November 15

Chew on this: just because it’s not cigarette, doesn’t mean it’s safe

Rick Bender was 12 when he took his first dip. His friends were mostly cigarette smokers. But Bender chose to use moist snuff–finely ground tobacco sold in cans and put between the gums and cheeks–because it was advertised as a safe alternative to cigarettes. However, when he was in his 20s, Bender got a mouth sore that wouldn’t go away.

And that’s when he realized that there’s no such thing as a safe tobacco product. “Tobacco companies used to say, ‘Take a snuff instead of a puff.’ Now they’re saying, ‘Take a snus instead of a snuff,'” Bender, now 47, told Current Health. “They’re supposedly selling a safe alternative to the safe alternative.”

Smokeless 101

Tobacco companies have been expanding their smokeless tobacco offerings for many reasons. The most obvious are indoor smoking bans and increases in cigarette taxes, both of which discourage people from smoking. To stop losing customers, cigarette makers are promoting smokeless alternatives for getting a fix of nicotine, the highly addictive drug in tobacco. Their efforts seem to be working. Although smoking rates among teens have declined, smokeless tobacco use by teens has risen. (See “Ditching Cigs for Smokeless Tobacco.”)

While cigarette smokers inhale does nicotine cause cancer from the fumes, smokeless tobacco users typically absorb it into their bloodstreams through the mouth. Traditional products include moist snuff (also called dipping tobacco) and chewing tobacco (tobacco leaves, plugs, or twists). Alternatives such as snus (a tea bag-like pouch of tobacco) and dissolvable tobacco (which dissolves in the mouth) are currently getting a lot of attention as well. There are even devices called electronic cigarettes that contain no tobacco but still give a nicotine fix.

Whatever the form, smokeless products are common sights at schools. At Victoria Young’s school in Omaha, Neb., the 18-year-old says she sees people using smokeless tobacco every day, usually during classes, when students are not able to smoke cigarettes. “Mostly boys do it,” Young says. “When the teacher is writing on the blackboard, they’ll take it out of a can and chew it and then spit into a coffee mug.”

“I know a lot of kids who do dip in the bathroom stalls. And a lot of people use … snus because it’s tiny and you don’t have to spit,” says 18-year-old Cody Bullock, who lives in southeastern Ohio. The 2009 Monitoring the Future survey found that use of smokeless tobacco in rural areas of Ohio and other central and western states is more common than in the rest of the country.

Starter Products

There are plenty of reasons why Bullock’s classmates may find these products attractive. Dissolvable tobacco and suns, unlike other forms of smokeless tobacco, do not require spitting, says Shelly Kiser, director of advocacy for the American Lung Association in Columbus, Ohio. And the sleek, colorful packaging appeals to image-conscious teens, she notes. “They’re going after you young because if they get you young, you’ll be addicted and they’ll get as much money as possible from you,” Kiser says.

Another way companies try to attract young people is by making products with candy or fruit flavors. “It’s not like [older users] are going to switch to vanilla,” says Danny McGoldrick, vice president for research for the Campaign for Tobacco-Free Kids. “They are clearly starter products.” Documents from tobacco companies, he says, reveal a strategy of drawing in new customers with flavors and lower nicotine levels and then “graduating” them to stronger, higher-nicotine brands.

For example, one tobacco manufacturer is test-marketing some new dissolvable tobacco products in Columbus. One product looks like candy, another resembles breath-freshener strips, and yet another is shaped to resemble cinnamon sticks, says Kiser. “People try them because they look familiar and innocent.”

A Risky Road

Smokeless tobacco products are far from innocent, say experts. “A lot of people think it’s relatively safe, but the fact is smokeless tobacco contains many well-established cancer-causing chemicals,” points out Jack Henningfield, a professor at Johns Hopkins University and a member of the U.S. Food and Drug Administration’s scientific advisory committee on tobacco products. “There’s a serious risk of oral and head and neck cancers.”

Many users of smokeless tobacco develop white, patchy areas in their mouths called leukoplakia, lesions that sometimes become cancerous. Bender started noticing those in his freshman year of high school. “They looked like when your fingers are kept in water too long…. I thought they were calluses,” he recalls.

By age 26, Bender had tried regular cigarettes a few times but was going through a can of “spit” every couple of days. When one sore in his mouth wouldn’t heal even after he quit using smokeless tobacco, he got it checked out and learned he had an aggressive form of oral cancer. Bender needed multiple surgeries to remove part of his tongue and much of his jawbone.

Smokeless tobacco can cause other side effects too. Dental problems such as gum disease, stained teeth, bad breath, and receding gums are quite common. Studies have also shown smokeless tobacco use decreases sperm count and can lead to premature births.

At first glance, electronic cigarettes, also called e-cigarettes, may seem safer because they don’t contain tobacco. However, the user inhales vaporized nicotine from the battery-operated devices. “It’s the Wild West with e-cigarettes–they are renegade products with wild claims and no oversight,” says Henningfield. Because makers don’t provide specific information, there is concern that e-cigs contain harmful ingredients or too much nicotine.

Generally, users absorb more nicotine from smokeless tobacco products than from cigarettes, so experts worry about their addiction potential. Nicotine withdrawal symptoms include cravings, irritation, and trouble concentrating. Studies have shown that does hookah have nicotine also constricts blood vessels, which increases heart rate and blood pressure. Smokeless tobacco, like cigarettes, can contribute to heart disease, according to Henningfield.

Keeping Them Honest

Still, some cigarette smokers try switching to smokeless products to quit. That’s what Bullock did. He tried dip for a few months in an effort to quit cigarettes but says, “I wouldn’t recommend it. Dip is so much more powerful than a regular cigarette.”

While it’s possible that using smokeless products could help smokers quit, Henningfield says, often the products discourage smokers from quitting or lead them to use both cigarettes and smokeless tobacco. At the same time, the products can attract new users and hook them on nicotine.

Experts say a better approach to quitting any type of tobacco use is to join a support group or talk to your doctor. He or she can steer you to proven methods, such as nicotine patches or chewing gum, that decrease cravings. And it’s important to keep trying. For Bullock, a smoking cessation program at school gave him the incentive he needed to put both cigarettes and smokeless tobacco behind him.

As for Bender, he shares his story with young people all over the country. “I tell them the tobacco companies lied to me 25 years ago. Why wouldn’t they lie to you now?”

Baseball and Smokeless

When tobacco companies started leaving free samples of dipping tobacco at baseball clubhouses in the 1970s, use among players (and the teen boys who idolized them) soared. Today, about one in three Major League Baseball players–such as former Montreal Expos pitcher Carlos Perez (above)–use smokeless tobacco. But studies show that figure is going down; Minor League Baseball hasn’t allowed smokeless tobacco since the early 1990s. In fact, look more closely at your favorite major-league players: Many are chewing gum or sunflower seeds, not tobacco.