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Snus (/snuːs/, SNOOSS; Swedish: [ˈsnʉːs] ) is a Swedish tobacco product (in Scandinavia). It is consumed by placing a pouch of powdered tobacco leaves under the lip for nicotine to be absorbed through the oral mucosa. Snus, not to be confused with nicotine pouches, consists of ground up tobacco leaves, salt, an alkalizer (e.g. Sodium Carbonate, Sodium Bicarbonate) and (optionally) flavorings. The final product is sold as both loose tobacco, and in portions with the tobacco mixture contained in a small teabag-like pouch.

The manufacturing process of snus differs from that of other oral tobacco products. Snus tobacco is heated and pasteurized rather than cured or fermented, resulting in a less harmful product which contains a lower concentration of TSNA carcinogens in comparison to other traditional tobacco products. Though research on the connection between snus and disease such as cancer is not conclusive, no associations between snus consumption and an increased risk of cancer have been found.

The warning text "causes cancer" was removed from snus packaging in Sweden and other countries because current scientific evidence indicates that the cancer risk associated with snus is significantly lower than that of smoking. The shift in labeling aims to provide accurate information while still cautioning consumers about potential health concerns.

Nicotine products in general have been linked to reproductive harms such as stillbirth, premature birth, and low birth weight. Conversely, non-tobacco-based nicotine pouches (also known as "nic pouches") are classified as non-carcinogenic since nicotine itself is not a carcinogen. However, they are still harmful to cardiovascular health due to their nicotine content, and are associated with moderately higher risk of cardiovascular disease, stroke, and reproductive harms. The main causes for mortality from smoking including cardiovascular disease from the effects of smoke on vascular coagulation and blood vessel walls are not caused primarily by nicotine and hence not to be considered equal to the moderate cardiovascular health risks from nicotine pouches.

The sale of tobacco-based snus is illegal in several countries, including Australia, New Zealand and all European Union (EU) countries except for Sweden. Non-tobacco nicotine pouches are presently not regulated at EU-level. It is the most common type of tobacco product in Sweden and Norway and is also available in Switzerland. Some European countries, such as the United Kingdom, Ireland and Estonia, allow the sale of non-tobacco-based snus. Snus is also available in the United States.

Overview

Snus is made from air-dried/pasteurized tobaccos from various parts of the world. In earlier times, tobacco for making snus was laid out for drying in Scania and Mälardalen, Sweden. Later, Kentucky tobaccos were used. The ground tobacco is mixed with water, salt, an alkalizing agent such as Sodium Carbonate or Sodium Bicarbonate (E500), and aroma, and is prepared through heating under pressure. After the heating process, food grade aromas are typically added. In Sweden, snus is regulated as a food product and, for this reason, all ingredients are listed on the label of each individual package (can) of snus. Moist snus contains more than 50% water, and the average use of snus in Sweden is approximately 800 grams (16 units) per person each year. About 12% (1.1 million people) of the population in Sweden use snus. Unlike dipping tobacco and chew, most snus today does not undergo the fermentation process, but is instead steam-pasteurized. Pasteurization inhibits the growth of bacteria that facilitate the formation of tobacco-specific nitrosamines, while preserving the desired texture and mouthfeel of the snus. The absorption of nicotine, the desired primary alkaloid in tobacco, greatly depends on the nicotine content in the snus and the pH of the final product. A voluntary quality standard for snus products has been introduced (Gothiatek) that sets maximum levels for certain controversial constituents including nitrosamines, heavy metals, and polyaromatic hydrocarbons. Most manufacturers of Scandinavian type snus adhere to this standard.

Snus is sold in containers of various sizes, originally made of porcelain, wood, silver, or gold. Portioned snus usually comes in plastic tins of 20 to 24 portions, containing about 0.75 to 1 gram of snus each, while loose snus is mostly sold in wax coated cardboard containers with plastic lids (similar to dip snuff), at 42 g (50 g before 2008). Mini-portion and medium-portion snus are increasingly popular formats. Most of these products come in tins containing 20 portions, of either 0.65 or 0.5 grams each for a total of just under 13 or 10 grams, particularly with those for whom concealing their use of smokeless tobacco in places is of utmost importance.

