Smokeless tobacco is a form of tobacco (dried leaves in the nightshade family of plants) that is not smoked but used in other ways such as chewing tobacco or snuff (powdered tobacco that is inhaled through the nostrils). Once considered a harmless pleasure, smokeless tobacco came to the forefront of health news at the turn of the millennium due to increasing evidence that it 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 tobacco was 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, a powdered form of smokeless tobacco, has also skyrocketed, rising 1,500 percent between 1970 and 1991. As of 1995, 2.9 percent of U.S. citizens used some form of smokeless tobacco. From 1998 to 1999, the production of snuff rose 8 percent, even in the face of increased health warnings and tax hikes.
Smokeless tobacco made its debut in the United States in about 1611, when it appeared 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 and 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 peoples used 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 boredom and stress, and allay unpleasant feelings.
There were plenty of adherents to the opposite camp, however, who maintained that 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 4,000 percent in the early 1600s to reduce its use. 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. By the end of the 19th century, anti-spitting laws were in force in most areas of the 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, a tumor 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 U.S. Surgeon General did not complete a 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 difficult 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 alkaloid derived from pyridine, a carcinogenic poison that occurs naturally in coal tar. The drug works through the central nervous system, binding (filling empty slots) 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 part in regulating mood and pleasure, both serving as a trigger for the synthesis of 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 time-period, 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 revealed the 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 ingredient in 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. Two of the main manufacturers in the United States are the U.S. Smokeless Tobacco Company, who make Copenhagen®, Skoal®, and other brand-names, and the Conwood Company, L.P, who make Levi Garrett®, Kodiak®, and others. 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 from dark, fire-cured tobacco grown in the states of 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 easily absorbed 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 it is sold in soft, plastic three-ounce pouches. Most chewing tobacco is derived from cigar-type, air-cured leaves that come from the states of 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 in magazines, is often targeted at young people, but especially young men. Once 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 on advertising for smokeless tobacco products. For magazine advertising alone, expenditures for companies advertising smokeless tobacco rose 150 percent from 1997 to 2001, from $9.4 million to $24 million. Like much targeted advertising, these advertisements typically communicate the idea that using snuff or chewing tobacco is "cool" and that "everybody does it," and that one's social life will improve once one takes up the habit. The advertisements capitalize on and exploit the typical teenage male's insecurities, encouraging him to take this step toward what they assure him will be the utmost degree of rugged masculinity. Other efforts to entice 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 of sugar to improve their taste. As with cigarettes, although the legal age limit to buy smokeless tobacco is eighteen or nineteen years in most states, many underage people (often as young as ten to twelve years) manage to procure the expensive products through less direct means. In the late 1990s, anti-smokeless tobacco campaigns capitalized on the same youthful insecurities to get their message across, reminding young men that having to spit odorous, brown juice every few minutes is not most young women's idea of sexy.
Perhaps the most common misconception about smokeless tobacco in modern times is that it is healthier; i.e., less damaging and risky, than cigarette smoking. This has contributed 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 more difficult to stop using. On average, one can of snuff contains as much nicotine as sixty cigarettes. The average habitual smokeless tobacco user will receive 130 to 250 milligrams nicotine per day, compared with 180 milligrams 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 (bad breath). 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 condition will cause the teeth to loosen. In addition, the large amount of sugar mixed in with smokeless tobacco, along with the friction of tobacco against the teeth, degrades the enamel coating that protects teeth, bringing on cavities and painful gum sores. Other problems include increased tooth sensitivity to 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 because the drug causes raised heart rate, arrhythmia (irregular heartbeat), and increased blood pressure. Nicotine also has the effect of making blood vessels narrow, 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, have gradually learned that nicotine actually harms their athletic performance, leading many of them to substitute equally messy but healthier sunflower seeds as their habit of choice.
Leukoplakia is another health risk of smokeless tobacco. Tough, scaly, white sores usually 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 are often distinguishable by their inability to heal. Leukoplakia will progress to oral cancer in about 3-to-5 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 tobacco use, since it could lead, if not to death, then surgical removal of parts of the face, cheek, lips, or tongue. As of 1996, there were 30,000 new cases of oral 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, nasal cavities, esophagus, pharynx (passageway for food and air), intestines, stomach, larynx (voice box), and urinary tract. Other non-cancer health problems associated 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, and tension) to a minimum. Yet even the patches have only a 25 percent success rate. Other programs use a nicotine-containing gum and follow the same principle.
From September 22 to 25, 2002, the Third International Conference on Smokeless Tobacco was held in Stockholm, Sweden. The mission of the conference was to "update the available information on the science of Smokeless Tobacco (ST) prevention and control with regard to what is known and what is not known." The sponsoring organizations to the conference were the National Cancer Institute (NCI, U.S.), the Centers for Disease Control and Prevention (CDC, U.S.), and the Centre for Tobacco Prevention (CTP, Sweden). These three organizations are dedicated to the "prevention, reduction, and cessation of smokeless tobacco in all parts of the world."