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...

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Autores principales:	C. Hajat, E. Stein, L. Ramstrom, S. Shantikumar, R. Polosa
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Tobacco harm reduction Smokeless tobacco Snus Snuff Moist snuff Smoking Public aspects of medicine RA1-1270
Acceso en línea:	https://doaj.org/article/be645e14ea304a008f2914ffe16008d7
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spelling	oai:doaj.org-article:be645e14ea304a008f2914ffe16008d72021-12-05T12:17:51ZThe health impact of smokeless tobacco products: a systematic review10.1186/s12954-021-00557-61477-7517https://doaj.org/article/be645e14ea304a008f2914ffe16008d72021-12-01T00:00:00Zhttps://doi.org/10.1186/s12954-021-00557-6https://doaj.org/toc/1477-7517Abstract 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.C. HajatE. SteinL. RamstromS. ShantikumarR. PolosaBMCarticleTobacco harm reductionSmokeless tobaccoSnusSnuffMoist snuffSmokingPublic aspects of medicineRA1-1270ENHarm Reduction Journal, Vol 18, Iss 1, Pp 1-21 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Tobacco harm reduction Smokeless tobacco Snus Snuff Moist snuff Smoking Public aspects of medicine RA1-1270
spellingShingle	Tobacco harm reduction Smokeless tobacco Snus Snuff Moist snuff Smoking Public aspects of medicine RA1-1270 C. Hajat E. Stein L. Ramstrom S. Shantikumar R. Polosa The health impact of smokeless tobacco products: a systematic review
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.
format	article
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
title	The health impact of smokeless tobacco products: a systematic review
title_short	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_sort	health impact of smokeless tobacco products: a systematic review
publisher	BMC
publishDate	2021
url	https://doaj.org/article/be645e14ea304a008f2914ffe16008d7
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The health impact of smokeless tobacco products: a systematic review

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