Spit (Smokeless) Tobacco

In 1986, the U.S. Surgeon General concluded that the use of spit tobacco is not a safe substitute for
smoking cigarettes or cigars, as these products can cause various cancers and non cancerous oral
conditions, and can lead to nicotine addition. Some of these conditions are listed below.

 Cancer of the mouth and pharynx

 Leukoplakia (white sores in the mouth that can lead to cancer)

 Gum recession, or peeling back of gums

 Bone loss around the teeth

 Abrasion of teeth

 Bad breath

The most serious health effect of spit tobacco is an increased risk of cancer of the mouth and pharynx. Oral cancer
occurs several times more frequently among snuff dippers compared with non-tobacco users. The risk of cancer of
the cheek and gums may increase nearly 50-fold among long-term snuff users.

Leukoplakia is a white sore or patch in the mouth that can become cancerous. Studies have consistently found
high rates of Leukoplakia at the place in the mouth where users place the "chew." One study found that almost
3/4 of daily users of moist snuff, and chewing tobacco had non-cancerous or pre-cancerous lesions (sores) in the
mouth. The longer you use spit tobacco, the more likely you are to have Leukoplakia.

Studies have shown that about 7% to 27% of regular spit tobacco users have gum recession and bone loss around
the teeth. The surface of the tooth root may be exposed where gums have drawn back. Tobacco can irritate or
destroy the tissue.

Spit tobacco may also play a role in cardiovascular disease and high blood pressure. Nicotine enters the users'
bloodstream through the lining of the mouth and/or the gastrointestinal tract. Nicotine causes your heart to beat
faster and your blood pressure to go up.

Why Is It So Hard To Quit?

Spit tobacco delivers a high dose of nicotine. An average dose for snuff is 3.6 mg, for chewing tobacco, 4.6 mg -
compared to 1.8 mg for cigarettes. Blood levels of nicotine throughout the day are similar among smokers and
those who use spit tobacco.

A report in the Journal of the American Medical Association calculated that smokeless tobacco users ". . . who use
dip or chew 8-10 times a day might be exposed to the same amount of nicotine as people who smoke 30-40
cigarettes a day." Stopping spit tobacco use causes symptoms of nicotine withdrawal that are similar to those
smokers get when they quit.
In a study of Swedish oral snuff users, many of the participants said they were addicted to snuff, and they
reported having as much trouble giving up spit tobacco as did cigarette smokers trying to quit smoking. Evidence
also suggests that when regular snuff users can't use snuff, they will smoke cigarettes to satisfy their need for
nicotine.

How Nicotine Affects the Body

Nicotine is a drug found naturally in tobacco. It is highly addictive, as addictive as heroin and cocaine. The body
becomes physically and psychologically dependent on nicotine, and studies have shown that users must overcome
both of these to be successful at quitting and staying quit.

Nicotine affects many parts of the body, including your heart and blood vessels, your hormonal system, your
metabolism, and your brain. During pregnancy, nicotine freely crosses the placenta and has been found in
amniotic fluid and the umbilical cord blood of newborn infants. Nicotine is metabolized mainly by the liver and
lungs, but a small amount is excreted by the kidneys. Nicotine is broken down by the body into the by-products
cotinine and nicotine-N'-oxide.

Nicotine produces pleasurable feelings that make the tobacco user want to use more and also acts as a depressant
by interfering with the flow of information between nerve cells. As the nervous system adapts to nicotine, tobacco
users tend to increase the amount of tobacco they use, and hence the amount of nicotine in their blood. After a
while, the tobacco user develops a tolerance to the drug, which leads to an increased use over time. Eventually, the
tobacco user reaches a certain nicotine level and then keeps up the usage to maintain this level of nicotine.

Immediate Benefits of Quitting

There are many reasons to stick it out through withdrawal and quit using tobacco for good. In addition to the
health reasons mentioned earlier, consider the following.

Chewing and dipping carry a heavy social stigma, especially with the opposite sex. Bad breath, gum disease, and
discolored teeth are very unappealing. The spitting associated with spit tobacco use is offensive and has a potential
health risk as well.

