Canadian health organizations are applauding a policy statement by the American Heart Association that warns against the use of smokeless tobacco products as an alternative to cigarettes or an aid to kicking the habit.

In a statement, the association says products such as snuff and chewing tobacco not only can cause nicotine addiction, but may also increase the risk of fatal heart attack, stroke and certain cancers.

'From a public health point of view, we definitely would not want to be promoting smokeless tobacco as a way of reducing risk of smoking-related diseases and of trying to encourage people to quit smoking.'— Manuel Arango

"No tobacco product is safe to consume," said Mariann Piano of the University of Chicago, lead author of the document, which was also published online Monday in the journal Circulation.

"Smokeless tobacco products are harmful and addictive — that does not translate to a better alternative."

The policy statement lays out an in-depth review of the medical literature on use of the products, which manufacturers have been touting as a "safer" alternative to cigarettes and other smoked tobacco products.

Manuel Arango, assistant director of health policy for the Heart and Stroke Foundation of Canada, said there has been a lot of debate over the notion that smokeless tobacco products are a viable cigarette replacement or smoking-cessation aid.

"This is a landmark document and good summary of the evidence that we've been waiting for," Arango said from Ottawa. "It has been a bit of a controversial issue, but this really, I think, settles a lot of question marks that we had in the past."

"So I think for us it's quite clear that from a public health point of view, we definitely would not want to be promoting smokeless tobacco as a way of reducing risk of smoking-related diseases and of trying to encourage people to quit smoking."

Cynthia Callard, executive director of Physicians for a Smoke-Free Canada, said her organization is also delighted by the AHA stance.

"It's a good strong report and I think it gives policy makers the direction they need," she said from Ottawa.

Growing concern

The AHA statement pointed out that smokeless products are increasingly being used by American teen boys seeking a nicotine buzz. That trend also seems to be occurring north of the border.

"Smokeless tobacco has never been used as widely in Canada, at least in the last 100 years or so, as it has been in the United States," said Callard. "However, there's growing concern about its use."

A 2008-2009 youth smoking survey conducted for Health Canada found almost eight per cent of high school boys and 2.5 per cent of girls reported using smokeless tobacco in the previous month. Almost 16 per cent of boys and about four per cent of girls said they had tried one of the products at least once.

"Even though usage is small here, there is anecdotal but reliable information that boys in hockey teams and other peer settings are using smokeless tobacco, especially because it's flavoured with cherry or peach or mint," said Callard, noting that the products were not included in recent legislation that banned flavoured cigarillos and other smoked tobacco products.

"It's been observed that young people who weren't even smoking cigarettes were turning to these products," she added.

Products of choice tend to be chewing tobacco, the longtime favourite of many baseball players, and wet or dry snuff, which is held between the lip and gum or cheek. Snus, a Swedish form of snuff, is sold in Canada as tiny tea bag-like products containing a fine tobacco mixture. When placed inside the mouth, nicotine is broken down by saliva and absorbed into the bloodstream.

The idea that smokeless tobacco products are preferable to cigarettes is based in part on the experience in Sweden, where there was a significant drop in smoking among men between 1976 and 2002 that corresponded to a rise in smokeless tobacco use, particularly snus.

However, a recent study found no reduction in smoking rates among Americans using smokeless tobacco.

Piano said the safest aids for helping a smoker butt out for good are nicotine-replacement and pharmaceutical therapies, in conjunction with counselling and support groups.