Snus is available in two main types:

• Loose snus (Swedish: lössnus) is a moist powder that can be shaped into a cylindrical or spherical form using the fingertips or a specialized cylindrical device. This final product is commonly known as a pris ('pinch'), buga, prilla, or prell (slang). Some individuals, particularly long-time users, opt to simply pinch the tobacco and place it under their upper lip (known as a farmer's pinch or living snus). However, the popularity of loose snus has gradually been overtaken by portioned alternatives. Nowadays, many snus users appreciate the discreet nature of these pre-portioned varieties.
• Portion snus (Swedish: portionssnus) is a convenient and discreet form of snus that comes in small teabag-like sachets filled with moist powder. It is available in smaller quantities compared to loose powder snus. There are two varieties of portion snus:
  • Original portion: This traditional form was introduced in 1973. The sachet material is moisturized during manufacturing, resulting in a brown, moist pouch.
  • White portion: This form has a milder taste and slightly slower release. The sachet material is not moisturized during manufacturing, resulting in a white, dry pouch. The tobacco within the portion material has the same moisture content as original portion snus, but the nicotine and flavor are delivered somewhat slower due to the drier sachet. Notably, "white portion" refers to the style, not the color. Some white portion snus use a black material instead of white, yet are still considered "white portion". Examples of such snus include General Onyx, Grovsnus Svart (Black), and Blue Ocean (Blue).
  • The Stingfree portion is a patented pouch for snus and modern oral nicotine pouches, approved in the US and Europe. It features a protective side that effectively reduces the burning sensation and irritation on the user's gum and oral mucosa.

Portioned snus comes in three sizes: mini, normal/large, and maxi. The weights vary, but most packages disclose the net weight. Mini portions weigh around 0.5 g, normal portions weigh 0.8 to 1 g, and maxi portions weigh up to 1.7 g. Some brands offer regular and long versions of the normal size sachet.

The nicotine content varies among brands, with the most common strength being 8 mg per gram of tobacco. Stark and extra stark varieties have higher nicotine content, with stark varieties containing 11–14 mg and extra stark varieties containing up to 22 mg. Siberia brand has an "Extremely Strong" snus with 43 mg of nicotine per gram of tobacco, the highest available.

Usage

Snus is typically used by being placed under the upper lip. This is true for both loose snus and portion snus. The pris (pressed pellet of loose snus) or pouch is typically left in place for anywhere between 30 and 120 minutes. No spitting is required, but some (especially new users) may prefer to.

Snus is not cured, so it can spoil much faster than cured tobacco. While tobacco-based snus is typically refrigerated for short term storage (up to a few months), it is typically frozen for longer term storage of a year or more. It can stay unrefrigerated for a week or more without spoilage. Some tobacco-based snus products are shipped very dry, so they have extended shelf life without needing any refrigeration. This makes them slower to initially "drip", as there is no appreciable moisture in the packet.

Differences to other oral tobacco products

Some forms of tobacco consumed in the mouth may be categorized as:

Swedish snus

A moist form of smokeless tobacco which is usually placed under the upper lip, and which does not result in the need for spitting. It is sold either as a moist powder known as loose snus, or packaged into pouches known as portion snus. Snus is often mildly flavored with food-grade smoke aroma, bergamot, citrus, juniper berry, herbs and/or floral flavors. Most Scandinavian snus is produced in Sweden and regulated as food under the Swedish Food Act.

American snus

Available since the late 1990s, this is similar to the Scandinavian form, but usually has a lower moisture content and lower pH, resulting in lower bioavailability of nicotine than Scandinavian varieties, meaning less is available for absorption. American snus is often flavored, e.g., with spearmint, wintergreen, vanilla or fruit (e.g. cherry), and may contain sugar.

Nasal snuff

Mostly English, German, and Scandinavian, this is referred to as luktsnus in Swedish and luktesnus in Norwegian, and as "Scotch snuff" in the US, is a dry, powdered form of snuff. It is insufflated – "sniffed" but not deeply "snorted" – through the nose. It is often mentholated or otherwise scented.

Chewing tobacco

North American and European product, also known as chew (or in some Southern US dialects as chaw or dip). It is tobacco in the form of short or long, loose leaf and stem strands (like pipe tobacco or longer), or less commonly of chopped leaves and stems compressed into blocks called plugs, or even finely ground pieces compressed into pellets. A few brands are cut into much finer loose strands, like cigarette rolling tobacco. Chew is placed between the cheek and the gums, or actively chewed. It causes copious salivation, especially when chewed, and due to its irritant (even nauseating) effect on the esophagus, this "juice" usually requires spitting. Chewing tobacco is a long-established North American form of tobacco (derived from traditional use of raw tobacco leaf by Indigenous peoples of the Americas), and is also legal in the European Union. Chewing tobacco is sometimes flavored, e.g. with wintergreen, apple, or cherry.