The tobacco habit can be expensive. It isn't hard to figure out how much you spend on tobacco: multiply how
much money you spend on tobacco every day by 365 (days per year). The amount may surprise you. Now multiply
that by the number of years you have been using tobacco and that amount will probably astound you.

Multiply the cost per year by 10 (for the upcoming 10 years) and ask yourself what you would rather do with that
much money. Do you really want to continue wasting your money with nothing to show for it except possible
health problems?

If you have children, you want to set a good example for them. When asked, nearly all tobacco users say they don't
want their children to chew or dip. You can become a good role model for them if you quit now.

Quitting Spit Tobacco

Surveys show that most people who use snuff or chew would like to quit. In one survey, more than half said they
would try to quit in the next year.

In many ways, quitting spit tobacco is a lot like quitting smoking. Both involve tobacco products that contain
nicotine and both involve the physical and psychological components of addiction. Many of the methods of
handling the psychological hurdles of quitting are the same. Two elements are unique for smokeless users,
however:

 There is often a stronger need for oral substitutes to take the place of the chew or snuff.

Because spit tobacco often causes sores in the mouth and gum problems, the disappearance of these after quitting
provides a readily visible benefit.

What in cigarette smoke is harmful?

Cigarette smoke is a complex mixture of organic and inorganic compounds produced by the burning of tobacco and
additives. The smoke contains tar, which is made up of more than 4,000 chemicals, including over 60 known to cause
cancer. Some of these substances cause heart and lung diseases, and all of them can be deadly. You might be surprised
to know some of the chemicals found in cigarette smoke. They include:

 cyanide

 benzene

 formaldehyde

 methanol (wood alcohol)

 acetylene (the fuel used in welding torches)

 ammonia

Cigarette smoke also contains the poisonous gases nitrogen oxide and carbon monoxide. Its main active ingredient is
nicotine, an addictive drug.

Why do smokers have "smoker's cough?"

Cigarette smoke contains chemicals that irritate the air passages and lungs. When a smoker inhales these substances,
the body tries to protect itself by producing mucus and coughing. The "early morning" cough of smokers happens for
several reasons. Normally, tiny hairlike formations (called cilia) beat outward and sweep harmful material out of the lungs.
Cigarette smoke slows the sweeping action, so some of the poisons in the smoke remain in the lungs and mucus remains
in the airways. When a smoker sleeps, some cilia recover and begin working again. After waking up, the smoker coughs
because the lungs are trying to clear away the poisons that built up the previous day. The cilia stop working after long-term
exposure to smoke. Then the smoker's lungs are even more exposed and susceptible than before, especially to bacteria
and viruses in the air.
What are some of the short- and long-term effects of smoking cigarettes?

Smoking causes many types of cancer, which may not develop for years. The truth is cigarette smokers die younger than
nonsmokers. In fact, according to a Centers for Disease Control and Prevention study conducted in the late 1990s,
smoking shortened male smokers’ lives by 13.2 years and female smokers’ lives by 14.5 years. Both men and women who
smoke are much more likely to die during middle age (between the ages of 35 and 69) than those who have never
smoked.

Smoking also causes many short-term effects, such as decreased lung function. Because of this, smokers often suffer
shortness of breath and nagging coughs, and they often will tire easily during physical activity. Some other common short-
term effects: a diminished ability to smell and taste, premature aging of the skin, and increased risk of sexual impotence in
men

Can quitting really help a lifelong smoker?

Yes. It is never too late to quit. The sooner smokers quit, the more they can reduce their chances of getting cancer and
other diseases. Within 20 minutes of smoking the last cigarette, the body begins to restore itself.

20 minutes after quitting: Your heart rate drops.

12 hours after quitting: The carbon monoxide level in your blood drops to normal.

2 weeks to 3 months after quitting: Your circulation improves and your lung function increases.

1 to 9 months after quitting: Coughing and shortness of breath decrease; cilia (tiny hair like structures that move mucus
out of the lungs) regain normal function in the lungs, increasing the ability to handle mucus, clean the lungs, and reduce
the risk of infection.

