation of snus

The chemical and physical characteristics of manufactured cigarettes are fairly similar around the world but smokeless tobacco products can vary considerably. 

Unlike some other smokeless tobacco products, snus manufacture includes a heat treatment process similar to pasteurisation.  This stops bacterial activity that would otherwise cause additional nitrosamine formation.  It is also manufactured to a voluntary product standard that limits the levels of certain toxicants.

Snus manufacture

Our research covers:

  • the chemistry of various snus products;
  • comparing snus with other smokeless tobaccos;
  • a study of the effects of processing and storage; and
  • determining transfer rates of toxicants in snus.

We are also working with other laboratories on proficiency trials that seek to improve the methods used for snus analyses.

Snus toxicology

There is no standard method for applying snus - or extracts of snus - to in vitro test systems such as the Ames test.  We are looking at ways to develop such tests and at developing new toxicological tests that might be more relevant to the disease end-points observed in snus users.  Part of this work involves the development and validation of a model for irritation in the oral mucosa.

Consumer surveys

Consumer research in Sweden has recently provided new data on consumption patterns in men and women which should be helpful with risk assessments.  This research included questions on:

  • quantity and frequency of snus use;
  • time that snus is kept in the mouth; and
  • how quickly snus is first used after waking.

We have also been researching consumer perceptions of the relative risks of snus and cigarettes in countries where snus use is new.

Clinical trials

The health risks associated with snus use are different from those associated with cigarette smoking, yet both involve tobacco products and some exposure to toxicants in tobacco. 

We are considering whether clinical trials involving measures of biomarkers of exposure and harm in subjects who are switching from smoking to snus might be useful.  We hope to get the views of public health scientists on the design of any such study.


  1. IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. (2007). Volume 89: Smokeless tobacco and some tobacco-specific N-nitrosamines. Lyon: International Agency for Research on Cancer.
  2. Royal College of Physicians. (2007). Harm reduction in nicotine addiction: helping people who can’t quit. A report by the Tobacco Advisory Group of the Royal College of Physicians. London: RCP.
  3. Araghi, M., Rosaria Galanti, M., Lundberg, M., Lager, A., Engström, G., Alfredsson, L., Knutsson, A., Norberg, M., Sund, M., Wennberg, P., Trolle Lagerros, Y., Bellocco, R., Pedersen, N. L., Östergren, P.-O. and Magnusson, C. (2017), Use of moist oral snuff (snus) and pancreatic cancer: Pooled analysis of nine prospective observational studies Opens new window. Int. J. Cancer, 141: 687–693. doi:10.1002/ijc.30773
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