Dipping tobacco

Also known as dip, spit tobacco or, ambiguously, as moist snuff, this is a common American form of tobacco. It is moist, and somewhat finely ground, but less so than snus. Dipping tobacco (so called because users dip their fingers into the package to pinch a portion to insert into the mouth) is placed between the lower lip or cheek and the gums; it is not used nasally. As with chewing tobacco, salivation is copious, and usually spat out. Dipping tobacco is usually flavored, traditionally with wintergreen or mint, though many other flavorings are now available, while some unflavored brands remain popular. Beginning in the mid-1980s, several brands have packaged American dipping tobacco in porous pouches like those used for many brands of Scandinavian and American snus.

Chema

This Algerian product is a moist tobacco similar to Scandinavian snus in many respects. Outside of Algeria, it is most widely known as "Makla", a name that originates from the Algerian brand "Makla El Hilal", which first produced this type of smokeless tobacco during the French colonization. It is placed in the upper lip in a manner similar to snus; it differs in that it is more finely ground and has an even higher nicotine content and pH level. Sales within the European Union are legal due to its classification as a chewing tobacco. Its safety in comparison to snus has not been studied sufficiently.

Naswar

A central Asian product which is a moist, powdered form of tobacco, often green and sometimes caked with the mineral lime and/or wood ash. It is used like dipping tobacco or put under the tongue, and is pungent and often heavily flavored, e.g. with culinary oils (cardamom, sesame), the fruit lime, menthol, etc.

Snus, dry snuff, and dipping tobacco are distinct products that some English speaking people may refer to as snuff but are all processed and used in very different ways, each with their own sets of risks.

Health risks

Various national and international health organizations stated that using snus is addictive, represents a health risk, has no safe level use, and is not a safe substitute for smoking. Using snus can cause a number of adverse health effects such as esophageal cancer, pancreatic cancer, stomach cancer, colorectal cancer, cardiovascular disease and stroke. Snus can also cause adverse reproductive effects including stillbirth, premature birth, low birth weight. Nicotine in snus products that are used during pregnancy can affect how a baby's brain develops in the womb.

Quitting snus use is as challenging as smoking cessation. There is no scientific evidence that using snus can help a person quit smoking, although widespread snus-usage is correlated with lower rates of smoking.

Nicotine pouches

The first tobacco-free product was developed in the beginning of the 2000s by a small start up company named Niconovum. Niconovum registered the non-tobacco in 2008 as a medicinal nicotine replacement product (Zonnic) with 2 mg of nicotine. In 2009, RJ Reynolds (now British American Tobacco) bought Niconovum. Thereafter tobacco companies, particularly Swedish Match, became active in the pouch category. Many of Sweden’s leading manufacturers, such as Swedish Match, Skruf and AG Snus created their nicotine pouch brands as a direct response to demand for a non-carcinogenic nicotine option with less health-risks.

In addition to nicotine, non-tobacco nicotine pouches typically contain food-grade fillers, sweeteners, and flavorings. The main ingredient in nicotine pouches in terms of volume is plant fiber. Plant fibers are used to fill the pouch and give it the desired shape, fit, and properties. Different brands use different fibers, but some of the most common derive from eucalyptus and pine. Nicotine pouches are sold in an array of flavors, such as peppermint, black cherry, coffee, citrus, and many others. The nicotine content among nicotine pouch brands typically varies from 1 mg/pouch to 10 mg/pouch although some have much more. Nicotine pouches usually have a longer shelf-life than traditional snus.

Since 2021, sales of nicotine pouches have grown exponentially with Zyn as the global leader. This popularity has led to controversy among government regulators who view the product's appeal to youth as concerning. In April 2024, the UK's Department of Health and Social Care announced new regulations banning the sale of nicotine pouches to children as part of the Tobacco and Vapes Bill which was announced in the King’s speech on 7 November 2023 and introduced to Parliament on 20 March 2024.

Regulation

Non-tobacco nicotine pouches are regulated differently around the world.

