Addicted to Dipping

Last Editorial Review: 1/30/2005

Chewing tobacco's grip on addicted users.

WebMD Feature

Feb. 21, 2000 (Minneapolis) -- On "Bill Tuttle Day" in Minnesota, former major league broadcaster Joe Garagiola stepped up to a microphone in the state capitol building in St. Paul. At his side was the honoree, who had been a Minnesota Twins outfielder in the early 1960s.

It was a bittersweet celebration. Tuttle already had lost much of his jaw and cheek to oral cancer, which his doctors had attributed to a 40-year habit of chewing tobacco. "Smokeless is not harmless," said an emotional Garagiola during the May 1998 event, pleading for a high tax on smokeless tobacco, also known as "spit" or "chew." Two months later, at age 69, Tuttle was dead.

Garagiola's National Spit Tobacco Education Program (NSTEP) has helped lower the use of smokeless tobacco from about 40% to 35% in Major League Baseball. A 1994 ban on smokeless tobacco in the minor leagues decreased use to 29%. Yet "chewing" remains a deeply entrenched part of the culture of the sport. In college baseball, where young players emulate the pros, usage is at an alarmingly high 52%, according to John Greene, D.M.D., a University of California, San Francisco, oral cancer specialist.

About 6 million people in the United States use smokeless tobacco on a daily basis (about 47 million Americans smoke cigarettes). A 1997 National Household Survey on Drug Abuse found that 92% of those who chewed were male. While the rate of use in the general U.S. population is significantly lower than among baseball players, the popularity of smokeless tobacco is increasing, especially among younger white males.

A study released by the American Legacy Foundation on January 28, 2000, found that 4.2% of middle school boys and 11.6% of high school boys use smokeless tobacco. While cigarette use is much higher -- 9.6% for middle school boys and 28.7% for high school boys -- the rate of smokeless tobacco use by adolescent boys is still troubling. According to Herb Severson, Ph.D., a scientist at the Oregon Research Institute, the median age for initial use of smokeless tobacco is 12, two years younger than the age for cigarettes.

More adults are also taking up the habit. Severson says firemen, policemen, airport workers, and even white-collar workers are resorting to smokeless tobacco to satisfy their nicotine addictions. "Historically, the prevalence of use was higher in rural areas, and while that is still true, the demographics are changing," he says.

Dentists are seeing signs of increased use among people who can no longer smoke on the job. Badly discolored teeth, receding gums, bad breath, and chronic sores are common among users.

But the real worry is cancer. Smokeless tobacco contains at least three known carcinogenic agents: N-nitrosamines, polycyclic aromatic hydrocarbons, and polonium 210. There are about 28,000 new cases of oral cancer a year, "and very, very few of the people who get it haven't used chew," Severson says. "And one-third of those diagnosed with oral cancer will die of it. It is a very deadly disease." As Garagiola tells baseball players, "You lose your face one piece at a time until you are dead." Users who swallow chewing tobacco increase their risk of esophageal damage and stomach ulcers.

According to Greene, between half and three-quarters of daily smokeless tobacco users have noncancerous and precancerous oral lesions. Called leukoplakia, these lesions are white, leathery ridges in the tissues of the mouth. They often resolve in about six weeks after stopping smokeless tobacco use.

That?s why the American Dental Association urges dentists and hygienists to counsel patients who use smokeless tobacco to quit. Severson says the success rate for quitting has been about the same as for cigarettes -- about 10% or 12% -- for many years. Quitting smokeless tobacco is as difficult as quitting cigarettes, and the approaches are similar. He notes that smokeless tobacco users are sometimes easier to convince to quit than cigarette smokers if they can be shown lesions inside their mouths. "Fear is a good motivator," he says.

Most experts agree that until people understand that smokeless tobacco isn't a safe alternative to cigarettes, efforts to get people to stop smoking may actually push many smokers to smokeless tobacco. Severson also worries that the number of smokeless tobacco users might be higher than surveys indicate. "You're dealing with a silent epidemic," he says, "because people can do this without others knowing."

Jim Dawson is the science writer for the Minneapolis Star Tribune. The co-author of two books, he is a former MIT Knight Science Journalism Fellow and science writing fellow at the Marine Biological Laboratory in Woods Hole.

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