Once considered a harmless pleasure, smokeless tobacco came to the forefrontof health news at the turn of the millennium due to increasing evidence thatit is just as dangerous as cigarette smoking. In fact, most medical professionals now agree that smokeless tobacco--also known as "chaw" or "chew"--is equally addictive and carcinogenic, and have come to consider the substance as contributing to the U.S. tobacco epidemic. Despite the medical community's efforts to warn people beginning in the mid-1980s, the use of smokeless tobaccowas on the rise as of the U.S. Surgeon General's report in 1997, which pinpointed young males as the largest growth area. Adolescent use of moist snuff, apowdered form of smokeless tobacco, has also skyrocketed, rising 1,500 percent between 1970 and 1991. As of 1995, 2.9 percent of Americans used some formof smokeless tobacco. From 1998 to 1999, the production of snuff rose eightpercent, even in the face of increased health warnings and tax hikes.
Smokeless tobacco made its debut in the United States in about 1611, when itappeared in Virginia's new Jamestown Colony, although it had already been used all over the world for many centuries. For instance, as early as 3500 B.C., people in Peru and Mexico used tobacco (both chewed or smoked) and there are records indicating that they regarded it as a valuable, tradable substance. In the colonial United States, it first took the form of "snuff," a dry powder inhaled through the nose. There are no records of tobacco chewing in the United States until almost a century later.
The topic of smokeless tobacco has always been a matter of heated debate. Until quite recently, many people believed it to be beneficial to health. One reason for this may have been that people with not enough food to eat found that chewing tobacco alleviated their hunger pains. Some Native American peoplesused it to relieve toothaches; treat insect, snake, and spider bites; and disinfect minor wounds. In addition, in the United States in the 1800s and early 1900s, snuff was thought to soothe toothaches; whiten teeth and stave off decay; and cure bleeding gums, scurvy, and neuralgia. Indeed, even in modern times, some people continue to use tobacco to reduce appetite, relieve boredomand stress, and allay unpleasant feelings.
There were plenty of adherents to the opposite camp, however, who maintainedthat chewing tobacco was a vile, unhealthy practice. Indeed, many rulers during the 1600s and 1700s banned its use and promised severe punishment of anyone caught using it. For example, in 1683 in China, anyone even possessing tobacco could be beheaded, while France's Louis XV banned snuff from his court during 1723 to 1774. Scotland's King James VI raised taxes on tobacco by 4,000percent in the early 1600s to reduce its use, and in 1633 Turkey's Sultan Murad IV, stating that tobacco use caused infertility and a decline in the performance of his soldiers, made using any form of tobacco a capital offense. Bythe end of the 19th century, antispitting laws were in force in most areas ofthe United States, indicting smokeless tobacco's loss of social acceptability. It would rapidly be replaced by cigarettes.
It was not until 1761, however, that any scientific observations were made about chewing tobacco and its effects on health. London physician John Hill noticed and reported the occurrence of nasal "polypuses" (now known as polyps, atumor on a stem-like extension) in some of his patients who chewed tobacco.He concluded that these "hard, black" tumors were the direct result of inhaling snuff. It took until 1915 for physicians in the United States and Europe to begin drawing the same conclusion about snuff and chewing tobacco as they witnessed increasing numbers of tobacco-using patients coming to them with oral and nasal cancers. Despite all this evidence of the ill effects of smokeless tobacco, though, the United States did not carry out an epidemiological study on the substance until the early 1950s and the Surgeon General did not doa report on the issue until 1979.
Why Smokeless Tobacco Is So Addictive
Smokeless tobacco, like cigarettes, is highly addictive because it contains nicotine. Some researchers have found evidence that nicotine is even more addictive than heroin, so it is no wonder that people are easily "hooked" on tobacco products and have a hard time quitting them. Nicotine is what produces the relaxing effect that tobacco users crave and come to expect. With the chemical symbol C10H14N2, nicotine is an alkaloidderived from pyridine, a carcinogenic poison that occurs naturally in coal tar. The drug works through the central nervous system, binding (filling emptyslots) with nicotinic receptors located in the brain's dopaminergic neurons(dopamine-sensitive nerve cells), causing the neurons to release more dopamine.