Europe

In some countries, like Norway, the sale of tobacco-free nicotine pouches is prohibited, as it would constitute the sale of a new nicotine-product in addition to cigarettes, snuff, and tobacco-based snus. In June 2018 the Norwegian Directorate of Health forced British American Tobacco Norway to remove the tobacco-free snus Epok, having been sold as the sole tobacco-free brand in Norway since 2014, since as it didn't contain any tobacco, it was a new form of nicotine product, distinct from the other forms of snus approved in Norway. Approval for the nicotine pouch brand ZYN had already been rejected twice for a very similar product. Within days of the ban, Epok was re-introduced to the Norwegian market, with a minute amount of bleached tobacco added, to qualify as snus, an already approved form of nicotine product. As of July 2024, Epok is still sold by Norwegian grocery stores. In Sweden, there was a growing debate before the EU referendum in 1994, whether snus would be prohibited in Sweden, as the EU had prohibited snus in 1992. A number of voters expressed concern that if Sweden became a EU member, they would have to kick the habit. The Swedish government requested an exception to the EU ban, which was granted.

In Finland, until April 2023, nicotine pouches were classified for medicinal use. The Finnish Medicines Agency (FIMEA) stated that nicotine pouches cannot be classified as medicinal products unless they are specifically marketed for a medicinal purpose or it can be demonstrated in some other way that they are typically used as medicinal products.

In some countries in Eastern Europe like Poland and the Baltics, nicotine pouches are sold freely, because they do not classify as a tobacco product although in Estonia, a special classification of "products related or similar to tobacco products" has been in place since 2020 and the same laws apply as for tobacco products. Although nicotine pouches are not heavily regulated in the European Union, some regulatory characteristics fall under the European Union CLP-Regulation (EC) 1272/2008.

The pouches are sold in supermarkets in the United Kingdom, and are not covered by tobacco or medical laws there. In 2022, the Action on Smoking and Health group called for a regulatory framework covering all nicotine products.

Canada

In Canada, 4 mg nicotine pouches became widely available for sale in gas stations and convenience stores as a form of nicotine replacement therapy, with Imperial Tobacco Canada receiving approval for its Zonnic brand in 2023. Their sale is covered under the Natural and Non-prescription Health Products Directorate; nicotine products in Canada with a standard dosage exceeding 4 mg are considered a prescription drug, therefore personal imports of nicotine pouches containing over 4 mg of nicotine per pouch are prohibited. Exceptions exist for those who are a health practitioner or medical practitioner, a drug manufacturer, a wholesale druggist, a pharmacist, or a resident of a foreign country while a visitor in Canada.

The 2023 launch of Zonnic was criticized by Health Minister Mark Holland, who felt that Imperial were not marketing them as a cessation product, and that the product was a "loophole" to "addict new young people to nicotine" due to flavouring, accessibility, and marketing appealing to youth (with its classification under natural health product regulations giving it looser restrictions on marketing than other tobacco products). Health Canada stated that regulation of their sale was the jurisdiction of provinces and territories, Imperial lobbied against regulation of the product, stating that it had voluntarily instructed retailers to sell it alongside other age-restricted tobacco products.

Due to local laws on health products, the pouches could only be sold in Quebec at pharmacies. In February 2024, British Columbia issued a ministerial order that prohibited nicotine pouches from being sold outside of pharmacies. That month, Holland threatened to regulate the product. In the 2024 Canadian federal budget, a provision was enacted which gives the Minister of Health power to restrict the sale, manufacture, importation, or promotion of health products, if they have a risk of harm associated with off-label use; Holland stated that the provision was intended primarily to target nicotine pouches. In August 2024, Holland invoked this power to issue a ministerial order effective 28 August 2024; under the order, Zonnic was prohibited from being sold outside of pharmacies, and flavours besides menthol and mint were recalled. The company will have six months to amend its packaging to include warnings on nicotine addiction, and modify its marketing as to not appeal to youth or promote other uses beyond nicotine therapy.

United States

It is assumed nicotine pouches are classified as tobacco products in the US because they contain nicotine obtained from tobacco.

Health risks

There is limited independent testing of the constituents, exposure, or biomarkers of effects for nicotine pouches, although independent research is now emerging. Nicotine itself is currently classified as non-carcinogenic according to the International Agency for Research on Cancer, and according to the Royal College of Physicians nicotine in itself is not a hazardous drug. In turn, it is hypothesized that if nicotine can be delivered without tobacco and smoke inhalation, most, if not all of the harm of smoking can be avoided. However, if not carcinogenic, nicotine is still moderately harmful to cardiovascular health, therefore long-term use of non-tobacco nicotine pouches very likely causes higher risks for cardiovascular diseases, stroke, and reproductive harms.

A meta-analysis from 2015 by members of Tata Memorial Hospital in Mumbai, India, argues that nicotine may be carcinogenic through indirect effects on a range of organ systems in the body. Specifically, they claim that nicotine "affects the cell proliferation, oxidative stress, apoptosis, DNA mutation by various mechanisms, which leads to cancer."

