How effective are behavioural and pharmacological interventions for the treatment of smokeless tobacco cessation?
Based upon a single study to date, varenicline appeared to be
effective for increasing tobacco abstinence rates among Swedish
snus users and could be offered clinically. Evidence for the effectiveness
of bupropion SR and nicotine replacement therapy for the
treatment of smokeless tobacco use was inconclusive. Behavioural
interventions increased tobacco abstinence rates among smokeless
tobacco users, whether or not they were already motivated to
stop and seek treatment. Telephone counselling and oral examination
and feedback about smokeless tobacco-induced mucosal
changes may be useful components of such an intervention.
The evidence for the use of pharmacotherapies is insufficient
to provide clear guidelines for practice. The inference of the
effect size of behavioural interventions for increasing smokeless
tobacco abstinence rates was weakened by the limited methodological
quality of some of these trials, including loss to follow-up
and potential baseline differences between the groups. Moreover,
there is the possibility publication bias may also have impacted
on the results.
Smokeless tobacco is tobacco that is consumed orally, not
burned. A variety of types of smokeless tobacco is consumed
throughout the world, and it is an important worldwide public
health issue. In the US, the principal types of smokeless tobacco
are chewing tobacco (cut tobacco leaves) and snuff (moist ground
tobacco). In Sweden, snus (finely ground moist tobacco) is used.
In India, smokeless tobacco contains tobacco leaf mixed with
other ingredients, such as areca nut and lime.1 In Sudan, toombak
is made from a fermented ground powdered tobacco mixed
with sodium bicarbonate.2 Use of smokeless tobacco can lead
to nicotine addiction, and long-term use can lead to health problems,
including periodontal disease, cancer, and cerebrovascular
and cardiovascular disease.
Cochrane Systematic Review:
Ebbert J et al. Interventions for smokeless tobacco use cessation.
Cochrane Reviews, 2011, Issue 2. Article No. CD004306.
This review contains 25 studies involving over 11,000 participants.