Snus

Not to be confused with the dry (inhaled through the nose) form of tobacco, snuff.

"White portion" snus of the Swedish label General.

Snus ( /ˈsnuːs/; Swedish pronunciation: [snʉːs]), or Swedish snuff, is a moist powder tobacco product originated from a variant of dry snuff in the early 19th century in Sweden, consumed by placing it under the lip for extended periods of time. The precursor of snus, the dry form of snuff inhaled through the nose, was introduced in Europe much earlier. Snus is a form of snuff that is used in a manner similar to American dipping tobacco, but typically does not result in the need for spitting. Snus is also unique in that it is steam-pasteurized rather than fire-cured, is not fermented and contains no added sugar. The sale of snus is illegal in the European Union,^[1][2] but due to exemptions, it is still manufactured and consumed primarily in Norway and Sweden. Its popularity is growing in the United States as an alternative to smoking and traditional "chewing" tobacco. In Sweden, snus is often used to quit smoking, which has led to a significant decrease in the prevalence of smoking among men. In fact, Sweden has the lowest male smoking rate in the European Union. Females in Sweden, who are less likely to use snus, have similar smoking rates to neighboring countries^{[citation needed]}.

Previously, Swedish snus was only available by mail order within the United States; however, an increasing number of tobacco retailers have begun to stock popular Swedish snus products. R. J. Reynolds Tobacco Company, Philip Morris USA, and U.S. Smokeless Tobacco Company now produce similar products called Camel Snus, Marlboro Snus, and Skoal Snus, respectively. While it's packaged in much the same way (moist tobacco in a small pouch), production methods vary considerably from traditional Scandinavian methods. Additionally, differences in the way American snus is formulated may also diminish some of the possible benefits.^[3] Swedish Match, the leading manufacturer of Swedish snus, is currently test-marketing snus in Canada, Russia and several regions throughout the United States.

History

"Ashtray" lid found on many snus tins, which snaps in and out of place. The small compartment is typically used for the temporary storage of used snus.

In the 16th century snuff (pulverized tobacco), the precursor of snus (moist snuff), was introduced to France by Jean Nicot, who worked at the court of King Henry II of France. He recommended snuff to Catherine de' Medici as a migraine remedy. As she became a regular user of snuff it became a fashion amongst the court and upper class citizens of France.

This trend of inhaling snuff through the nose also spread to Sweden at the beginning of the 17th century. Later in the 19th century Swedish producers began to manufacture local brands of moist snuff placed under the upper lip which did not require spitting, and became known as snus. As of today, Ettan, registered since 1822, remains the oldest snus still sold.

A wide-spread urban legend holds that snus and other forms of smokeless tobacco contain fragments or particles of glass as an aid to absorbing nicotine into the user's blood.^{[citation needed]} However, mucous membranes readily absorb free-nicotine; the key to absorbing nicotine is having it in an unprotonated form in which it is freely available. Thus, the prick or burning sensation in the palate is a result of food additives, such as table salt, and/or sodium carbonate (E500); a food additive which is used to increase the pH of the tobacco, and the bioavailability of the nicotine, thereby decreasing the amount of time for nicotine to enter the bloodstream. The burning sensation occurs, often because the tobacco is much higher in pH than the mouth and saliva. The greater the difference in pH between the user's mouth and the snus, the more vigorously the tissues respond to the more alkaline snus, precipitating an exothermic acid-base reaction, in a manner similar to pouring hydrogen-peroxide on a wound, or baking soda into vinegar and observing the fizzing. This causes inflammation of the tissues, and sometimes can be perceived by the user as painful.

Confusion of snus and snuff

Confusingly, the English word snuff is translated to snus in Swedish and the word snuff is, often incorrectly and outside Sweden, used to refer to both the inhaled form and the placed under the lip form of snus/snuff.

However, snuff intended to be inhaled through the nose is referred to as torrsnus (dry snus) or more correctly as luktsnus (smelling-snus) in Swedish. The moist form of snuff placed under the upper lip is just called snus in Swedish, and the correct word for referring to this form would be snus in English as well.

Moreover, what may add to the confusion is that the word snuff may also refer to dipping tobacco (also known as moist snuff which may confuse even more), which is applied to the lower lip and the gums rather than inhaled or placed under the upper lip. Thus all three forms are different products.

