Tobacco: Smokeless

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Tobacco is a plant native to the Americas, and Native Americans were the first to use it. In addition to smoking it, they used it in smokeless forms, mainly as a chewing material and in teas and other drinks. The ash was used in rituals throughout the Americas and the Caribbean. Tobacco was used along with many other plants for both ritual and medicinal purposes.

Christopher Columbus and other explorers brought tobacco to Europe, where it was taken up for recreation in both smoked form (cigars and pipes) and smokeless. Smokeless tobacco (ST) became popular in British society in the practice called sniffing. British colonists in the Americas preferred to chew tobacco or use snuff. In the 1800s chewing tobacco was widespread in the United States. This use decreased when the spitting that resulted (into spittoons or cuspidors or wherever the spit fell) was linked to the spread of tuberculosis, one of the most dreaded and fatal of diseases. In addition, the mass production of machine-rolled cigarettes further decreased use of smokeless tobacco. Around 1900, 52 percent of all tobacco used was smokeless. By 1952 that number had dropped to 6 percent. Sales of chewing tobacco declined until about 1970, and those who used it were mainly rural residents or baseball players.

The two most common types of ST used in the twentieth century were snuff and chewing tobacco. Snuff is a cured, ground tobacco that comes in three forms: fine-cut tobacco, moist snuff, and dry snuff. Snuff is used by placing a pinch between the cheek and gum or lower lip and gum. Chewing tobacco is also produced in three forms: looseleaf tobacco, plug tobacco, and twist chewing tobacco. All three forms are used by placing a "chaw" in the cheek and periodically chewing.

In the 1970s the use of ST surged in the United States, with most smokers preferring moist snuff. Young people began using ST products much more than they did in the past. Use of ST among young people rose throughout the 1980s and peaked in 1995. Since then, a gradual decline in use by young people has been reported in national surveys. In 2001 an estimated 4 percent of 8th graders and 7.8 percent of 12th graders reported using ST within the past month. The renewed popularity of ST, which reached its peak in the 1990s, may have been the result of innovative advertising campaigns by tobacco companies. These campaigns used sports superstars, country-western entertainers, and rodeo celebrities to promote tobacco products. The advertising tried to replace the old image of the smokeless tobacco habit as unclean with a manly or macho image.

Smokeless tobacco, like cigarettes, contains nicotine, a drug that can lead to physical dependence. Cigarette smokers inhale smoke containing nicotine into their lungs, and the nicotine is then transported into the bloodstream. ST users absorb nicotine directly through the lining of their mouths. Each time smokers smoke a cigarette, they absorb approximately 1 milligram of nicotine into their system. By comparison, people who use chewing tobacco receive approximately 4.5 milligrams of nicotine per chaw, and people who use snuff receive approximately 3.6 milligrams of nicotine per pinch.

ST is sometimes viewed as a safe alternative to cigarettes, but this view is incorrect. In addition to dependence on nicotine, ST is directly related to a variety of health problems:

• bad breath
• abrasion (wearing down) of the teeth
• receding gums
• periodontal bone loss (affecting the structures that support the teeth)
• tooth loss
• leukoplakia (a condition in which thick white patches form on the mucous membranes of the mouth)
• various forms of oral (mouth) cancer

Smokeless tobacco may also play a role in cardiovascular changes and damage to the nervous and muscular systems.

Survey data as of 2001 indicate that users of smokeless tobacco are almost exclusively male. In a large national survey of smokeless tobacco use by young people, about 14.2 percent of male 12th graders used smokeless tobacco, while only 1.6 percent of female 12th graders used it. While ST users are mostly male, a 2000 study found that ST use is popular among some Native American women. Eastern Band Cherokee Indian women in North Carolina who used ST had an eight times greater risk of breast cancer than nonusers.

As the use of smokeless tobacco has risen, education and programs to help people quit have become necessary. In 1994, Oral Health America created the National Spit Tobacco Education Program (NSTEP) as part of its Oral Health 2000 initiative. NSTEP is endorsed by Major League Baseball and encourages players and users to quit. But the main goal is to reduce ST use among kids. NSTEP's chairman is Hall of Fame broadcaster Joe Garagiola, and baseball stars Frank Thomas, Jeff Bagwell, and Hank Aaron endorse the program. Baseball star Lenny Dykstra, who had all his teeth pulled because of overuse of ST, did a public service announcement supporting the NSTEP cause, as did country music star Garth Brooks. During spring training in 1997, NSTEP counseled sixteen major league teams on ST education, providing intervention and programs aimed at helping people quit. Not only is it important to help the players quit, but it is equally important to reduce the number of ST-using players whom kids idolize. The national preventative health initiative, Healthy People 2010, is involved in several new programs to discourage all forms of tobacco use, including ST. Many quit-smoking programs and guides are now also addressing issues related to ST, from informing about the health risks to helping people quit ST use.

NSTEP offers users tips on quitting ST:

1. Be committed, and do not be discouraged by setbacks.
2. Quit with a friend or ask for support from friends who do not use ST.
3. Put three dollars in a jar every day to see the financial benefits of quitting.
4. Chew seeds or gum instead of tobacco while playing sports.
5. When the quit date is set, visit the dentist for a teeth cleaning, which should help ease the initial nicotine craving.

Users of ST who are dependent on nicotine may require therapy or use of a nicotine patch to kick this dangerous habit.

Adolescents, Drug and Alcohol Use; Advertising and the Tobacco Industry; Nicotine; Nicotine Withdrawal.

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