Alarming Number of Teens Reported Chewing Tobacco, Dipping Snuff : Health: Researchers predict epidemic of mouth cancer in a few years. Receding gums, white leathery patches in mouth are signs often ignored.
When 17-year-old Todd Dittman must lose weight before a wrestling match, he puts wads of snuff between his cheek and gum.
“It’s a good substitute when you can’t eat because you’re trying to make your weight,” says Dittman of Blacksville, a senior at Clay-Battelle High School. “I don’t think it hurts me at all. But I haven’t been using it that long. I’ll quit before I get cancer.”
A classmate, senior Shawn Tennant, 17, says he “rubs” smokeless tobacco to relax.
“I use it whenever I get nervous or anxious about something. It calms me down,” Tennant says. “Some people have a candy bar. I rub tobacco.”
The use of chewing tobacco, snuff and other smokeless tobacco products among the nation’s teen-agers has been increasing at an alarming rate in recent years, says Elbert D. Glover, a professor of psychiatry and behavioral medicine at West Virginia University.
Gary Smith, principal at Clay-Battelle, estimated that 40% of the boys enrolled in grades 7 to 12 at the school use smokeless tobacco. Dittman and Tennant estimated that 80% of the senior boys at the school chew tobacco or dip snuff.
Glover, director of the school’s Tobacco Research Center and a leading health researcher on the product, says receding gums and white leathery patches inside the cheeks of many young tobacco chewers are the first inklings of a mouth cancer epidemic within the next 15 years.
“We don’t have a lot of problems yet, but it takes about 25 years of tobacco use for cancer to manifest,” Glover says. “My estimate is that between 2000 and 2005, mouth cancer is going to take off if we don’t do something about smokeless tobacco use right now.”
An estimated 12 million Americans regularly use snuff, twist, plug and other types of smokeless tobacco, Glover says. It is chewed, sucked or, in a finely ground form, inhaled into the nostrils.
Such usage disturbs Betty Marsee of Reading, Ohio. Her son, Sean, was in his senior year in high school in Talhina, Okla., when he died of mouth cancer that his doctors attributed to snuff.
“He thought it was just a canker sore,” Marsee said in a telephone interview from her home near Cincinnati. “I’m a registered nurse and I know it wasn’t a canker sore. A head and neck surgeon told him the next day that it was cancer.”
Sean died in February, 1984, nine months after doctors diagnosed his cancer and removed much of his tongue, cheeks, lymph glands, facial nerves and arteries and all of his right jaw.
“I don’t think he ever tried to quit,” said Marsee, 55, who now speaks to about 9,000 schoolchildren each year about the dangers of smokeless tobacco.
“My husband had died the year before from heart problems related to smoking, so Sean never smoked,” she says. “But if you live in Oklahoma, you know that 75% of the kids in school use smokeless tobacco.
“Kids think they’re going to live forever. Unless they have someone they can relate it to, they don’t listen when you tell them they can get sick and die of cancer if they use the stuff.”
West Virginia ranked first in smokeless tobacco use in a 1988 federal survey of the health behaviors of people living in 36 states and the District of Columbia.
About 20% of adult men living in West Virginia reported using some form of smokeless tobacco, according to the study. One-third of the men living in one isolated county reported using it.
More than 30% of the users were between ages 18 and 24, according to the survey.
“No one even comes close to West Virginia in terms of smokeless tobacco use,” Glover says.
The cancer risk makes the high rate of smokeless tobacco use by children especially disturbing to Glover.
About 16% of 4,230 randomly selected West Virginia students in grades 5 to 12 reported chewing tobacco in a 1989 study conducted by the state Department of Education.
Among the boys in the study, 29% of the 7th-, 8th- and 9th-graders and 39% of the 10th-, 11th- and 12th-graders said they were regular users. About 1% of the girls in each group said they had tried a pinch between their cheek and gum.
The study also found that the mean age for trying smokeless tobacco was 10. More than half reported that they were regular users by the time they reached 11.
In a 1988 national survey of college students, 22% of the males and 2% of females reported that they had used smokeless tobacco in the previous month.
“We’ve seen tons of problems in younger people, especially in this area,” says Dr. Kathleen Schroeder, an oral biology researcher and associate director of West Virginia University’s tobacco center.
“We’ve even seen preschoolers whose parents have put a little bit of snuff in their mouth to suck on,” she says. “It’s considered a folk remedy for teething. It numbs the gums.”
Glover says smokeless tobacco use causes stained teeth, bad breath, tooth sensitivity, cavities and gum recession. Other consequences include tooth loss, addiction, irritation of the mouth and tongue tissue and cancer.
Research has shown that snuff or chewing tobacco delivers 10 times more cancer-causing substances to the bloodstream than cigarettes, Glover says.
And an average pinch of snuff or chewing tobacco pumps three times more nicotine into the body through the lining of the mouth than the average cigarette delivers through the lungs, according to Glover.
The nicotine jolt speeds the heartbeat, raises blood pressure and contributes to heart disease and arteriosclerosis, researchers say.
Mark McHale, a spokesman for the Smokeless Tobacco Council, a trade group based in Washington, D.C., challenged Glover’s findings, saying they had not been proved.
“The only response the council has to make is that smokeless tobacco has not been scientifically established to cause any disease whatsoever, including oral cancer,” McHale says.
The council represents snuff and chewing tobacco manufacturers, including Brown and Williamson Corp., Conwood Co., L. P., Helme Tobacco Co., National Tobacco Co., The Pinkerton Tobacco Co. and U.S. Tobacco Co.
A 1986 report on smokeless tobacco by former U.S. Surgeon Gen. C. Everett Koop found that the substance caused cancer and was highly addictive. An independent review of Koop’s report by the Institute of Medicine, a private group of physicians based in Washington, D.C., reached the same conclusions.
“The evidence on smokeless tobacco is solid,” says Jack E. Henningfield, chief of clinical pharmacology research at the National Institute of Drug Abuse in Baltimore.
About 30,000 new cases of mouth cancer were reported last year in the United States, according to Louis W. Sullivan, secretary of health and human resources.
Only 51% of mouth cancer patients survive five years, Sullivan said.
A Federal Trade Commission report to Congress last year indicated that smokeless tobacco sales in this country increased to 116.4 million pounds, 2 million pounds more than the total sold in 1988.
Smokeless tobacco sales soared in the late 1960s and early 1970s after the serious health consequences of smoking cigarettes became widely accepted, Glover says.
Advertisements featuring major league ballplayers, professional football players and rodeo stars boosted sales through the mid-1980s. Smokeless sales were down in 1986 and 1987, after the government tightened controls on smokeless tobacco advertising and required that health warnings be put on packages.
But the industry has rebounded and registered annual increases since 1988, Glover says.
School officials in West Virginia and other states are using pamphlets, presentations, suspensions and even paddling to persuade their students to quit using snuff and other tobacco products.
A new West Virginia law that went into effect Jan. 1 prohibits tobacco use by anyone on school property, including administrators, teachers and coaches.
Smokeless Tobacco Ten states with the highest rates of chewing tobacco, snuff and other smokeless products by teenage males aged 16 and older. West Virginia: 23.1% Mississippi: 16.5% Wyoming: 15.8% Arkansas: 14.7% Montana: 13.7% Kentucky: 13.6% Kansas: 11.7% Oklahoma: 11.0% North Dakota: 10.7% Tennessee: 10.3% Source: Office on Smoking and Health, Department of Health and Human Services