Difference between dip, chew, snuff and snus

See also: Smokeless tobacco

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

• Snus (Scandinavian), a moist Scandinavian form of snuff which is placed under the upper lip which does not result in the need for spitting.
• Snus (American), similar to Scandinavian form of snus. Most American Snus generally have a lower moisture content and lower pH, resulting in lower bioavailability of nicotine than Swedish varieties ^[3]
• Chewing tobacco, tobacco furnished as long strands which is placed between the cheek and gum or teeth.
• Nasal snuff (luktsnus in Swedish and luktesnus in Norwegian), a dry form of snuff which is insufflated or "snuffed" through the nose.
• Dipping tobacco (also known as dip, spit tobacco or confusingly even moist snuff), a moist and American form of traditional snuff which is placed between the lower lip and the gums and often causes excess saliva while dipping.

Types

Cylindrical shaped (fingertips) pris of Swedish brand Skruf.

Left is an original (or "regular") portion. Right is a "white portion". White portions can be any color, as the name refers to the style, not the color.

There are many types of snus on the market:

• Loose snus is a moist powder which can be portioned and packed into a cylindrical or spherical shape with the fingertips or a purpose-made cylindrical device. The end result is often referred to as a pris (pinch), buga, prilla, or prell (slang). As well, some users (usually long time users) simply pinch the tobacco and place it in their upper lip (farmer's pinch or læmpert).
• Portion snus is prepackaged moist powder in small teabag-like sachets. It comes in smaller quantities than the loose powder but is considered more convenient and discreet than loose snus. Moreover, there are two variants of Portion snus:
  • Original Portion, introduced in 1977, is the traditional form of portion snus. The sachet material is moisturized during the manufacturing process, resulting in a brown, moist pouch.
  • White Portion is a milder-tasting and slightly slower release form of portion snus. The sachet material is not moisturized during the manufacturing process, 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 somewhat slower in delivery due to the drier sachet. "White portion" refers to the style, not the color, as many white portion snus use a black material instead of white, yet are "white portion". Examples include General Onyx and Grovsnus Svart (black).

Portioned snus is available in three different sizes: mini, normal/large (most common) and maxi. The weights may vary, but most snus labels share their weight. Mini portions typically weigh close to 0.5g, normal (large) portions weigh around 1g, and Maxi portions weigh up to 1.7g, depending on brand. Some brands also offer the choice of "regular" and "long" versions of the normal size sachet, which are similar in content weight. These long portions differ from traditional sachets by being slimmer but longer, to fit against the gums more comfortably.

The nicotine content of snus varies between brands, with the most common strength being 8mg of nicotine per gram of tobacco. In recent years, snus manufacturers have released stark (strong or sterk) and extra stark (extra strong or extra sterk) varieties with greater nicotine content. Stark varieties contain, on average, 11 mg of nicotine per gram of tobacco, while Extra Stark varieties may contain up to 22mg of nicotine per gram of tobacco.

Contents

Swedish snus is made from air dried tobacco from various parts of the world. In earlier times tobacco for making snus used to be laid out for drying in Scania and Mälardalen. Later Kentucky tobaccos were used. The ground tobacco is mixed with water, salt, and an alkylizing agent (today this is) sodium carbonate and aroma and is prepared through heating. 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. 12% (1.1 million people) of the population in Sweden use snus [2]. Unlike dipping tobacco and chew, most snus today does not undergo the fermentation process, but is instead steam-pasteurized. Although steam-pasteurization is remarkably complex, it has the advantages of inhibiting the formation of bacteria that facilitate the growth of tobacco-specific nitrosamines (TSNAs) while preserving the desired texture and mouthfeel of the snus.

Snus is sold mainly in Sweden and Norway, and has more recently been introduced to South Africa and the United States. It can be found in various places frequented by Scandinavian tourists like Murmansk in Russia (with the notable exception of countries in the EU; see below). It is sold in small tins, which in the earlier years were made of porcelain, wood, silver or gold. At the time of writing, portioned snus usually comes in plastic tins of 24 portions, containing about a gram of snus each, while loose snus is mostly sold in compressed paper tins with plastic lids, at 45g (50g before 2008). Mini-portion and medium-portion snus is an increasingly popular format of snus. Most of these products come in tins containing 20 portions, of either .65 or .5 grams each for a total of just under 13 or 10 grams of snus, particularly with those for whom concealing their use of smokeless tobacco in places is of utmost importance.