Dopamine is the key to why tobacco is so addictive. It has an important partin regulating mood and pleasure, both serving as a trigger for the synthesisof adrenaline and noradrenaline and acting as a neurotransmitter. When nicotine goes to the brain, it produces a rush of dopamine into the bloodstream, causing the user to become more relaxed and calm. In this respect, nicotine's chemical action is very similar to such other drugs as cocaine, amphetamines,and morphine. In effect, each time a smokeless tobacco user puts a pinch of tobacco in his or her mouth or inhales some powder, he or she gets a powerfully reinforcing and rewarding chemical message from the brain that, over a short period of time, will cause physical and emotional dependence on tobacco. However, because the body quickly becomes used to nicotine through a process called "tolerance," users experience a gradual rise in the amount of tobacco they need to get the same physiological effect.
In addition to the risk of addiction, however, tobacco users must also be aware that in many cases their favorite products are tainted, intentionally or otherwise, with potentially dangerous ingredients. Some studies have revealedthe presence of more than 120 chemicals in a single cigarette, for example. Some of the most common substances found in smokeless tobacco include radioactive polonium 210 (a nuclear-processing waste product), cadmium (an ingredientin car batteries), formaldehyde (embalming fluid), lead, and n-nitrosamines(carcinogenic compounds). In fact, researchers have found levels of the latter substance to exist in smokeless tobacco at up to 100 times the amount permitted in beer, bacon, and other foods.
What Is Smokeless Tobacco?
Smokeless tobacco occurs in two forms--snuff and chewing tobacco--and the main manufacturers in the United States are Copenhagen, Skoal, and Levi Garrett.Snuff is ground, finely cut, or powdered tobacco that usually comes in small, round cans. The most popular snuff is the moist kind. It mainly comes fromdark, fire-cured tobacco grown in Tennessee and Kentucky. Users put a pinch of the powder (called a "quid") between the lower lip and gum, where the extremely thin skin quickly soaks up the tobacco's nicotine (buffered to an easilyabsorbed alkaline pH) without chewing. This product usually remains in the mouth for 30 minutes to an hour. The inhaled kind of snuff is much more prevalent in Great Britain. Chewing tobacco comes in leaf ("twists") or pressed brick ("plug") form and is sold in soft, plastic three-ounce pouches. Most chewing tobacco is derived from cigar-type, air-cured leaves that come from Wisconsin and Pennsylvania. The method of use (known as "dipping," "pinching," or "rubbing") is the same as snuff, but users insert a golf ball-sized amount (a"chaw"), giving them the characteristic swollen-cheeked appearance. Chewing tobacco users often keep the tobacco between the cheek and gum, occasionally chewing on it, for up to three hours to take full advantage of the nicotine contained in it. Some people practice "double dipping," which is combining snuff and chewing tobacco. Saliva is an excellent extractor of the nicotine in these products.
Smokeless tobacco advertising, which is banned from television but common inmagazines, is often targeted at young people, but especially young men. Oncepopular in the United States (mainly in the South) and considered an unsociable, dirty practice, advertising has turned smokeless tobacco into a billion-dollar industry. In 1995, the tobacco industry spent more than $127 million onadvertising for smokeless tobacco products. Like much targeted advertising,these ads typically communicate the idea that using snuff or chewing tobaccois "cool," that "everybody does it," and that one's social life will improveonce one takes up the habit. The ads capitalize on and exploit the typical teenage male's insecurities, encouraging him to take this step toward what theyassure him will be the utmost degree of rugged masculinity. Other efforts toentice young people to use smokeless tobacco center on prize giveaways at sporting and music events and adding appealing flavors such as mint, licorice,wintergreen, and menthol to the products. Most of them also contain a lot ofsugar to improve their taste. As with cigarettes, although the legal age limit to buy smokeless tobacco is 18 or 19 in most states, many underage people (often as young as 10 to 12) manage to procure the expensive products throughless direct means. In the late 1990s, antismokeless tobacco campaigns capitalized on the same youthful insecurities to get their message across, remindingyoung men that having to spit odorous, brown juice every few minutes is notmost young women's idea of sexy.
