Toxicology of Smokeless Tobacco: Implications for Immune, Reproductive, and Cardiovascular Systems

Abstract

The popularity of smokeless tobacco (ST), or noncombusted tobacco, usually placed within the mouth to be chewed, sucked, or swallowed, is growing rapidly and its prevalence of use is rising globally, due (in part) to greater convenience, as allowable cigarette smoking areas are rapidly decreasing, and increased social acceptability. Though data are limited, ST usage has been directly linked to a number of adverse health outcomes. The potential role that immune dysfunction, including dysregulation of immune cells and their components, may play in the progression of these adverse health outcomes is only just beginning to emerge. Evidence suggesting reproductive outcomes, such as perinatal mortality, preterm birth, and reduced sperm viability, also exists in conjunction with ST use. Cardiovascular health may also be impacted by ST use, resulting in increased blood pressure and endothelial dysfunction, both of which may potentially lead to cardiovascular diseases. This review describes the toxicological implications associated with ST use, with emphasis on immune, reproductive, and cardiovascular outcomes. Epidemiological studies are discussed with respect to experimental studies to help develop the relationship between ST and disease pathology. This review also summarizes the gaps in ST knowledge and potential future directions that are needed to more fully delineate the complex systems driving the adverse health outcomes associated with its use.

Physical activity, fatness, educational level and snuff consumption as determinants of semen quality: findings of the ActiART study

“…Also, in our study, snuff users had significantly lower sperm concentration, motile sperm number, motile sperm concentration and motile sperm percentage. In Nordic countries, snuff is frequently used: about 20% of Swedish men use snuff regularly, and its use is rapidly increasing worldwide (Willis et al, 2012). Among our study population, the prevalence of snuff users was even higher than in previous studies (28%).…”

Electronic Cigarettes—A Narrative Review for Clinicians

“…Although smokeless tobacco associated cardiac events have been studied in the past, it is difficult to extrapolate data to e-cigarettes considering their different mechanism of nicotine delivery. 56 There are currently no published studies on e-cigarette use and thrombosis, platelet reactivity, atherosclerosis or blood vessel function.…”

Smokeless Tobacco (Shammah) in Saudi Arabia: A Review of its Pattern of Use, Prevalence, and Potential Role in Oral Cancer

“…Cardiovascular health may also be impacted by ST use, resulting in augmented blood pressure and dysfunction of CVS endothelia, both of which may possibly lead to cardiovascular illnesses. Intoxicating carcinogens have been examined in ST products, with levels of tobaccospecific nitrosamines 100-fold greater than legal limits for nitrosamines in foodstuffs (Walsh et al, 2010;Warnakulasuriya et al, 2010;Ebbert et al, 2011;Klesges et al, 2011;Bhattacharyya, 2012;Willis et al, 2012). The use of nicotine replacement therapy (patches or gum), and bupropion have not been revealed to assist people to quit ST.…”

“…Elongated period chewing of tobacco or the use of snuff has been associated with cancer of oral cavity, cheek, gums and oropharynx (Albar, 1994;Willis et al, 2012;Foulkes, 2013). Oral cancer is one of the ten most frequent cancers in the world (Jemal et al, 2010;Jemal et al, 2011).…”