Despite weight, the price of both 10g, 13g, 24g, and 45g tins is approximately -5 in Sweden and -10 in Norway as Norwegian consumption taxes are considerably higher. Prices in the US vary per tin, depending on brand and source. Local or state taxes may also add considerably to this price, and vary widely across states.

Health consequences

Warning label on a container of Swedish snus. The text reads: "This tobacco product may damage your health and is addictive". Note the expiration date and list of ingredients, which is required by Swedish law.

Since snus is not intended nor recommended for inhalation, it does not affect the lungs as cigarettes do. Because it is steam-cured, rather than fire-cured like smoking tobacco or other chewing tobacco, it contains lower concentrations of nitrosamines and other carcinogens that form from the partially anaerobic heating of proteins; 2.8 parts per mil for Ettan brand compared to as high as 127.9 parts per mil in some American brands, according to a study by the Commonwealth of Massachusetts Department of Health.^[4] The World Health Organization (WHO) acknowledges that Swedish men have the lowest rate of lung cancer in Europe, partly due to the low tobacco smoking rate, but does not argue for substituting snus for smoking, citing that the effects of snus still remain unclear. Around 2005 several reports, partially funded by the snus industry, pointed to the fact that no carcinogenic effects could be attributed to Nordic snus and this resulted in the removal of the warning label that claimed snus could cause cancer. It was replaced with the more vague label "May affect your health negatively". Research is still going on but at the moment no conclusive reports have been made regarding the health effects of snus.

Many cardiologists believe that nicotine products (oral) contribute to the potentiation of sympathetic nerve tone, and may aggravate hypertension due to the effects of nicotine on cholinergic and dopaminergic neurotransmission. At higher doses, tachycardia and reflex bradycardia can also occur, trigerring serious arrythmias or even cardiac arrest in sensitive individuals. Further studies are needed in this regard.

The European Union banned the sale of snus in 1992, after a 1985 WHO study concluded that "oral use of snuffs of the types used in North America and western Europe is carcinogenic to humans", but a WHO committee on tobacco has also acknowledged that evidence is inconclusive regarding health consequences for snus consumers.[3]. Only Sweden and EFTA-member Norway are exempt from this ban. A popular movement during the run-up to the 1994 referendum for Sweden's EU membership made exemption from the EU sale ban of snus a condition of the membership treaty.

Recent actions by many European governments to limit the use of cigarettes has led to calls to lift the ban on snus, as it is generally considered to be less harmful than cigarette smoke, both to the user^[5] and to others.

Debate among public health researchers

There is some debate among public health researchers over the use of "safer" tobacco or nicotine delivery systems, generally dividing along two lines of thought. A minority (primarily in the European Union and Canada) believes in "harm reduction," where the belief is generally that, while it should remain a goal to reduce addiction to nicotine in the population as a whole, the reduction of harm to the health of those who choose to use nicotine should override the need to reduce overall nicotine addiction. For example, some research [4] available today shows that snus use reduces or eliminates the risk of cancers associated with the use of other tobacco products such as "chewing tobacco" (the type primarily used in the United States and Canada, created in a process similar to cigarette tobacco) and cigarettes. It is hypothesized that the widespread use of snus by Swedish men (estimated at 30% of Swedish male ex-smokers), displacing tobacco smoking and other varieties of snuff, is responsible for the incidence of tobacco-related mortality in men being significantly lower in Sweden than any other European country; in contrast, since women traditionally are less likely to use snus, their rate of tobacco-related deaths in Sweden can be compared to that of other European countries.