Perhaps the most common misconception about smokeless tobacco in modern timesis that it is healthier, i.e., less damaging and risky, than cigarette smoking. This has contributed to many parents tolerating their children's use of smokeless tobacco, believing it to be a more wholesome alternative to cigarettes. However, this has been shown to be far from the truth. In study after study, researchers have proved that smokeless tobacco is actually more far addictive than cigarettes because of its higher nicotine levels, making the products even harder to stop using. On average, one can of snuff contains as much nicotine as 60 cigarettes. The average habitual smokeless tobacco user will receive 130-250 mg nicotine per day, compared with 180 mg for a person with a pack-a-day cigarette habit.
The most common health problem associated with short-term smokeless tobacco use is gum and tooth disease, which usually produces pronounced halitosis (badbreath). The nicotine and other substances in the products cause hard-to-remove stains, while its direct contact with the gums causes them to recede. Eventually, this will cause the teeth to loosen. Also, the large amount of sugarmixed in with smokeless tobacco, along with the friction of tobacco againstthe teeth, degrades the enamel coating that protects teeth, bringing on cavities and painful gum sores. Other problems include increased tooth sensitivityto heat and coldness and reduced ability to smell and taste.
With increasing length of smokeless tobacco use come increasingly serious health problems. For instance, heart disease has been linked to nicotine becausethe drug causes raised heart rate, arrhythmia (irregular heart beat), and increased blood pressure. Nicotine also has the effect of making blood vesselsnarrow, which reduces the amount of blood the heart can deliver throughout the body. Less blood flow can produce dizziness and slower reaction times. Professional baseball players, who once were major smokeless tobacco users, havegradually learned that nicotine actually harms their athletic performance, leading many of them to substitute equally messy but healthier sunflower seedsas their habit of choice.
Leukoplakia is another health risk of smokeless tobacco. Tough, scaly, whitesores almost always located at the site where the user habitually keeps the tobacco, leukoplakia is a precancerous lesion produced by chronic irritation and exposure to nicotine. More than 50 percent of users will develop these cellular abnormalities after an average 3.3 years of habitual use. The sores areoften distinguishable by their inability to heal. Leukoplakia will progressto oral cancer in about three to five percent of cases, but will usually disappear on its own if tobacco use stops.
Oral cancer is perhaps the most feared outcome of long-term smokeless tobaccouse, since it could lead, if not to death, then surgical removal of parts ofthe face, cheek, lips, or tongue. As of 1996, there were 30,000 new cases oforal cancer diagnosed in the United States, one-third of which were fatal. Some studies estimate that using smokeless tobacco raises the risk of oral cancer, which includes cancers of the throat, by as much as 50 percent. Smokeless tobacco use has also been strongly linked to cancers of the pancreas, nasalcavities, esophagus, pharynx (passageway for food and air), intestines, stomach, larynx ("voice box"), and urinary tract. Other noncancer health problemsassociated with smokeless tobacco include peptic ulcers, danger to fetuses,and damage of the salivary glands.
Trying to Quit
Informed of these multiple dangers, many people try to stop their smokeless tobacco habit. However, the hold that nicotine quickly establishes on the brain is not to be lightly dismissed, and the majority of would-be quitters fail.Most doctors recommend using products specifically designed to help people shake off nicotine dependence. Often taking the form of patches worn on the upper arm, these products deliver carefully regulated amounts of nicotine through the skin ("transdermal"). The patch programs gradually reduce the amount of nicotine to zero, with the goal of keeping the inevitable nicotine withdrawal symptoms (irritability, craving, agitation, overeating, tension) to a minimum. Yet even the patches have only a 25 percent success rate. Other programsuse a nicotine-containing gum and follow the same principle.