Advocacy groups opposed to the introduction of nicotine pouches in Kenya have protested that they may raise the risk of cancer, heart disease, and reproductive or developmental harms. The Kenya Tobacco Control Alliance alleged that given the higher levels of some toxic chemicals, and what the U.S. Food and Drug Administration said was a lack of medical data showing the pouches are safer than cigarettes (as claimed by manufacturer British American Tobacco), the government should not license the product.

History

Snus has a long history of use, reaching back to the 16th century and concentrated in Sweden. Its origin lies in an invention by Jean Nicot (1530–1600), a French diplomat residing in Portugal who cultivated tobacco in his garden, and was one of the pioneers in recognizing the medicinal properties of tobacco. Nicot is also the originor of the word nicotine. Nicot meticulously dried and ground the tobacco leaves into a fine powder, which could be inhaled as snuff. He presented this powder to Catherine de’ Medici (1519–1589), the Queen of France, in an effort to alleviate her migraines. The use of snuff quickly gained popularity among the French court and the upper-class citizens, becoming a fashionable trend. By the early 17th century, the practice of using nasal snuff had also spread to Sweden.

Tobacco use became so prevalent in Sweden that in 1724, King Fredrik I issued a decree mandating that Swedes cultivate their own tobacco. Consequently, farmers and homesteaders started grinding their own locally grown tobacco.

Due to manual laborers typically working outside where frequent use of a dry, finely ground nasal snuff is not convenient, they opted to crush their tobaccos into a paste-like consistency and allowed it to ferment in jars for several weeks. The final product was then portioned and placed under the lip for extended periods of time, eventually gaining popularity as snus.

Ettan is the still extant snus brand, which dates to 1822. Its founder, Jakob Fredrik Ljunglöf, introduced pasteurization into snus making, reducing production time by several weeks and preventing microbial contamination. In the years that followed, numerous manufacturers further improved of snus manufacturing, leading to the flourishing of many brands. Several of these brands from that era continue to exist.

In 1914, the Swedish parliament made the decision to nationalize the entire tobacco industry. This led to the transformation of numerous tobacco companies into the state-owned monopoly known as AB Svenska Tobakmonopolet. As a result, the number of available tobacco products decreased significantly from approximately four hundred local brands to just seventeen, although these were now distributed nationwide. Consequently, employment within the industry experienced a fifty percent decline. In the 1960s, Sweden decided to abolish the import and sales monopoly on tobacco. AB Svenska Tobaksmonopolet later merged with the match manufacturer Swedish Match and was listed on the stock market in 1996.

