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Say So Long to Spit Tobacco

Dipping, chewing aren't safe alternatives to smoking, experts say

MONDAY, May 31, 2004 (HealthDayNews) -- Smokers have no doubt been barraged with warnings about the dangers of their bad habit, but those who use smokeless tobacco might also want to heed the health cautions.

"Smokeless tobacco is not without health risks," said Dr. John Spangler, a family medicine specialist at Wake Forest University who studies tobacco use. "Although it doesn't seem to cause cardiovascular disease or cancers to the same rate that cigarette smoking does, it definitely does cause them."

It seems a perfect time to stop, since May 31 has been designated World "No Tobacco" Day, when smokers will put away their cigarettes in a gesture to good health.

The American Cancer Society says people who use chewing tobacco and snuff face 50 times the risk of developing cancers in their cheeks and gums as those who don't chew. Every day, an estimated 24 Americans die of oral cancer -- nearly 8,800 a year -- according to the Oral Cancer Foundation.

The habit is also linked to cancer of the pancreas, kidneys, prostate and possibly the breast, Spangler said.

Chewing tobacco and snuff -- another form of the leaf that's put in the mouth -- should be a particular concern for America's youth. Nearly 10 percent of the nation's high school students (almost 16 percent of boys and 1.5 percent of girls) say they've used smokeless tobacco in the past month, according to the U.S. Centers for Disease Control and Prevention.

One misconception about spit tobacco is that it's chemically more benign than tobacco that's smoked. Untrue, Spangler said. Both products contain the same litany of cancer-causing chemicals, especially tobacco-specific nitrosamines (TSNAs). However, smokeless tobacco users ingest far greater concentrations of these TSNAs than do smokers, 10 times more, on average, according to the Oral Cancer Foundation.

Less serious but by no means pleasant, smokeless tobacco use is associated with cosmetic problems such as chronic bad breath, stained teeth and gum and tissue disease.

One "dip" of spit tobacco is said to contain 10 times the nicotine jolt of a cigarette, and that sends the heart racing, constricts blood vessels, kicks up blood pressure and strains the heart, Spangler said. It also makes spit tobacco more addictive than cigarettes, and therefore potentially more difficult to give up, he added.

Difficult, but not impossible. Herbert Severson is a researcher who studies spit tobacco cessation programs. He and his colleagues at the Oregon Research Institute are launching an online program to help people quit chewing.

Like other chewing tobacco cessation efforts, resembles smoking cessation plans in several respects, but it's not identical.

"There are subtle differences," Severson explained. "The kind of withdrawal symptoms people experience with chewing tobacco are a little different." While smokers may become depressed when they quit, chewers are more likely to become agitated and angry and to see their ability to concentrate suffer.

Oral substitutes, such as nicotine gum, are quite important for chewers, and use patterns are different, Severson said. That last point is key, he added, because chewing tobacco often takes on a more central part of a person's life. Ironically, users -- almost always men -- may work at smoke-free companies that have indirectly encouraged employees to go smokeless, Severson said.

Chewing tobacco also provides background activity for typically male pursuits -- hunting, fishing and baseball -- when smoking isn't necessarily possible. "You can use it in a lot of situations where you can't smoke," Severson said., which has received funding from the National Cancer Institute, offers tips for successful cessation. It also provides information on a "blending program" that reduces nicotine exposure by mixing tobacco with nicotine-free plants such as mint snuff or herbal alternatives.

Perhaps the most effective component, Severson said, is encouraging men to take a look at the damage chewing tobacco is doing to their mouth. "It's really quite motivational" to see the lesions that form where the tobacco sits against the gums, he said. Seven in 10 regular users develop these sores; 3 percent to 4 percent of those sores become tumors. Having mouth damage "is directly related to the length of time a man has chewed and the weekly amount," Severson said.

More information

For more on the harms of chewing tobacco, try the Oral Cancer Foundation.

SOURCES: John Spangler, M.D., associate professor, family and community medicine, Wake Forest University Baptist Medical Center, Winston-Salem, N.C.; Herbert Severson, Ph.D., senior research scientist, Oregon Research Institute, Eugene; photo courtesy of National Institutes of Health
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