Snus may be less harmful than other tobacco products; according to Kenneth Warner, director of the University of Michigan Tobacco Research Network,

"The Swedish government has studied this stuff to death, and to date, there is no compelling evidence that it has any adverse health consequences. ... Whatever they eventually find out, it is dramatically less dangerous than smoking." [5]

Ongoing discussion and debates among primary scientific researchers of the effects of snus use on life expectancy appears to indicate that there is a significant increase in life expectancy among persons who previously smoked tobacco and switch to snus, depending on the age of the persons who switch, even when it is assumed that 100% of the risk of cardiovascular diseases among smokers transfers to snus users.^[6] It is also noted, in the correspondence seen in the previous citation^[7][8] that concerns about the effect of marketing by the tobacco industry, as influenced by the results of these scientific studies, is of primary concern to many researchers in the field, including the risk of emboldening the industry to attempt to increase snus sales among young people and promote dual-use of snus and smoked tobacco, and that the use of medical nicotine, rather than snus, can better target at-risk populations, given better access and pricing. However, a growing consensus among researchers of smoking cessation have found NRT products to be minimally effective because tobacco users are often seeking the combination of MAO inhibitors (which are found in tobacco)and nicotine. MAO inhibitors in tobacco act to amplify the rewarding effects of nicotine, but may also act as a form of self-medication for people with depression. This would explain the association between mental illness and smoking, the minimal efficacy of NRT and the findings from numerous studies that smokers will choose a denicotinized cigarette over a dose of nicotine. These denicotinized cigarettes can also reduce subjective measures of craving in abstinent smokers.

Opponents of snus sales maintain that, nevertheless, even the low nitrosamine levels in snus cannot be completely risk free, but snus proponents point out that inasmuch as snus is used as a substitute for smoking or a means to quit smoking, the net overall effect is positive, similar to the effect of nicotine patches.^[9]

In addition, this eliminates any exposure to second-hand smoke, further reducing possible harm to other non-tobacco users. This is seen by public health advocates who believe in "harm reduction" as a reason for recommending snus as well as other nicotine replacement therapies rather than continued use of cancer-causing nicotine delivery systems.

This does not, however, eliminate any harm to health caused by the nicotine itself. Current research focuses on possible long-term side effects of nicotine on blood pressure, hypertension and possible risk of pancreatic cancer due to tobacco-specific nitrosamines (TSNAs). TSNAs are the only component of tobacco shown to induce pancreatic cancer in laboratory animals.^[10] Nicotine may also exacerbate pancreatic illness, because nicotine stimulates the gastrointestinal tract's production of cholecystokinin, which stimulates pancreatic growth and may be implicated in pancreatic cancer. Thus far the evidence specifically implicating snus in pancreatic cancer is only suggestive.^[11][12] It should also be noted that the probability of developing pancreatic cancer from cigarettes is higher than the suggested chance of developing pancreatic cancer from snus.^[13][14]

The effects of Swedish snus on blood pressure has been studied at Umeå University in a randomly selected population sample of 4,305 Swedish men between 25 and 74 years of age. In the study, published in November 2008, the researchers found no elevation of blood pressure in snus users who had never been smokers compared to non tobacco users. In fact, snus users had lower systolic blood pressure than non tobacco users in the unadjusted data.^[15]

