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Health Applications of Smokeless Tobacco Use
JAMA. 1986;255(8):1045-1048.
Abstract
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Smokeless tobacco includes both chewing tobacco and snuff. These products contain tobacco leaf and a variety of sweeteners, flavorings, and scents. In chewing tobacco, the leaf may be shredded (loose-leaf), pressed into bricks or cakes (plugs), or dried and twisted into ropelike strands (twists). A portion is either chewed or held in place in the cheek or between the lower lip and the gum. The two categories of snuff, dry and moist, are made from powdered or finely cut tobacco leaves. In some countries, including historically the United Kingdom, dry snuff is sniffed through the nose, but in the United States both dry and moist snuff are used in the mouth or "dipped." A small amount (pinch) is held in place between the lip or cheek and the gum.
Although smokeless tobacco was widely used in the United States in the past, during this century its use has declined sharply. There is evidence that this trend has reversed, and that smokeless tobacco is regaining popularity. Market data show increases in manufacturing and sales, especially in the category of moist snuff, and total annual sales of smokeless tobacco are now close to $1 billion. Reports from schools in different regions of the country indicate that smokeless tobacco—principally moist snuff—is being used by very young people, especially adolescent males.
Serious questions have been raised regarding health and behavioral effects of use of smokeless tobacco. Most notably, it has been linked to oral cancer. If smokeless tobacco use does produce adverse health effects, then its extensive use could have long-term public health consequences. It is important at this time that the available information be assessed, both to provide the scientific community with a synthesis of current knowledge and a framework for further research and to provide the public with the information it needs to make informed decisions regarding use of smokeless tobacco.
To this end, the National Cancer Institute, the National institute of Dental Research, and the National institutes of Health Office of Medical Applications of Research convened a consensus development conference on Health Implications of Smokeless Tobacco Use from Jan 13 to 15, 1986. After 1 1/2 days of presentations by experts in relevant fields, a consensus panel including representatives of epidemiology, cancer, dentistry, psychology, pediatrics, psychopharmacology, education, and the public considered the evidence and agreed on answers to the following questions:
- What are the current trends in the use of smokeless tobacco in the United States?
- Does the use of smokeless tobacco increase the risk of oral or other cancers?
- Does the use of smokeless tobacco increase the risk of periodontal disease or other oral and health problems?
- What are the behavioral consequences of smokeless tobacco use?
- What issues regarding the health consequences of smokeless tobacco use require further research?
Footnotes
From the Office of Medical Applications of Research, National Institutes of Health, Bethesda, Md.
Reprint requests to Office of Medical Applications of Research, Bldg 1, Room 216, National Institutes of Health, Bethesda, MD 20205 (Michael J. Bernstein).
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