year; this represents 0.5 percent of people who had not previously used smokeless tobacco. In 2016 about 2 of every 100 middle school students in the US (2.2%) reported current use of smokeless tobacco. In 2016 nearly 6 of every 100 high school students in the US (5.8%) reported current use of smokeless tobacco. Health effects Positions of medical organizations , the World Health Organization states that "Smokeless tobacco use is a significant part of the overall world tobacco problem." , the American Cancer Society states that "Using any kind of spit or smokeless tobacco is a major health risk. It's less lethal than smoking tobacco, but less lethal is a far cry from safe." , the National Cancer Institute states that "because all tobacco products are harmful and cause cancer, the use of all of these products should be strongly discouraged. There is no safe level of tobacco use. People who use any type of tobacco product should be urged to quit". A panel of experts convened by the National Institutes of Health (NIH) in 2006 stated that the "range of risks, including nicotine addiction, from smokeless tobacco products may vary extensively because of differing levels of nicotine, carcinogens, and other toxins in different products". According to a 2002 report by the Royal College of Physicians, "As a way of using nicotine, the consumption of non-combustible tobacco is of the order of 10–1,000 times less hazardous than smoking, depending on the product". As long ago as 1986, the advisory committee to the Surgeon General concluded that the use of smokeless tobacco "is not a safe substitute for smoking cigarettes. It can cause cancer and a number of noncancerous oral conditions and can lead to nicotine addiction and dependence". Smoking cessation Quitting smokeless tobacco use is as challenging as smoking cessation. There is no scientific evidence that using smokeless tobacco can help a person quit smoking. Harm reduction , the World Health Organization states that "There is no evidence to recommend that any smokeless tobacco product should be used as part of a harm reduction strategy." Tobacco companies that sell smokeless tobacco products promote them as harm reduction products and a less harmful substitute to cigarettes. Safety Smokeless tobacco products vary extensively worldwide in both form and health hazards, with some evidently toxic forms such as from South Asia, and some forms with less hazards such as snus from Sweden.