1 year after quitting: The excess risk of coronary heart disease is half that of a smoker's.

5 years after quitting: Your stroke risk is reduced to that of a nonsmoker 5-15 years after quitting.

10 years after quitting: The lung cancer death rate is about half that of a continuing smoker's. The risk of cancer of the
mouth, throat, esophagus, bladder, cervix, and pancreas decrease.

15 years after quitting: The risk of coronary heart disease is that of a nonsmoker's.

It’s important to note that the extent to which these risks decrease depends on how much the person smoked, the age the
person started smoking, and the amount of inhalation.
Are chewing tobacco and snuff safe alternatives to cigarette smoking?

Smokeless tobacco contains nicotine. The amount of nicotine absorbed is usually more than the amount delivered by a
cigarette. Overall, people who dip or chew receive about the same amount of nicotine as regular smokers. The most
harmful cancer-causing substances in smokeless tobacco are tobacco-specific nitrosamines (TSNAs), which have been
found at levels 100 times higher than the nitrosamines that are allowed in bacon, beer, and other foods.

The juice from the smokeless tobacco is absorbed directly through the lining of the mouth. This creates sores and white
patches that often lead to cancer of the mouth.

Smokeless tobacco users greatly increase their risk of other cancers including those of the pharynx (throat), larynx (voice
box), and esophagus. Other effects of smokeless tobacco use include chronic bad breath, stained teeth and fillings, gum
disease, tooth decay, tooth loss, tooth abrasion, and loss of bone in the jaw. Users may also have problems with high
blood pressure and increased risk for heart disease.

What about more "exotic" forms of smoking tobacco, such as clove cigarettes, bidis, and
hookahs?

Several forms of flavored tobacco have become popular in recent years, especially among younger people. Clove
cigarettes, bidis, and, more recently, hookahs, often appeal to those who want something a little different. But these
products carry many of the same risks of cigarettes and other tobacco products.

Clove cigarettes, also called kreteks, are imported mainly from Indonesia and contain 60% to 70% tobacco and 30% to
40% ground cloves, clove oil, and other additives. The chemicals in cloves have been implicated in some cases of asthma
and other lung diseases. Users often have the mistaken notion that smoking clove cigarettes is safer than smoking
tobacco or marijuana. But they are a tobacco product with the same health risks as cigarettes.

Bidis are flavored cigarettes imported mainly from India. They are hand-rolled in an unprocessed tobacco leaf and tied
with strings on the ends. Their popularity has grown in recent years in part because they come in a variety of candy-like
flavors such as strawberry, vanilla, and grape, they are usually less expensive than regular cigarettes, and they often give
the smoker an immediate buzz.

Even though bidis contain less tobacco than regular cigarettes, recent studies have found that they have higher levels of
nicotine (the addictive chemical in tobacco) and other harmful substances such as tar and carbon monoxide. And because
they are thinner than regular cigarettes, they require about 3 times as many puffs per cigarette. They are also unfiltered.
Bidis appear to have all of the same health risks of regular cigarettes, if not more.

Hookah smoking, which started in the Middle East, involves burning flavored tobacco in a water pipe and inhaling the
smoke through a long hose. It has recently become popular among young people, especially around college campuses. It
is marketed as being safer than cigarettes because the percent of tobacco in the product smoked is low. This claim for
safety is not true. Several types of cancer, as well as other health effects, have been linked to hookah smoking.

All forms of tobacco are dangerous. Even if the health risks were smaller for some tobacco products as opposed to others,
all tobacco products contain nicotine, which can lead to increased use and addiction. Tobacco cannot be considered safe
in any amount or form.

.
Tobacco production, trade and industry

Agriculture In 1993, 417,700 hectares were harvested for tobacco, down from 436,600 hectares in 1985.
About 0.2% of all arable land is used for tobacco growing.

