Objective To review the implications of recommending smokeless tobacco (ST) use as a harm reduction approach for low-income and middle-income countries (LMICs). Method Narrative review of published papers and other data sources (including conference abstracts and internet-based information) on the health risks posed by the use of ST products for individual smokers and for the population with a focus on their implications for LMICs. Results Swedish snus has a relatively lower toxicity profile than ST products available in other markets, including older products used in the US and products used in Africa and Asia. The experience with snus in Sweden provides information on the effects of snus use in a population where cigarette smoking was already culturally ingrained. However, population effects are likely to be different in those LMICs where smoking is not yet the dominant culturally accepted form of tobacco use. The total effect may be negative in countries where locally-popular ST products have substantially higher disease risks than Swedish snus and where there is limited regulatory and tobacco use surveillance capacity. Conclusions Issues relating to how populations in LMICs respond to marketing efforts, the risks of the dual use of ST and smoking, and the capacity to regulate ST products need to be considered in making decisions about harm reduction strategies in LMICs. The public health effects of supporting ST as a harm reduction strategy may vary substantively in countries with different pre-existing tobacco use patterns.

Objectives:Smokeless tobacco (SLT) use is popular among black South African women and children. The study sought to determine the nicotine delivery capability of popular industrialised and traditional SLT brands in South Africa, and to provide information for policy action by regulatory authorities.Design:Laboratory chemical analysis of four industrialised and one traditional SLT products commercially available, using previously published analytical methods. Potential for dependence was inferred from nicotine delivery capabilities determined by the percentage free base nicotine.Measurements:Moisture, pH, total nicotine, and percentage free base nicotine.Results:Total nicotine content was between 6–16 mg/g. The pH varied between 7–10 and this correlated with percentage free base nicotine, which ranged between 10–99%. The nicotine delivery capability of the traditional product was lower than that of the industrialised products except for the recently introduced portion bag snus, which had comparable total nicotine but the lowest pH and percentage free base nicotine. The most popular SLT brands showed the highest percentage free base nicotine ever reported for any industrialised SLT or cigarette brands. Small cans contained higher nicotine than the large cans of the same brand tested. Findings from the study support a potential for limited “product graduation” by users.Conclusions:South African SLT users are mostly exposed to potentially very highly addictive levels of nicotine that may favour tobacco dependence and its consequent health risks. The increasing use of SLT by women of childbearing age support the need for intensified policy action to control its use.

Primary health care (PHC) settings offer opportunities for tobacco use screening and brief cessation advice, but data on such activities in South Africa are limited. The aim of this study was to determine the extent to which participants were screened for and advised against tobacco use during consultations.

Aim: This study examined the influence of the social context in which people live on self-ratings of their oral health. Method: This study involved a representative sample of 2,907 South African adults (≥16 years) who participated in the 2007 South African Social Attitude Survey (SASAS). We used the 2005 General Household Survey (n = 107,987 persons from 28,129 households) to obtain living environment characteristics of SASAS participants, including sources of water and energy, and household cell-phone ownership (a proxy measure for the social network available to them). Information obtained from SASAS included socio-demographic data, respondents’ level of trust in people, oral health behaviors and self-rated oral health. Results: Of the respondents, 76.3% self-rated their oral health as good. Social context influenced women’s self-rated oral health differently from that of men. Good self-rated oral health was significantly higher among non-smokers, employed respondents and women living in areas with higher household cell-phone ownership. Furthermore, trust and higher social position were associated with good self-rated oral health among men and women respectively. Overall, 55.1% and 18.3% of the variance in self-rated oral health were explained by factors operating at the individual and community levels respectively. Conclusion: The findings highlight the potential role of social capital in improving the population’s oral health.