Interventions for smokeless tobacco use cessation

  • Review
  • Intervention


  • JO Ebbert,

  • LC Rowland,

  • V Montori,

  • KS Vickers,

  • PC Erwin,

  • LC Dale,

  • LF Stead

Jon Ebbert, Department of Internal Medicine, Mayo Clinic College of Medicine, 200 1st Street Southwest, Rochester, MN, 55905, USA.



Use of smokeless tobacco (ST) can lead to nicotine addiction and health problems including periodontal disease and oral cancer


To assess the effects of behavioural and pharmacotherapeutic interventions to treat ST use.

Search strategy

We searched the Cochrane Tobacco Addiction Group trials register (February 2004), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 1, 2004), MEDLINE (January 1966-February 2004), EMBASE (1988-January 2004), CINAHL (1982-February 2004), PsycINFO (1984-February 2004), Database of Abstract of Reviews of Effectiveness (DARE, The Cochrane Library, Issue 1, 2004).

Selection criteria

Randomized trials of behavioural or pharmacological interventions to help users of ST to quit, with follow-up of at least six months.

Data collection and analysis

Two authors independently extracted data.

Main results

One trial of bupropion did not detect a benefit of treatment after six months (Odds Ratio (OR) 1.00, 95% Confidence Interval (CI): 0.23 to 4.37). Three trials of nicotine patch did not detect a benefit (OR 1.16, 95% CI: 0.88 to1.54), nor did two trials of nicotine gum (OR 0.98, 95% CI: 0.59 to1.63). There was statistical heterogeneity among the results of eight trials of behavioural interventions included in the meta-analysis. Three trials showed significant benefits of intervention. In a post-hoc analysis the trials of interventions which included an oral examination and feedback about ST-induced mucosal changes had homogeneous results and when pooled showed a significant benefit (OR 2.41 95% CI: 1.79 to 3.24).

Authors' conclusions

Behavioural interventions should be used to help ST users to quit. Pharmacotherapies have not been shown to affect long-term abstinence but larger trials are needed.

Plain language summary

Plain language summary

Behavioural treatments may help people to stop using smokeless tobacco (ST).

Smokeless tobacco includes ground tobacco (snuff, snus) and chewing tobacco. Nicotine replacement therapy (patches or gum), and bupropion have not been shown to help people to stop using ST. Dentists and hygienists may help their patients to stop, especially when they show them the damage that ST causes in their mouths. Advice, support and counselling may also be helpful, though the evidence on this is less clear. More and larger studies are needed.