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Three percent of American adults are smokeless tobacco users. They run the same risks of gum disease, heart disease and addiction as cigarette users, but an even greater risk of oral cancer. Each year about 30,000 Americans are diagnosed with oral and pharyngeal cancers, and more than 8,000 people die of these diseases. Despite the health risks associated with tobacco use, consumers continue to demand the product. In 2001, the five largest tobacco manufacturers spent $236.7 million on smokeless tobacco advertising and promotion.

What is smokeless tobacco?

There are two forms of smokeless tobacco: chewing tobacco and snuff. Chewing tobacco is usually sold as leaf tobacco (packaged in a pouch) or plug tobacco (in brick form). Both are placed between the cheek and gum. Users keep chewing tobacco in their mouths for several hours to get a continuous high from the nicotine in the tobacco.

Snuff is a powdered tobacco (usually sold in cans) that is put between the lower lip and the gum. It is also referred to as “dipping.” Just a pinch is all that’s needed to release the nicotine, which is then swiftly absorbed into the bloodstream, resulting in a quick high.

The chemicals contained in chew or snuff are poisonous and addictive. Every time smokeless tobacco is used, the body adjusts to the amount of tobacco needed to get a high. Consequently, the next time tobacco is used, the body will need a little more to get the same feeling. Holding an average-sized dip or chew in the mouth for 30 minutes gives the user as much nicotine as smoking four cigarettes

Is smokeless tobacco less harmful than cigarettes?

In 1986, the U.S. Surgeon General declared that the use of smokeless tobacco “is not a safe substitute for smoking cigarettes. It can cause cancer and a number of noncancerous conditions and can lead to nicotine addiction and dependence.” Also, since 1991, the National Cancer Institute has recommended that the public avoid the use of all tobacco products, due to their high levels of nitrosamines.

In a recent study, cancer researchers found that oral tobacco products, including lozenges and moist snuff, are not a good alternative to smoking, since the levels of cancer-causing nitrosamines in smokeless tobacco and lozenges are very high. Some smokeless products contain the highest amounts of nicotine that can be readily absorbed by the body.

What are the ingredients in smokeless tobacco?

  • Polonium 210 (nuclear waste)
  • N-Nitrosamines (cancer-causing)
  • Formaldehyde (embalming fluid)
  • Nicotine (addictive drug)
  • Cadmium (used in batteries and nuclear reactor shields)
  • Cyanide (poisonous compound)
  • Arsenic (poinsonous metallic element)
  • Benzene (used in insecticides and motor fuels)
  • Lead (nerve poison)

Who are the most common smokeless tobacco users?

According to the 2000 National Household Survey on Drug Abuse conducted by the Substance Abuse and Mental Health Services Administration, young adults between the ages of 18-25 are the most common smokeless tobacco users. This trend may be influenced by innovative marketing tactics targeted at a younger audience.

Smokeless tobacco manufacturers are marketing flavored smokeless tobacco. A 2005 American Legacy Foundation and National Cancer Institute study noted, “Tobacco companies are using candy-like flavors and high-tech delivery devices to turn a blowtorch into a flavored popsicle, misleading millions of youngsters to try a deadly product.”

What are the physical and mental effects of smokeless tobacco use?

Cancer. Smokeless tobacco is a cancer-causing agent, also known as a carcinogen. Cancers are most likely to develop at the site where tobacco is held in the mouth, but it may also include the lips, tongue, cheek and throat.

Leukoplakia. Smokeless tobacco users may develop a condition in which white spots form on the gums, inside of the cheeks and sometimes on the tongue. It can be caused by the irritation from the tobacco juice, and the disorder can be considered pre-cancerous. Therefore, if a white patch does not heal within one week, consult a doctor.

Heart disease. The stimulating effects of nicotine, an organic compound made of carbon, hydrogen, nitrogen and sometimes oxygen, increase the heart rate and blood pressure and may trigger irregular heartbeats.

Gum and tooth disease. Smokeless tobacco permanently discolors teeth, causes halitosis (bad breath) and may contribute to tooth loss. Smokeless tobacco contains a lot of sugar which forms an acid that may eat away the tooth enamel, causing cavities and mouth sores. Also, its direct and repeated contact with the gums may cause them to recede.

Social effects. Bad breath, discolored teeth.

What are some early warning signs of oral cancer?

  • A sore that bleeds easily and does not heal
  • A lump or thickening anywhere in the mouth or neck
  • Soreness or swelling that does not go away
  • A red or white patch that does not go away
  • Trouble chewing, swallowing or moving the tongue or jaw

Tips to quit using smokeless tobacco for a lifetime

Write down a list of reasons to quit. For example:

  • Don’t want to risk getting cancer.
  • Family members find it offensive.
  • Don’t like having bad breath after chewing and dipping.
  • Don’t want stained teeth or no teeth.
  • Don’t like being addicted to nicotine.
  • Want to start leading a healthier life.

