The Reemergence of Smokeless Tobacco

Smokeless tobacco (snuff and chewing tobacco) is reemerging as a popular form of tobacco, particularly among male adolescents. In different regions of the United States, from 8 to 36 percent of male high-school students are regular users. The use of smokeless tobacco has been shown to cause oral–pharyngeal cancer. The strongest link is with cancers of the cheek and gum. White mucosal lesions (leukoplakia) are found in 18 to 64 percent of users, often at the site where the tobacco was held. Other associations have been suggested for cancers of the esophagus, larynx, and pancreas. Nitrosamines, found in high concentrations in smokeless tobacco, most likely have a role in its carcinogenicity. Other health problems include periodontal disease, acute elevations of blood pressure, and dependence. In early 1986, after action at the state level, Congress enacted a federal law requiring health-warning labels on packages of smokeless tobacco and a ban on electronic advertising. Other regulatory measures under consideration include raising state and federal excise taxes, tightening controls on advertising, and prohibiting sales to minors. In view of the recent growth of this problem, policy makers are taking the opportunity to intervene with preventive measures to protect a new generation of tobacco users. (N Engl J Med 1986; 314: 1020–7.), TWO types of smokeless tobacco, snuff and chewing tobacco, are in common use. Snuff is a cured, ground tobacco that is produced in three forms: dry snuff, moist snuff, and fine-cut tobacco. Chewing tobacco also comes in several forms, including the popular loose-leaf variety, plug tobacco, and the less popular twist chewing tobacco.^{1 2 3} The most common way of using smokeless tobacco in the United States is either placing a pinch of snuff between the gum and cheek or chewing the leaf or plug. The tobacco mixes with the saliva, and the nicotine is absorbed through the oral mucosa into the…