References

1. ^ Gray N (September 17–23, 2005). "Mixed feelings on snus". Lancet 366 (9490): 966–7. doi:10.1016/S0140-6736(05)67352-7. PMID 16168760. 
2. ^ Directive 2001/37/EC of the European Parliament and of the Council of 5 June 2001 on the approximation of the laws, regulations and administrative provisions of the Member States concerning the manufacture, presentation and sale of tobacco products & Commission statement
3. ^ ^{a b} [1] Jonathan Foulds, Helena Furburg "Is low-nicotine Marlboro snus really snus?" Harm Reduct J. 2008; 5: 9. Published online 2008 February 27. doi: 10.1186/1477-7517-5-9.
4. ^ Gregory N. Connolly, and Howard Saxner (August 21, 2001). Informational Update Research on Tobacco Specific Nitrosamines (TSNAs) in Oral Snuff and a Request to Tobacco Manufacturers to Voluntarily Set Tolerance Limits For TSNAs in Oral Snuff. http://smallbusiness.findlaw.com/finances-taxes/news/hdocs/docs/tobacco/masnuffsstudy.pdf. 
5. ^ David T. Levy, Elizabeth A. Mumford, K. Michael Cummings, Elizabeth A. Gilpin, Gary Giovino, Andrew Hyland, David Sweanor and Kenneth E. Warner (December 2004). "The Relative Risks of a Low-Nitrosamine Smokeless Tobacco Product Compared with Smoking Cigarettes: Estimates of a Panel of Experts". Cancer Epidemiology Biomarkers & Prevention 13 (12): 2035–2042. PMID 15598758. http://cebp.aacrjournals.org/cgi/content/full/13/12/2035. 
6. ^ Gartner CE, Hall WD, Vos T, Bertram MY, Wallace AL, Lim SS (June 2007). "Assessment of Swedish snus for tobacco harm reduction: an epidemiological modelling study". Lancet 369 (9578): 2010–4. doi:10.1016/S0140-6736(07)60677-1. PMID 17498798. 
7. ^ McKee M, Gilmore A (October 2007). "Swedish snus for tobacco harm reduction". Lancet 370 (9594): 1206; author reply 1206–7. doi:10.1016/S0140-6736(07)61530-X. PMID 17920913. http://www.thelancet.com/journals/lancet/article/PIIS014067360761530X/fulltext. 
8. ^ Lambe M (October 2007). "Swedish snus for tobacco harm reduction". Lancet 370 (9594): 1206; author reply 1206–7. doi:10.1016/S0140-6736(07)61531-1. PMID 17920911. http://www.thelancet.com/journals/lancet/article/PIIS0140673607615311/fulltext. 
9. ^ Furberg, H. Lichtenstein, P. Pedersen, N. L. Bulik, C. M. Lerman, C. and Sullivan, P. F. (September 2008). "Snus use and other correlates of smoking cessation in the Swedish Twin Registry". Psychological Medicine 38 (9): 1299–1308. doi:10.1017/S0033291707002346. PMC 2914546. PMID 18680625. http://pt.wkhealth.com/pt/re/pgme/abstract.00006826-200809000-00010.htm. 
10. ^ Rivenson A, Hoffmann D, Prokopczyk B, Amin S, Hecht SS (1 December 1988). "Induction of lung and exocrine pancreas tumors in F344 rats by tobacco-specific and Areca-derived N-nitrosamines". Cancer Res. 48 (23): 6912–7. PMID 3180100. http://cancerres.aacrjournals.org/cgi/pmidlookup?view=long&pmid=3180100. 
11. ^ Smokeless Tobacco, Swedish Snus, and Pancreatic Cancer
12. ^ Luo J, Ye W, Zendehdel K, et al (June 2007). "Oral use of Swedish moist snuff (snus) and risk for cancer of the mouth, lung, and pancreas in male construction workers: a retrospective cohort study". Lancet 369 (9578): 2015–20. doi:10.1016/S0140-6736(07)60678-3. PMID 17498797. 
13. ^ "Use Of Swedish 'Snus' Is Linked To A Doubled Risk Of Pancreatic Cancer". Science Daily. May 11, 2007. http://www.sciencedaily.com/releases/2007/05/070510095314.htm. 
14. ^ "Swedish Snus Much Safer Than Smoking But Linked To Pancreatic Cancer". Medical News Today. 10 May 2007. http://www.medicalnewstoday.com/articles/70389.php+. 
15. ^ "Snus och blodtryck". Läkartidningen. 2008-11-21. http://www.lakartidningen.se/07engine.php?articleId=1081. 

Further reading

A number of peer-reviewed studies of snus use have been published:

• Effect of smokeless tobacco (snus) on smoking and public health in Sweden, October, 2003 (full text)
• Broadstock M. Systematic review of the health effects of modified smokeless tobacco products, N Zealand Health Technol Assessment Rep, February 2007 (full text)

Cardiovascular diseases

• Hergens MP, Ahlbom A, Andersson T, Pershagen G (January 2005). "Swedish moist snuff and myocardial infarction among men". Epidemiology 16 (1): 12–6. doi:10.1097/01.ede.0000147108.92895.ba. PMID 15613940. http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=1044-3983&volume=16&issue=1&spage=12. 
• Broadstock M. Systematic review of the health effects of modified smokeless tobacco products, N Zealand Health Technol Assessment Rep, February 2007, p37-56 (full text)

Diabetes

• Eliasson M, Asplund K, Nasic S, Rodu B (August 2004). "Influence of smoking and snus on the prevalence and incidence of type 2 diabetes amongst men: the northern Sweden MONICA study". J. Intern. Med. 256 (2): 101–10. doi:10.1111/j.1365-2796.2004.01344.x. PMID 15257722. 