Production and Trade In 1992, 578,800 tonnes (7.0% of world total unmanufactured tobacco) was
produced in India, making it the world's third largest tobacco-growing country. In 1992, India produced
about 767,436 million manufactured cigarettes and bidis, accounting for 13.5% of the world total. About
2,100 million cigarettes were exported. Only 30 million manufactured cigarettes were imported. In 1990,
India's earnings from tobacco exports totalled US$ 127.7 million, compared with US$ 122.2 million in
1985. Import costs of cigarettes rose tenfold in the same period to US$ 3.0 million.

Industry In 1993, 3.4 million people were estimated to be engaged full-time in tobacco manufacturing.
This accounts for 11.7% of all manufacturing work. Almost 0.9 million people (full-time equivalent) work
in growing and curing tobacco.

Tobacco consumption

Annual consumption of manufactured cigarettes declined between 1984 and 1992 from around 90 billion
to about 85 billion. In 1992, 6.1% of world total un manufactured tobacco and 1.5 % of world total
manufactured cigarettes were consumed in India. Only about 20% of the total tobacco consumed in India
(by weight) is in the form of cigarettes. Bidis account for about 40% of tobacco consumption (about
675,000 million bidis), with the rest divided among chewing tobacco, pan masala, snuff, hookah, hookli,
chutta dhumti, and other tobacco mixtures featuring ingredients such as areca nut. Chuttas and dhumtis
are also smoked in reverse fashion, with the lighted end inside the mouth. Consumption patterns of
tobacco show major differences across regions.

Consumption of Manufactured Cigarettes

Tar/Nicotine/Filters In 1990, tar levels of cigarettes ranged from 18.0 - 28.0 mg, and nicotine levels
from 0.9 - 1.8 mg. Tar levels of bidis are much higher at 45-50 mg. In 1990, 51% of the cigarettes sold
were filter-tipped, however, there is little difference in nicotine yields of filter and non-filter cigarettes
manufactured in India.

Prevalence

Adequate national data on tobacco prevalence of tobacco is not currently available. However, based on
estimated per capita consumption figures, it appears that bidi smoking has risen substantially during the
last three decades. Cigarette smoking increased up to the 1970s, remained stationary or declined
somewhat during the 1980s. Other forms of tobacco use have declined considerably over the years.
Tobacco use among population sub-groups It is estimated that 65% of all men use some form of
tobacco, (about 35% smoking, 22% smokeless tobacco, 8% both). Prevalence rates for women differed
widely, from 15% in Bhavnagar to 67% in Andhra Pradesh. However, overall prevalence of bidi and
cigarette smoking among women is about 3%. The use of smokeless tobacco is similar among women and
men. About one-third of women use at least one form of tobacco. Differences in tobacco use also vary
among other groups; Sikhs do not use tobacco at all, and Parsis use very little, while tobacco use is
permissible among Hindus, Moslems and Christians. Smoking rates tend to be higher in rural areas than
urban areas. Smoking is a status symbol among urban educated youths, but most appear to be unaware
of the hazards of smoking.

Mortality from Tobacco Use

Tobacco is responsible for a significant amount of morbidity and mortality among middle-aged adults.
India has one of the highest rates of oral cancer in the world, and the rates are still increasing. Tobacco-
related cancers account for about half of all cancers among men and one-fourth among women. Oral
cancer accounts for one-third of the total cancer cases, with 90% of the patients being tobacco chewers.
Clinical observations in some areas have revealed that over 60% of heart disease patients under 40 years
of age are tobacco users; over half of the patients aged 41-60 are also smokers.

Tobacco Control Measures

Control on Tobacco Products Tobacco advertising has been banned in state-controlled electronic media,
but continues without restriction in newspapers, magazines, on posters, billboards, and in the video
cassettes of Indian films. A proposal for a total ban on advertising and sponsorship of all tobacco products
is under consideration by the Indian Government.

Health warnings are required on cigarette packets since the "Cigarette Act" of 1975. The government has
appointed a full-time coordinator of tobacco control activities. However, also in 1975 the government
dropped restrictions on package size and contents for cigarettes, cigars and 22 other products, and
initiated a Tobacco Development Board for promoting tobacco by offering direct subsidies and a price
support system to farmers.