See also

• Health effects of snus
• Chewing tobacco
• Pituri
• Röda Lacket

References

1. "Snus". www.pmi.com. Retrieved 3 July 2024.
2. Valen, Håkon; Becher, Rune; et al. (7 June 2023). "A systematic review of cancer risk among users of smokeless tobacco (Swedish snus) exclusively, compared with no use of tobacco". International Journal of Cancer. 153 (12). John Wiley & Sons Ltd: 1942–1953. Retrieved 27 October 2024 – via Wiley Online Library.
3. Lee, Peter N. (6 December 2013). "Epidemiological evidence relating snus to health – an updated review based on recent publications". Harm Reduction Journal. 10 (1): 36. doi:10.1186/1477-7517-10-36. ISSN 1477-7517. PMC 4029226. PMID 24314326.
4. ^ Brinchmann, Bendik C.; Vist, Gunn E.; Becher, Rune; Grimsrud, Tom K.; Elvsaas, Ida-Kristin Ørjasæter; Underland, Vigdis; Holme, Jørn A.; Carlsen, Karin C. Lødrup; Kreyberg, Ina; Nordhagen, Live S.; Stensby Bains, Karen Eline; Carlsen, Kai-Håkon; Alexander, Jan; Valen, Håkon (16 December 2022). "Use of Swedish smokeless tobacco during pregnancy: A systematic review of pregnancy and early life health risk". Addiction. 118 (5): 789–803. doi:10.1111/add.16114. hdl:11250/3065807. ISSN 0965-2140. PMID 36524899.
5. ^ M. Jackson, Joshua; Weke, Anthony; Holliday, Richard (October 2023). "Nicotine pouches: a review for the dental team". British Dental Journal. 235 (8): 643–646. doi:10.1038/s41415-023-6383-7. ISSN 1476-5373. PMC 10611559. PMID 37891304.
6. ^ Avenue, 677 Huntington; Boston; Ma 02115 (16 April 2024). "Zyn pouches safer than smoking, but still pose risks". News. Retrieved 15 July 2024.{{cite web}}: CS1 maint: numeric names: authors list (link)
7. ^ Blum, Dani (25 January 2024). "Can Nicotine Pouches Like Zyn Harm Your Health?". The New York Times. ISSN 0362-4331. Retrieved 15 July 2024.
8. ^ Avenue, 677 Huntington; Boston; Ma 02115 (16 April 2024). "Zyn pouches safer than smoking, but still pose risks". News. Retrieved 4 July 2024.{{cite web}}: CS1 maint: numeric names: authors list (link)
9. ^ "Are Oral Nicotine Pouches Safe? | Johns Hopkins | Bloomberg School of Public Health". publichealth.jhu.edu. 24 April 2024. Retrieved 4 July 2024.
10. "Nicotine without smoke Tobacco harm reduction A report by the Tobacco Advisory Group of the Royal College of Physicians" (PDF). Royal College of Physicians. 2016.
11. "Burning Issues: The Global State of Tobacco Harm Reduction 2020". Global State of Tobacco Harm Reduction.
12. Gray, Nigel (2005). "Mixed feelings on snus". The Lancet. 366 (9490): 966–7. doi:10.1016/S0140-6736(05)67352-7. PMID 16168760. S2CID 706773.
13. "Europe's war against tobacco has a new target: Nicotine". POLITICO. 4 January 2024. Retrieved 15 July 2024.
14. "What is snus and why do so many Norwegians use it?". 28 June 2021. Retrieved 17 March 2022.
15. "Nordic Spirit UK".
16. "Dáil Éireann debate. Question 507 – Health services [snus/nicotine pouches] [507/24]". www.oireachtas.ie. 30 January 2024. Retrieved 10 September 2024.
17. "Seni keelatud Snus ehk mokatubakas jõudis nüüd Eestis ametlikult müügile, and Lithuania" (in Estonian). 16 July 2019. Retrieved 4 September 2020.
18. "Snusandet ökar - trots stor ovisshet om riskerna". snuskaufenschweiz.ch. Archived from the original on 27 September 2007. Retrieved 16 August 2007.
19. Scientific Committee on Emerging and Newly Identified Health Risks, SCENIHR. Health Effects of Smokeless Tobacco Products. 2008:78-79
20. "Swedish Patent Database, Patent SE 1450234-8, SE 539029". was.PRV.se. Archived from the original on 2 October 2019. Retrieved 2 January 2018.
21. "Siberia Dip and Siberia Chew rock the US and the UK |". Swedishproducts.online. 5 February 2021. Retrieved 5 February 2021.
22. "How to Use Snus and Nicotine Pouches". Snussie.com. 15 February 2024. Retrieved 30 November 2024.
23. "Snus – The Swedish Experience" (PDF). World Health Organization. Archived from the original (PDF) on 6 November 2015. Retrieved 20 October 2014.
24. Foulds, Jonathan; Furberg, Helena (2008). "Is low-nicotine Marlboro snus really snus?". Harm Reduction Journal. 5: 9. doi:10.1186/1477-7517-5-9. PMC 2288606. PMID 18304348.
25. Differences between American and Swedish snus SnusDirect September 2020
