Men who switch from cigarettes to spit tobacco aren't getting the same benefits as they would if they quit, new research from the American Cancer Society shows.

Men who gave up cigarettes for chewing tobacco or snuff still had higher death rates from lung cancer, heart disease, and stroke than men who quit smoking without taking up another form of tobacco. They also had higher death rates from these tobacco-related illnesses than men who never smoked.

The study, published in the latest issue of Tobacco Control, is the first to compare men who quit smoking with those who switched from smoking to spit tobacco. It shows that switching to spit tobacco isn't a good alternative to quitting smoking.

And it's not a good first step on the way to quitting, either.

"Any smoker who is trying to quit should use proven methods such as nicotine replacement, antidepressants, and behavioral counseling rather than other tobacco products if they do not succeed in quitting without assistance," says Michael Thun, MD, vice president of epidemiology and surveillance research at ACS and the study's senior author.

Smokers should be given proven cessation products at low cost, say Thun and his coauthors.

The study looked at more than 116,000 men who were taking part in the Cancer Prevention Study II, a large ACS study of lifestyle and cancer. Of those, 4,443 switched from cigarettes to spit tobacco, while the rest quit smoking without using another type of tobacco.

Thun and his colleagues compared causes of death between men in the two groups, while controlling for factors like diet, weight, occupation, and how long and how much the men had smoked.

"Smokers who switched to snuff or chewing tobacco had considerably worse health outcomes than those who quit entirely," Thun says.

The study was not designed to determine whether spit tobacco causes death from these diseases, Thun and his colleagues note. But it does suggest that spit tobacco may be more harmful than many people realize. This form of tobacco is known to raise the risk of cancer of the mouth and pharynx, as well as cause mouth sores, receding gums, and bone loss around the teeth.

Citation: "Tobacco-related disease mortality among men who switched from cigarettes to spit tobacco." Published in the Feb. 2007, Tobacco Control (Vol. 16, No. 1: 22-28). First author: S. Jane Henley, American Cancer Society.