Taxes are levied on tobacco products, at varying rates and with varying degrees of effectiveness. Between
1987 and 1992, excise duty on many Indian cigarettes increased between 64% - 112%. Cigarette taxes
represent about 75% of the retail price. Taxes are much lower on packaged chewing tobacco and are
rarely collected on bidis and unpackaged tobacco products. Regulatory control and the application of retail
taxes on these products is extremely difficult as there is a large sector which operates outside of official
control. For example, the bidi industry is highly decentralized and many manufacturers are unlicensed.
Much of bidi manufacturing is one in cottage industry. Often whole families, including women and children,
are engaged in bidi production.

High taxes on manufactured cigarettes and low taxes on bidis and other tobacco products are encouraging
substitution of bidis and other products for manufactured cigarettes.

Protection for non-smokers In 1990, through an executive order, the government implemented a
prohibition on smoking in all health care establishments, government offices, educational institutions, air-
conditioned railway cars, chaircars, buses, and domestic passenger flights.
Health education There is no organization currently working at the national level for tobacco
control. Several non-governmental organisations and committed individuals at the local levels
are also involved, but to date, no perceptible attitudinal changes among tobacco consumers
have been found.

Tobacco and Personal Appearance

• Tobacco smoke can make hair and clothes stink.

• Tobacco stains teeth and causes bad breath.

• Short-term use of spit tobacco can cause cracked lips, white spots, sores, and bleeding in the
mouth.

• Surgery to remove oral cancers caused by tobacco use can lead to serious changes in the face.
Sean Marcee, a high school star athlete who used spit tobacco, died of oral cancer when he was 19
years old.

S0. . .

• Know the truth. Despite all the tobacco use on TV and in movies, music videos, billboards and
magazines – most teens, adults, and athletes DON’T use tobacco.

• Make friends, develop athletic skills, control weight, be independent, be cool ... play sports.

• Don’t waste (burn) money on tobacco. Spend it on CD’s, clothes, computer games, and movies.

Get involved: make your team, school, and home tobacco-free; teach others; join community efforts to
prevent tobacco use.
 Tobacco-Related Cancers Fact Sheet

• Lung cancer is the leading cause of cancer death in the US for both men and women.

 Lung cancer is the most preventable form of cancer death in our society.

 87% of lung cancer deaths can be attributed to tobacco use.

 Lung cancer estimates for 2004

 New cases: 173,770

 Males: 93,110

 Females: 80,660

 Deaths: 160,440

 Males: 91,930

 Females: 68,510

 Besides lung cancer, tobacco use also causes increased risk for cancer of the oral cavity, nasal cavities,
larynx, pharynx, esophagus, stomach, liver, pancreas, kidney, bladder, uterine cervix, and myeloid
leukemia.

 In the US, tobacco use is responsible for nearly 1 in 5 deaths or an estimated 440,000 deaths per year
during 1995-1999.

 In 2004, more than 180,000 cancer deaths will be caused by tobacco use.

 Tobacco use accounts for at least 30% of all cancer deaths and 87% of lung cancer deaths.

 In 2002, an estimated 45.8 million US adults (22.5% of the population) were current smokers.

 More than 80% of smokers surveyed in 1991 began to smoke before age 18, and 35% had become daily
smokers by age 18.
  Each year, secondhand smoke may be responsible for about 3,000 lung cancer deaths in nonsmoking
adults and an additional 35,000 to 40,000 cases of heart disease in people who are not current smokers.

 Cigars contain many of the same carcinogens that are found in cigarettes. Cigar smoking, which has
steadily increased since 1993, causes cancer of the lung, oral cavity, larynx, esophagus, and possibly the
pancreas.

 Among adults age 18 and older, national data showed 6% of men and 1% of women were current users of
chewing tobacco or snuff.

 Oral cancer occurs several times more frequently among chewing tobacco or snuff users compared with
non tobacco users.

Smoking-related medical costs totaled $75.5 billion in 1998 and accounted for 8% of personal health care medical
expenditures. This translates to $1,623 in excess medical expenditures per adult smoker in 1999