26. "Tabacs en Algerie-La Chemma - Algerazur". 15 February 2010.
27. "Recommendation on smokeless tobacco products" (PDF). World Health Organization. 2017. pp. 1–9.
28. "Health Risks of Smokeless Tobacco". American Cancer Society. 13 November 2015.
29. ^ "Smokeless Tobacco and Cancer". United States Department of Health and Human Services. National Cancer Institute at the National Institutes of Health. 25 October 2010. This article incorporates text from this source, which is in the public domain.
30. Royal College of Physicians of London. Tobacco Advisory Group (2002). Protecting Smokers, Saving Lives: The Case for a Tobacco and Nicotine Regulatory Authority. Royal College of Physicians. pp. 5–. ISBN 978-1-86016-177-3.
31. Valen, Håkon; Becher, Rune; Vist, Gunn Elisabeth; Holme, Jørn Andreas; Mdala, Ibrahimu; Elvsaas, Ida-Kristin Ørjasæter; Alexander, Jan; Underland, Vigdis; Brinchmann, Bendik Christian; Grimsrud, Tom Kristian (15 December 2023). "A systematic review of cancer risk among users of smokeless tobacco (Swedish snus) exclusively, compared with no use of tobacco". International Journal of Cancer. 153 (12): 1942–1953. doi:10.1002/ijc.34643. hdl:10852/105193. ISSN 0020-7136. PMID 37480210.
32. Gupta, Ruchika; Gupta, Sanjay; Sharma, Shashi; Sinha, Dhirendra N; Mehrotra, Ravi (1 January 2019). "Risk of Coronary Heart Disease Among Smokeless Tobacco Users: Results of Systematic Review and Meta-Analysis of Global Data". Nicotine & Tobacco Research. 21 (1): 25–31. doi:10.1093/ntr/nty002. ISSN 1469-994X. PMC 6941711. PMID 29325111.
33. Benowitz, Neal L.; Liakoni, Evangelia (29 September 2021). "Tobacco use disorder and cardiovascular health" (PDF). Addiction. 117 (4): 1128–1138. doi:10.1111/add.15703. ISSN 0965-2140. PMID 34590373.
34. Lipari, Rachel N.; Van Horn, Struther L. (31 May 2017). "Trends in Smokeless Tobacco Use and Initiation: 2002 to 2014". The CBHSQ Report. Substance Abuse and Mental Health Services Administration. PMID 28636307. This article incorporates text from this source, which is in the public domain.
35. "ERS Position Paper on Tobacco Harm Reduction". European Respiratory Society. 29 May 2019. Retrieved 30 May 2024.
36. Nicotine Pouch Side Effects Prilla.com January 2023
37. ^ Robichaud, Meagan O.; Seidenberg, Andrew B.; Byron, M. Justin (21 November 2019). "Tobacco companies introduce 'tobacco-free' nicotine pouches". Tobacco Control. 29 (e1): e145–e146. doi:10.1136/tobaccocontrol-2019-055321. PMC 7239723. PMID 31753961.
38. "What are Nicotine Pouches? Complete Guide - Swenico". 9 February 2023. Retrieved 16 February 2023.
39. Stanfill, S.; Tran, H.; Tyx, R.; Fernandez, C.; Zhu, W.; Marynak, K.; King, B.; Valentín-Blasini, L.; Blount, B. C.; Watson, C. (September 2021). "Characterization of Total and Unprotonated (Free) Nicotine Content of Nicotine Pouch Products". Nicotine & Tobacco Research. 23 (9): 1590–1596. doi:10.1093/ntr/ntab030. PMID 34233354.
40. Difference between Nicotine Pouches and Snus SnusDirect February 2021
41. Rodenburg, Malissa (8 March 2024). "Nicotine pouches are growing in popularity. Are they safe?". The Hub. Retrieved 28 April 2024.
42. "What to know about Zyn, the tiny nicotine pouch that's sparked a big health debate". AP News. 26 April 2024. Retrieved 28 April 2024.
43. "Are Nicotine Pouches Being Banned? | Prime® Nic Pouches". www.primenicpouches.co.uk. Retrieved 18 July 2024.
44. Journalist, Lene Skogstrøm (25 July 2018). "Denne snusen blir nå trukket tilbake fra hyllene. Årsak: Den inneholder ikke tobakk". Aftenposten. Retrieved 3 February 2020.
45. Klausen, Marte (26 July 2018). "Disse snusboksene forsvinner fra butikkene". Dagbladet.no (in Norwegian). Retrieved 3 February 2020.
46. "Epok | Meny.no". www.meny.no (in Norwegian). Retrieved 3 February 2020.
47. "Epok - Kolonial.no". Kolonial.no (in Norwegian Bokmål). Retrieved 3 February 2020.
48. "Höjd EU-skatt på snus - Sveriges Riksdag". riksdagen. Retrieved 29 August 2024.
49. ^ "Fimea supports legislative reform concerning nicotine pouches - fimea englanti". Uutinen. Retrieved 16 August 2023.
50. Vitásek, Petr (30 September 2020). "Zrádné nikotinové sáčky nepodléhají zákonné regulaci a mohou vést k závislosti". Deník.cz (in Czech). Retrieved 29 June 2021.
