Inside a waterfront factory soaked with the acrid smell of tobacco, about half the blue-clad workers show an odd facial deformity: Their upper lips look swollen.
It’s a telltale sign they are sampling some of the 20 tons of smokeless tobacco being produced here daily.
Snus (pronounced snoos) -- a Scandinavian form of moist snuff -- has been banned elsewhere in the European Union for more than a decade, but its popularity has rebounded strongly in its country of origin, where one of every nine Swedes uses it.
And the top snus maker, Swedish Match, now is targeting world markets with claims that its blend of tobacco, water, salt and flavoring is a safer alternative to smoking.
“We don’t claim that snus is a completely problem-free product,” Stefan Gelkner, a Swedish Match executive, says while squeezing a pouch of prepackaged snuff under his upper lip. “But we refer to the scientific studies conducted that haven’t found any link between snus and cancer.”
After falling out of style in the 1970s, the traditionally male, working-class habit has spread into virtually every sector of Swedish society, male and female. Grimy, used snus packets litter the otherwise clean streets and subway stations of Stockholm.
Meanwhile, the smoking rate has fallen below 20% in the Scandinavian country of 9 million people -- the lowest in the world.
Unlike American snuff, which is placed in the lower part of the mouth, causing users to salivate and spit, a Swedish snus portion, or “prilla,” is savored on the gum above the front teeth. Many users opt for snus in thumbnail-sized paper pouches, to prevent the tobacco from spreading around the mouth.
As protruding upper lips replace smoke rings in Swedish bars and offices, scientists are debating the ethics of replacing cigarettes with another tobacco product -- less harmful, perhaps, but just as addictive because of the nicotine it contains.
“I don’t think there’s any question that Sweden is a model for safer use of tobacco products,” said Dr. Brad Rodu, a smokeless tobacco advocate at the University of Alabama-Birmingham. “The only consequential risk of smokeless tobacco is mouth cancer, and historically that risk is extremely small.”
Rodu spent six months researching snus in northern Sweden and claims it’s a much safer alternative for smokers who can’t kick the nicotine habit. He noted several studies had failed to link snus to cancer, which Swedish Match attributes to its efforts to remove carcinogens during manufacturing.
But critics say there are other concerns. Apart from causing stained teeth and bad breath, snus raises the pulse and blood pressure. Some studies have linked it to increased risk of heart disease, diabetes and premature births.
“I’m not interested in whether it causes cancer,” said Dr. Gunilla Bolinder, chief physician at Karolinska Hospital in Stockholm. “I think it’s about quality of life. Snus is extremely addictive.”
First-time snus users often feel dizzy and nauseated. Some throw up. But those who get past that often find quitting is difficult.
“I’ve tried to stop several times, but it is awfully hard,” says Rikard Palm, a television news anchor at public service network SVT, whose smile reveals a lump of the black mash. “I use snus almost all the time.”
Other well-known users include Lars Lagerback, a national soccer team coach; Lars Engqvist, social affairs minister; and Ingvar Kamprad, founder of the furnishings giant Ikea.
According to the World Health Organization, Swedish men have the lowest rate of lung cancer in Europe, partly because of the low smoking rate. Nevertheless, WHO argues against substituting snus for smoking, saying the health effects of snus remain unclear.
The European Union banned the sale of snus in 1992, citing a 1985 WHO study that said “oral use of snuffs of the types used in North America and Western Europe is carcinogenic to humans.” A WHO committee on tobacco has acknowledged that evidence on Swedish snus is inconclusive.
Only Sweden is exempt from the European Union ban -- a concession considered key to Swedish voters when they approved membership in the bloc. Bumper stickers reading “EU -- not without my ‘prilla’ ” were a common sight leading up to the 1994 referendum.
Swedish Match is lobbying for an end to the EU ban and has two legal challenges before the European Court of Justice.
“It’s illogical and discriminating,” says Gelkner, head of the firm’s northern Europe division. “All other tobacco products are allowed, while snus, which is considered the least damaging to health, is prohibited.”
Swedish Match is exploring other markets with traditions of smokeless tobacco, including North America, South Africa and India. Export products are modified to local tastes: American snus is flavored with wintergreen oil.
The company’s factory in Owensboro, Ky., accounts for about 9% of the moist snuff sold in the United States.
At home, Swedish Match has a virtual monopoly. Its factory in Goteborg makes 212 million cans of snus yearly for Sweden and Norway, which is not a European Union member.