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Daily Use of Smokeless Tobacco: Systemic Effects

Neal L. Benowitz, MD; Peyton Jacob III, PhD; and Lisa Yu, BS
[+] Article and Author Information

Grant Support: Supported in part by grants CA32389, DA02277, DA01696, and RR-0083 from the National Institutes of Health.

Requests for Reprints: Neal L. Benowitz, MD, San Francisco General Hospital Medical Center, Building 30, 5th Floor, 1001 Potrero Avenue, San Francisco, CA 94110.

Current Author Addresses: Dr. Benowitz: San Francisco General Hospital Medical Center, Building 30, 5th Floor, 1001 Potrero Avenue, San Francisco, CA 94110.

Dr. Jacob and Ms. Yu: San Francisco General Hospital Medical Center, Building 100, Room 235, 1001 Potrero Avenue, San Francisco, CA 94110.


© 1989 American College of PhysiciansAmerican College of Physicians


Ann Intern Med. 1989;111(2):112-116. doi:10.7326/0003-4819-111-2-112
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Study Objective: To compare exposure to nicotine and related cardiovascular effects as well as urinary mutagenicity (a potential marker of systemic absorption of carcinogenic compounds) during use of oral snuff, chewing tobacco, and cigarettes, as desired.

Design: Crossover sequential treatments, balanced-order experimental study.

Setting: Clinical research center.

Participants: Eight healthy men who regularly smoked cigarettes and had previous experience with the use of both oral snuff and chewing tobacco.

Interventions: Four 3- or 4-day blocks during which participants used oral snuff, chewing tobacco, and cigarettes as desired, or abstained from all tobacco. Concentrations of nicotine and cotinine (the primary metabolite of nicotine), cardiovascular effects, and urine sodium, catecholamine and mutagenicity were measured over 24 hours at the end of each treatment block.

Measurements and Main Results: Circadian exposure to nicotine and cardiovascular effects, including urinary catecholamine excretion, were similar for all forms of tobacco use. Urine sodium excretion was greater while using smokeless tobacco than while smoking, probably due to absorption of sodium from the smokeless tobacco. Urine mutagenicity was markedly increased while smoking cigarettes and tended to be increased (P < 0.10) while chewing tobacco but not while using oral snuff.

Conclusions: Systemic absorption of nicotine, sodium, and carcinogenic chemicals from smokeless tobacco may cause or aggravate human illness in addition to the known adverse effects on the oral cavity.

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