Health Effects of Smokeless Tobacco

What to know

  • Smokeless tobacco products can contain nicotine, which is addictive.
  • Smokeless tobacco products cause cancer of the mouth, esophagus, and pancreas.
  • These products can cause nicotine poisoning in children.

Smokeless tobacco is associated with many health problems

Using smokeless tobacco:

  • Can lead to nicotine addiction.12
  • Causes cancer of the mouth, esophagus, and pancreas. The esophagus is the passage that connects the throat to the stomach. The pancreas is a gland that helps with digestion and maintaining proper blood sugar levels.12
  • Is associated with diseases of the mouth, such as leukoplakia and cancers of the oral cavity, pharynx, or larynx.13
  • Can increase risks for early delivery and stillbirth when used during pregnancy.2
  • Can cause nicotine poisoning in children.4
  • May increase the risk for death from heart disease and stroke.13


Using smokeless products can cause serious health problems.
Protect your health; don't start. If you do use them, quit.

Addiction to smokeless tobacco

  • Smokeless tobacco contains nicotine, which is addictive.12
  • Nicotine affects the developing brain.
  • Nicotine addiction may make it more likely to start using cigarettes.
  • Young people who use smokeless tobacco may be more likely to also use cigarettes.5

Smokeless tobacco and cancer

Smokeless tobacco causes cancer of the mouth, esophagus, and pancreas.1

Many smokeless tobacco products contain cancer-causing chemicals.16

  • The most harmful chemicals are tobacco-specific nitrosamines.1 These are organic compounds that may increase the risk of cancer. They form during the growing, curing, fermenting, and aging of tobacco. The amount of these chemicals present varies by product.1
  • The higher the levels of these chemicals, the greater the risk for cancer.2

Other chemicals found in tobacco can also cause cancer. These include:6

  • A radioactive element (polonium-210) found in fertilizer used to grow tobacco and which is taken up into the tobacco plant.
  • Chemicals formed when tobacco is cured with heat (polynuclear aromatic hydrocarbons—also known as polycyclic aromatic hydrocarbons)
  • Harmful metals (arsenic, beryllium, cadmium, chromium, cobalt, lead, nickel, mercury)

Smokeless tobacco and oral disease

  • Smokeless tobacco can cause white or gray patches inside the mouth (leukoplakia) that can lead to cancer.1
  • Smokeless tobacco can cause gum disease, tooth decay, and tooth loss.123

Reproductive and developmental risks

  • Using smokeless tobacco during pregnancy can increase the risk for early delivery and stillbirth.2
  • When smokeless tobacco products are used during pregnancy the nicotine can affect how a baby's brain develops before birth.27

Other risks

  • Using smokeless tobacco increases the risk for death from heart disease and stroke.13
  • Smokeless tobacco can cause nicotine poisoning in children.4

Additional Information: Smokeless Tobacco Products, Including Dip, Snuff, Snus, and Chewing Tobacco | FDA

  1. World Health Organization. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans. Volume 89: Smokeless Tobacco and Some Tobacco-Specific N-Nitrosamines. World Health Organization; 2007. Accessed August 13, 2020.
  2. US Dept of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. US Dept of Health and Human Services; 2014. Accessed August 13, 2020.
  3. Piano MR, Benowitz NL, Fitzgerald GA, et al. Impact of smokeless tobacco products on cardiovascular disease: implications for policy, prevention, and treatment: a policy statement from the American Heart Association. Circulation. 2010;122(15):1520–1544.
  4. Connolly GN, Richter P, Aleguas A Jr, Pechacek TF, Stanfill SB, Alpert HR. Unintentional child poisonings through ingestion of conventional and novel tobacco products. Pediatrics. 2010;125(5):896–899.
  5. Lund I, Scheffels J. Smoking and snus use onset: exploring the influence of snus debut age on the risk for smoking uptake with cross-sectional survey data. Nicotine Tob Res. 2014;16(6):815–819.
  6. Stanfill SB, Connolly GN, Zhang L, et al. Global surveillance of oral tobacco products: total nicotine, unionised nicotine and tobacco-specific N-nitrosamines. Tob Control. 2011;20(3):e2.
  7. California Environmental Protection Agency. Safe Drinking Water and Toxic Enforcement Act of 1986: Chemicals Known to the State to Cause Cancer or Reproductive Toxicity (November 23, 2018). California Environmental Protection Agency. Accessed August 13, 2020.