Chew on This: The Real Dangers of Smokeless Tobacco

Whether tucked in a burly athlete's cheek or daintily positioned in a gentleman's lip, smokeless tobacco has long been a public bane.
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Whether tucked in a burly athlete's cheek or daintily positioned in a gentleman's lip, smokeless tobacco has long been a public bane. So here's a cheer for Commissioner Bud Selig's timely proposal to ban pro baseball players from chewing tobacco in Major League games -- and, while we're at it, let's go ahead and see that the chaw, snuff and other smokeless tobacco products disappear from use.

Though minor league parks banned the chaw back in 1993, it has taken a sudden upswing in popularity among young men, after declining in the years 2000-2003. The Centers for Disease Control reported that in 2009, 15 percent of U.S. high school boys used smokeless tobacco, which represents a 36 percent increase from 2003. Its use was highest among those 18 to 24 years old and those with a high school education or less. A survey by Monitoring the Future, which is an on-going study of America's young adults funded by the National Institutes of Health, also detected greater abuse among the young: from 2006 to 2010, the number of high school seniors ingesting tobacco increased 39.3 percent (to 8.5 percent from 6.1 percent), and among high school sophomores, there was a 53 percent increase in use from 2004 to 2010 (to 7.5 percent from 4.9 percent).

Californian adults tend to use tobacco less than those in other states. We rank second to lowest (behind Washington) for percentage of cigarette smokers in the population and are among the bottom three states for smokeless tobacco, the CDC says.

Tobacco Products Proliferate
In the United States, men, mostly, long have ingested tobacco in cured strips (loose leaf), as bricks (plugs), twists of rope, finely ground (snuff), or snus (pouches or packets of snuff placed between the lip and gum). The makers flavor the different products as part of their insidious marketing. The chaw once held a place in popular culture at the pinnacle of manliness, with guys stuffing wads of it in their cheeks, then spitting out gross streams of tobacco-laden saliva. More refined gents, at points in history, have taken pinches of "dip" or snuff and put it on their gums or mouth lining.

Tobacco companies -- with their smoked products declining in profit in the face of overwhelming scientific evidence that they cause cancer and other diseases -- have sought to exploit the market potential of smokeless tobacco. That brought back not only the chaw and snuff but also saw the rise of tobacco as dissolvable candy-like lozenges, tablets and breath strips, as well as sticks similar to toothpicks.

Considering the deserved stigma attached to tobacco, it's clear how the novelty and discreetness of smokeless tobacco products might prove alluring to adults and teens. Frankly, the gimmickry aims just to hook users, ultimately, putting them back on the road to smoking: A study in the American Journal of Preventive Medicine suggested that the prevalence of smoking was substantially higher among men who had used and then quit snuff compared to those who never used snuff at all.

Tobacco and Health Woes
Contrary to popular belief, ingesting tobacco carries risks just as serious and severe as smoking. Many people fool themselves into thinking that just because they're not inhaling smoke, their heart and lungs are safer with ingested tobacco. While their lungs may not be savaged, users' constant exposure to tobacco juice -- and its 28 known carcinogenic substances -- puts them at increased risk for cancers of the mouth, esophagus, throat, stomach and pancreas. The WHO International Agency for Research on Cancer reported in 2008 that those who ingest tobacco have an 80 percent higher risk of developing oral cancer and 60 percent higher risk of contracting pancreatic and esophageal cancer. Leukoplakia, a precancerous condition characterized by white patches in the mouth, has been linked directly to oral use of tobacco; it occurs in more than half of all users in the first three years of use. Serious dental problems, such as dental caries, gingivitis, periodontitis and resultant tooth loss, also are commonly associated with smokeless tobacco.

And make no mistake about it: all tobacco products, no matter how consumed, contain nicotine. It not only is highly addictive but also carries a host of health risks, including coronary artery disease, hypertension, peptic ulcer disease and fetal disorders. Here's where ingested tobacco may be even more dangerous than cigarettes: it's been shown that nicotine absorbed via the mouth and gums stays in the blood longer than nicotine taken in the lungs.

How to Quit
So how to quit the chew or snuff? It's akin to stopping smoking, with its nicotine dependence and attendant mental and physical challenges. Those who ingest tobacco may have stronger need for oral substitutes to replace the feeling of having something in the mouth as well as the act of chewing, sucking and spitting.

Withdrawal symptoms may be eased with nicotine replacements -- the patch, gum or inhaler. Many people find tougher the mental and emotional aspects of quitting. Support from family and friends is key, as is a definitive plan on how to quit. Many states offer comprehensive help; California's anti-tobacco program offers services and California Smoker's Helpline provides support in multiple languages. The National Cancer Institute's website, the American Cancer Society and the Centers for Disease Control and Prevention also provide resources for the addicted.

There's a best course with tobacco, of course: don't start at all. If you need to see ghastly images of how oral cancers savage patients to persuade you, your doctor probably will be happy to help. There's certainly no glamor, either, in watching someone chew and spit in public, whether or not they're Big League role models destroying their health. So let's cry foul to the chaw, snuff and toss them and other tobacco products out.

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