51. "Tubakaseadus–Riigi Teataja". www.riigiteataja.ee. Retrieved 16 August 2024.
52. Consolidated text: Regulation (EC) No 1272/2008 of the European Parliament and of the Council of 16 December 2008 on classification, labelling and packaging of substances and mixtures, amending and repealing Directives 67/548/EEC and 1999/45/EC, and amending Regulation (EC) No 1907/2006
53. "Nikotiinipussien etämyynti Suomessa - Snuush - vahvat nikotiinipussit reseptillä" (in Finnish). 20 March 2022. Retrieved 6 April 2022.
54. "Call to ban nicotine pouch sale to under-18s". BBC News. 31 October 2022. Retrieved 9 March 2024.
55. "Local public health experts warn about nicotine pouches | CityNews Kitchener". kitchener.citynews.ca. 19 December 2023. Retrieved 26 January 2024.
56. "Product information". health-products.canada.ca. Retrieved 26 January 2024.
57. ^ "B.C. to remove nicotine pouches from convenience stores". CTV News British Columbia. 7 February 2024. Retrieved 27 August 2024.
58. "Consolidated federal laws of Canada, Natural Health Products Regulations". 24 November 2023.
59. "Notice: Prescription Drug List (PDL): Nicotine Qualifier Clarification | Canada.ca". www.canada.ca. 23 August 2018. Retrieved 15 December 2020.
60. "Food and Drug Regulations | laws-lois.justice.gc.ca". www.laws-lois.justice.gc.ca. 19 December 2013. Retrieved 15 December 2020.
61. ^ "Health minister defends new powers to pull products off shelves". CBC News. 29 May 2024. Retrieved 27 August 2024.
62. "'We were duped': Health minister vows to close 'loophole' on flavoured nicotine pouches". CBC News. 30 November 2023. Retrieved 27 August 2024.
63. "Health minister puts nicotine pouches behind the counter, bans flavours". Canadian Press. 22 August 2024. Retrieved 27 August 2024 – via CTV News.
64. "Canada banning sales of flavoured nicotine pouches in convenience stores, gas stations". CBC News. 22 August 2024. Retrieved 27 August 2024.
65. Robichaud, Meagan O.; Seidenberg, Andrew B.; Byron, M. Justin (21 November 2019). "Tobacco companies introduce 'tobacco-free' nicotine pouches". Tobacco Control. 29 (e1): e145–e146. doi:10.1136/tobaccocontrol-2019-055321. PMC 7239723. PMID 31753961.
66. Robichaud, Meagan O.; Seidenberg, Andrew B.; Byron, M. Justin (21 November 2019). "Tobacco companies introduce 'tobacco-free' nicotine pouches". Tobacco Control. 29 (e1): e145–e146. doi:10.1136/tobaccocontrol-2019-055321. PMC 7239723. PMID 31753961.
67. Stanfill, Stephen; Tran, Hang; Tyx, Robert; Fernandez, Carolina; Zhu, Wanzhe; Marynak, Kristy; King, Brian; Valentín-Blasini, Liza; Blount, Benjamin C.; Watson, Clifford (18 August 2021). "Characterization of Total and Unprotonated (Free) Nicotine Content of Nicotine Pouch Products". Nicotine & Tobacco Research. 23 (9): 1590–1596. doi:10.1093/ntr/ntab030. ISSN 1469-994X. PMID 34233354.
68. "IARC Monographs on the Identification of Carcinogenic Hazards to Humans". International Agency for Research on Cancer. World Health Organization.
69. "Nicotine without smoke: Tobacco harm reduction". Royal College of Physicians.
70. "Nicotine without smoke: Tobacco harm reduction". Royal College of Physicians.
71. Mishra, Aseem; Chaturvedi, Pankaj; Datta, Sourav; Sinukumar, Snita; Joshi, Poonam; Garg, Apurva (2015). "Harmful effects of nicotine". Indian Journal of Medical and Paediatric Oncology. 36 (1): 24–31. doi:10.4103/0971-5851.151771. ISSN 0971-5851. PMC 4363846. PMID 25810571.
72. ^ Kabale, Nasibo (8 June 2019). "Lobby alleged the introduction of pouches could result in increased risk for cancer". Daily Nation. Archived from the original on 2 December 2019. Retrieved 24 November 2019.
73. "nicotine | Etymology of nicotine by etymonline". www.etymonline.com. Retrieved 15 July 2024.
74. Loewe, Walter (1999). Liten svensk historia om snus (Swedish).
75. Westerberg, Fredrik (10 March 2022). "Snus production". Svea Tobacco.
76. Jonson, Mats (2018). SNUS! The complete guide to brands, manufacturing, and art of enjoying smokeless tobacco. Racehorse. ISBN 978-1-63158-381-0.
77. Ulf, af Trolle (1965). Om tobak i Sverige. Svensk Tobaks AB.

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