Cancer

• Juhua Luo MSc, Weimin Ye MD, Kazem Zendehdel MD, Johanna Adami MD, Prof Hans-Olov Adami MD, Prof Paolo Boffetta MD and Prof Olof Nyrén MD Oral use of Swedish moist snuff (snus) and risk for cancer of the mouth, lung, and pancreas in male construction workers: a retrospective cohort study The Lancet, Volume 369, Issue 9578, Pages 2015-2020 (abstract - full text by subscription only)
• Roosaar A, Johansson AL, Sandborgh-Englund G, Axéll T, Nyrén O (July 2008). "Cancer and mortality among users and nonusers of snus". Int. J. Cancer 123 (1): 168–73. doi:10.1002/ijc.23469. PMID 18412245. 

Smoking cessation

• Gilljam H, Galanti MR (September 2003). "Role of snus (oral moist snuff ) in smoking cessation and smoking reduction in Sweden". Addiction 98 (9): 1183–9. doi:10.1046/j.1360-0443.2003.00379.x. PMID 12930201. http://www3.interscience.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=0965-2140&date=2003&volume=98&issue=9&spage=1183. 
• Rodu B, Godshall WT (December 2006). "Tobacco harm reduction: an alternative cessation strategy for inveterate smokers". Harm Reduct J 3: 37. doi:10.1186/1477-7517-3-37. PMC 1779270. PMID 17184539. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=1779270. 

Medical community discussions and reports

• Kjell Asplund. Snuffing, Smoking and the risk for heart disease and other vascular diseases. 3rd revised version. ASH Britain; 2002 (full text)
• The 3rd (2002) International Conference on Smokeless Tobacco - Daily Media Summaries from the U.S. National Cancer Institute
• Discussion of Declining smoking in Sweden: is Swedish Match getting the credit for Swedish tobacco control’s efforts?; Tobacco control (BMJ). 2003.
• Some practical points on harm reduction: what to tell your lawmaker and what to tell your brother about Swedish snus, Tobacco Control Online, December, 2003

External links

Articles

• "Use of Swedish 'snus' is linked to a doubled risk of pancreatic cancer". EurekAlert. May 11, 2007. http://www.eurekalert.org/pub_releases/2007-05/ki-uos051007.php. 
• "Use Of Swedish 'Snus' Is Linked To A Doubled Risk Of Pancreatic Cancer", Science Daily, May 11, 2007
• Snus - a safer option for smokers Slate, July 10, 2007
• Dr. Gunilla Bolinder talked about snus (video, in Swedish)
• The Snus Experience - Lessons from Norway Sweden and Canada on the public health consequences of widespread oral tobacco use (PDF) Physicians for a Smoke-Free Canada, October, 2007 - PSC's response to claims made by Imperial Tobacco Canada that snus is linked to reduction of smoking rates and tobacco-related deaths using statistics from snus and non-snus countries
• A Smokeless Alternative To Quitting (Unabridged Version), The New York Times, April 6, 2004
• Should Snuff Be Used as a Tool To Quit Smoking?, The Wall Street Journal, September 16, 2006; Page A1.
• Doctors: Swedish snus cut risk of cancer, Associated Press via USA Today, May 10, 2007
• Swedish Smokeless Tobacco Aims at U.S. Market New York Times, October 3, 2007
• Doctors call for new nicotine products Reuters (UK) Oct 5, 2007 12:48pm BST
• Going Smokeless, 60 Minutes, April 4, 2010 5:00 PM

Non-medical blogs and commentary

• Tobacco Truth blog - science and policy information about tobacco harm reduction, by university-based expert
• Snubie.com -A complete snus news, reviews, and information site with a compilation of snus related health articles.
• SnusAuthority.com -A blog with information and reviews on snus and snuff. Also has articles about health effects, getting started guides, deals, and more.
• Snus forum & discussion database, more than 7000 snus related topics