Smokeless tobacco, also called spit tobacco, chewing tobacco, chew, chaw, dip, plug, and probably a few other things, comes in two forms: snuff and chewing tobacco
Smokeless tobacco (ST) products are derived from the same botanical source as smoking tobacco (Nicotiana species). Smokeless tobaccos are often flavored with sugar or artificial sweeteners.
Smokeless tobacco has not been used medically. Its recreational use carries many of the risks and dangers of smoking tobacco.
Smokeless tobacco has caused bad breath, discolored teeth, excessive tooth surface wear, decreased ability to taste and smell, gingival recession, advanced periodontal soft and hard tissue destruction, tooth loss, oral leukoplakia, and increased risk of cancers in the mouth and gums.
Smokeless tobaccos have been used by men and women of all levels of society. In Europe, snuffing involves placing a small pinch of tobacco in the nostrils while inhaling slightly. In the United States and many other parts of the world, "snuff dipping" is the more common practice. In this case, the user places a "quid" of powdered tobacco in the buccal area between the gum and cheek and retains the material for a period of time, usually swallowing the resultant saliva. Quids are taken as loose portions or as small prepackaged bags of tobacco. In many parts of the world, the quid is mixed with other stimulants such as betel nut. Lastly, some users chew a "chaw" of ST.
Recent national data compiled from several large-scale studies indicate that 10 to 12 million Americans use some form of ST. The use of ST is prevalent throughout the United States and users often begin at very early ages. From the responses of 3,725 high school students in the southeastern United States, 20% reported trying ST products at some time. Of these users, 44% reported a first use of ST before age 13. Family influences and peer pressure were major factors in initiating use. Of concern was the indication that 8.4% of the users felt they were addicted to the substance. Another survey of children in grades 3 to 12 in a Pennsylvania school district found that experimentation with ST had begun as early as the third grade, with the prevalence of use increasing with age. Nearly half of the boys in grades 7 to 12 did not believe ST products to be harmful.
Children are strongly influenced by role models regarding the use of ST. To this end a survey was conducted of major league baseball personnel during the 1987 season to determine their use and understanding of the hazards of ST. Twenty-five of 26 teams participated. The players (46%) "dipped" or "chewed," more than the managers (35%), followed by the trainers (30%). Although the users recognize the harmful potential of ST, its use remains high among baseball personnel. ST use is generally more prevalent among males. It should be noted that in one study, the prevalence of snuff use by women in the general population of central North Carolina was 30% (compared to 1.3% of women and 2.5% of men in the general US population).
Analysis of the personality characteristics of 289 collegeage users of ST found them to be significantly more reserved, less socially outgoing, less sentimental, more conforming, and more group-dependent than non-ST users.
The use of ST is increasing in the United States and remains prevalent throughout the world. Flavored tobaccos are used orally or nasally. ST preparations deliver as much nicotine as cigarettes. The use of ST is associated with a constellation of side effects. The risk of oral leukoplakia is more than 5 times greater among snuff users, and the use of ST is a major determinant of most oropharyngeal cancers. Public Law 99-252 (the Comprehensive Smokeless Tobacco Health Education Act of 1986) was developed as a federal platform for disease prevention and health promotion with respect to ST use.
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