Pick a date to quit and throw out all chewing tobacco and snuff.

  • Remember daily your decision to stop chewing tobacco.
  • Ask friends and family to help you stay committed to the decision to quit, by giving you support and encouragement.
  • Find alternatives to smokeless tobacco to chew, such as sugarless gum, pumpkin or sunflower seeds, apple slices, raisins or dried fruit.
  • Engage in recreational activities to keep your mind off smokeless tobacco.
  • Develop a personalized plan that works best; set realistic goals.
  • Reward your successes.

© 2016 American Academy of Otolaryngology – Head and Neck Surgery

El humo de segunda mano es una combinación del que brota de un cigarrillo ardiendo y el humo que exhala un fumador. También llamado Humo de Tabaco Ambiental (HTA), es fácilmente reconocido por su olor distintivo, el HTA contamina el aire y es retenido en la ropa, cortinas y muebles. Mucha gente encuentra que el HTA es desagradable, molesto e irritante para los ojos y la nariz.

¿Es común la exposición al humo de tabaco ambiental?

Aproximadamente un 26 por ciento de los adultos en los Estados Unidos fuman cigarrillos, y entre 50 por ciento a 67 por ciento de los niños viven en hogares con al menos un adulto fumador.

Efectos del humo del tabaco ambiental

El feto y el recién nacido

La sangre maternal, fetal, y placental cambian cuando una mujer embarazada fuma, aunque los efectos a largo plazo todavía no son bien conocidos. Algunos estudios sugieren que fumar durante el embarazo produce defectos tales como labio leporino y fisura de paladar.

Las mujeres que fuman producen menos leche, y sus bebés tienen menos peso al nacer. El fumar materno también está asociado con el Síndrome de Muerte Súbita Neonatal, la mayor causa de muerte en infantes entre un mes y un año de vida.

Los pulmones y el tracto respiratorio de los niños

La exposición al HTA disminuye la eficiencia de los pulmones y altera la función en los menores, al igual que aumenta tanto la frecuencia como la severidad del asma infantil. El fumar pasivamente agrava la sinusitis, la rinitis, la fibrosis quística, y los problemas respiratorios crónicos tales como la tos y el goteo nasal posterior. También aumenta el número de episodios de resfríos y de dolores de garganta.

En los niños de menos de dos años de edad, la exposición al HTA aumenta la posibilidad de desarrollar bronquitis y neumonía. En efecto, un estudio realizado en 1992 por la Agencia de Protección Ambiental de Estados Unidos dice que el HTA causa un promedio de 150-300 mil infecciones respiratorias cada año en infantes y niños de menos de 18 meses de vida. Estas enfermedades resultan en 15,000 hospitalizaciones. Los niños cuyos padres fuman medio paquete de cigarrillos o más por día tienen el doble de riesgo de hospitalización por una enfermedad respiratoria.

Los oídos

La exposición al HTA aumenta tanto el número de las infecciones de oído que el niño va a experimentar, como el término de la enfermedad. El humo inhalado irrita la trompa de Eustaquio, que es la que conecta la parte posterior de la nariz con el oído. Esto causa inflamación y obstrucción, la que interfiere con la ecualización de presión en el oído medio, llevando dolor, derrame e infección. Las infecciones del oído son la causa más frecuente de pérdida auditiva en los niños. Cuando ellos no responden al tratamiento medicamentoso, a menudo se requiere la inserción quirúrgica de tubos de ventilación.

El cerebro

Los hijos de madres que fuman durante o después del embarazo están más expuestos que otros niños a sufrir problemas de comportamiento, tales como hiperactividad. También se ha demostrado una ligera disminución de su rendimiento en la escuela y en los logros intelectuales.

¿Quién esta en riesgo?

A pesar de que el HTA es peligroso para todo el mundo, los fetos, los infantes, y los niños, sufren un riesgo mayor. Esto es así porque el HTA puede dañar órganos en desarrollo, como los pulmones y el cerebro. Más de 4000 productos químicos han sido identificados en el HTA, y al menos 43 de estos causan cáncer.

Fumar pasivamente produce cáncer

Usted ha leído como el HTA daña el desarrollo de su hijo; ¿Pero sabía que el riesgo de que usted desarrolle cáncer por HTA es alrededor de100 veces mayor que el que producen los otros agentes de contaminación externos? Sabía usted que el HTA causa en no fumadores más de 3000 muertes por cáncer de pulmón en Norteamérica cada año? En razón de que estos datos son bastante alarmantes para cualquiera, deberíamos dejar de exponer a nuestros niños al Humo de Tabaco Ambiental.

