Comparison of the Health Effects Associated with the Use of Snus and Tobacco-Free Oral Nicotine Pouches: A Systematic Review

Abstract This work attempts to summarize current knowledge about the health effects associated with the use of snus and TF-ONPs. The literature search was performed in July 2026 in Pub Med, EMBASE, Scopus and the Cochrane Database of Systematic Reviews. There was an increase in blood pressure, heart rate and presence of oral mucosal changes among snus and TF-ONPs users. Switching to such products helped to reduce the number of cigarettes smoked per day, urges to smoking and increased the odds of quitting. Using snus was associated with an increased risk of asthma, atrial fibrillation, hypertension, heart failure, stroke, diabetes type 2 and metabolic disorder. There was a weak association between using snus and schizophrenia and non-affective disorders and an increased risk of pancreatic and rectal cancer among snus users. Finally, maternal snus usage increased the risk of pregnancy complications, intellectual disability or giving birth to a newborn small for gestational age of offsprings and asthma in preschool age. Current literature confirmed negative health consequences associated with regular use of snus. However, the findings are based on the studies performed mostly on male participants living in Scandinavia. Moreover, there is currently too little data to clearly determine the health effects of using TF-ONPs. Therefore, long-term randomized controlled trials involving individuals (males and females) exclusively using TF-ONPs, as well as snus (from different manufacturers and composition) should be performed in the future. Trial registration : The study protocol of this systematic review was registered in International Prospective Register of Systematic Reviews (PROSPERO) with registration number CRD420251062250.