Tobacco Documents Online

dAMA THE JOURNAL of the Am'erican Medic,al Association July 11, 1980 Vol 244. No. 2 Questions and Answers 'Smokeless' Tobacco • QDuring the 1980 Olympic G~mes at "Lake Placid, NY, television advertisements showed professional athletes rec= ontmending the use of .so-called smokeless tobacco, whose manufacturer was noted to be an• official Olympic sponsor. On March 30, 1980, the Atlanta Journal and Constitution carried an article headlined "A Little. Plug •for Chewing Tobacco," which extolled "America's most misunderstood indulgence." Is it true that using snuff or chewing tobacco is much less harmful than smoking cigarett.~s? MD, Georgia' Snuff-dipping, the placing of a pinch of powdered, A. flavored tobacco in the cavity between gum' and cheek and sucking on the "quid," is reported to be increasing among youths of Southern. states, including grade-schoolers.' In addition, .the US Department of Agriculture says there is a "r~cent 6% increase in the consumption of chewing tobacco; the use'of which involves a. golf-ball size "chow" thaf~ is~. held in the in~er cheek area? Such a phenomenon comes at the heels of television and printed media advertising by the United States Tobacco Co that features the testimonials of well2known athletes and country-rock stars for various hran, ds of snuff and by the P. Lorillard Co for its Beech-Nu.t cl~ewfng ~tob~cco. Advertising research by the industry has resulted in:these campaigns being directed at the youth market. The role models are portrayed as intelligent and "with-it," partly because they have switched to smokeless tobacco out of concern for their health. H6wever, based on the current medical evidence, their long-term health would be far better if they did not use tobacco at all. Because snuff still is not as widely used as other forms of tobacco and because it is not inhaled as smoke, it does not present as great a danger to health as cigarettes. But such a risk is purely relative, for snuff seems to he even more injurious to the oral cavity than cigarettes. Snuff can appreciably accelerate a litany of destructive changes, including gingival recession, tooth abrasion~ and periodontal bone destruction? Leukoplakia (also dubbed snuff-dipper's keratosis), a nonspecific white patch involving the nonkeratinized epithelium of the oral muc0•sa, is most often attributed to the use of tobacco. Upwards of one in 20 cases of leukoplakia will hndergo malignant transformation into an epidermoid carcinoma.2 A nitrosamine, N-n~trosonornicotine, which can be iso- lated from snuff, has been shown to be tumorigenic.in experimental..animals~ The c~se agai.nst chewing tobacco may prove to be even ~nore damning~n an analysis of 2,005 patients in India with oral,~ph~ynge.al, and esophageal cancers (and an equal number of"control subjects cgmpar.able in age, sex,. and religion), Jayant e~ ;iP quanti.fi.ed tbe.relative etiologic fraction--the proportion bf cases of a disease'attributable to a particular factor--from chewing and smoking tobacco for these' cancers. Overall, chewing or smoking, or both, accdunted fo~ 70% of cancers of.the oral cavity, 84% of cancers of the oropharynx, 75% of cancers of the hypo- pharynx and larynx; and 50% of cancers of the esopha- gus.. ,, - Chewing and ~moking act synergistically in varying degrees, Jayant et aP noted. For instance, chewing alone has a sixfold higher risk of.cancer of the oral cavity relative to the nqnchewer., nonsmoker, while smoking alone has "only" a threefold increase. Both.chewing and smoking increases the risk .tenfold. Despite t~he evidence attributing serious health prob- lems to smokeless tobacco, Frankel" points out that there is no warning required on packages•or adv. ertisements for these products. Nor have pz:ofessional health organiza- tions, publishers, or broadcasting corporations taken any significant steps to counteract an advertising onslaught aimed at young people. ALAN BLUM, MD 1. Christen .AG: Tobacco chewing and snuff dipping. N Engl J Med 302:818, 1980. 2. Christen AG, McDaniel,RK, Doran JE: Snuff dipping and tobacco chewing in a group ef Texas college athletes. Tvx Dent J 97:6-10, 1979. 3. Christen AG, hrmstrnng WR, McDaniel RK: Intraoral leukopla.kia, periodontal breakdown, and teath loss in :t snuff" dipper. J Am Dcnl Assoc 98:5~t -,5811, 1979. 4. (~,ddsmith DP, Winn DM: Hazards with snulL l,a~cct i~8~5, 1980. " 5. Jayant K, Balakrishnan V, Sangbvl IA). et ah Quantification of the role of smoking and chewing tobacco in neat, pharyngeal, and besophageal cancers. Br J Cancer 35:232-235, 1977. 6. Frankel l I1 !: Another cowboy selling cancer. Wcsl J Mcd 13(1:.270-271, 1979. 19 2