Consejos para proteger a sus niños del HTA

  • Deje de fumar, si lo hace. Consulte a su médico por ayuda, si lo necesita. Hay muchos productos farmacéuticos disponibles que pueden ayudar a dejarlo.
  • Si usted convive con fumadores, ayúdelos a dejar el hábito.
  • Pídale a los fumadores que viven en casa y también a sus visitas que fumen fuera de su hogar.
  • No permita que fumen en su automóvil.
  • Asegúrese que no se fume en la escuela o guardería de sus hijos.
  • Háblele a los niños de los daños que causa el tabaco y anímelos a nunca adoptar el hábito de fumar cigarrillos o masticar tabaco.

Consejos para el romper el hábito de fumar

  • Elija una fecha fija en la cual dejará de fumar y deságase de todos los cigarrillos en su casa, carro, o trabajo.
  • Pídale a sus amigos o familiares que fumen fuera de su casa o automóvil.
  • Piense en todos los beneficios que le brindará a su salud el dejar de fumar.
  • Una vez que ya ha dejado de fumar, no vuelva a probar ni un cigarrillo más.
  • Cambie su rutina diaria para evitar los momentos en los que solía fumar.
  • Tome mucha agua o fluidos.
  • Evite el estrés.
  • Este listo para no caer en un relapso. La mayoría de relapsos ocurren en los primeros tres meses. No se desanime si vuelve a fumar e intente nuevamente.

Se le agradece a la Academia Americana de Pediatría por su contribución de información para este panfleto.

© 2016 American Academy of Otolaryngology – Head and Neck Surgery

Access to quality healthcare for children is forwarded by the availability of good healthcare information. With this year’s release of a new surgeon general’s report on secondhand smoke, the following information should be shared with patients.

New Warning on Secondhand Smoke

In July 2006, the Surgeon General released evidence supporting the fact that secondhand smoke, smoke from a burning cigarette and the smoke exhaled by the smoker, represents a dangerous health hazard.

The new report states that there is no risk-free level of secondhand smoke exposure. Although secondhand smoke is dangerous to everyone, fetuses, infants and children are at most risk. Even brief exposures can be harmful to children. This is because secondhand smoke can damage developing organs, such as the lungs and brain.

Infants and Children Effects and Exposure

  • Babies of mothers who smoked and those exposed to smoke are more likely to die from Sudden Infant Death Syndrome (SIDS) than babies who are not exposed to smoke.
  • Babies of mothers who smoked and those exposed to smoke after birth have weaker lungs and thereby increased risk of more health problems.
  • Children with asthma exposed to secondhand smoke experience more frequent and severe attacks.
  • Children exposed to secondhand smoke are at increased risk for ear infections and are more likely to need an operation to insert ear tubes for drainage.

Youth and Teens Effects and Exposure

  • Secondhand smoke exposure causes respiratory symptoms, including cough, phlegm, wheeze and breathlessness, among school-aged children.
  • On average, children are exposed to more secondhand smoke than nonsmoking adults.

Statistics

  • More than 4,000 different chemicals have been identified in secondhand smoke and at least 43 of these chemicals cause cancer.
  • On average, children are exposed to more secondhand smoke than nonsmoking adults.
  • Approximately 26 percent of adults in the United States currently smoke cigarettes, and 50 to 67 percent of children less than five years of age live in homes with at least one adult smoker.
  • 28 percent of high schoolers are exposed to secondhand smoke in their own homes.
  • A recent study found that 34 percent of teens begin smoking as a result of tobacco company promotional activities.
  • Among middle school students who were current smokers, 71 percent reported never being asked to show proof of age when buying cigarettes in a store, and 66 percent were not refused purchase because of their age.

Checklist for Protection Against Secondhand Smoke:

Young children

  • Remember that you are a powerful role model. If you don’t smoke, your children are less likely to smoke.
  • Make your home and car smoke-free spaces. Put up no-smoking stickers and signs in your home.
  • Make sure you and your kids aren’t exposed to second-hand smoke at daycare, school or friends’ homes.
  • Support businesses and activities that are smoke-free. Let other businesses owners know that you can’t support their businesses until they become 100 percent smoke-free too.
  • If you can’t find a smoke-free restaurant and must go to one that allows some smoking, ask to sit in the nonsmoking section.
  • If your asthma or COPD is triggered by smoke, don’t risk it – stay away from any place that allows smoking.
  • Support laws that restrict smoking.

Parents

  • Talk to your children about smoking; they’ll be less likely to smoke than if you ignore the problem.
  • Support tobacco education in the schools and ban all smoking on school grounds, on school buses, and at school-sponsored events for students, school personnel and visitors.
  • Ask that schools enforce the policy and consistently administer penalties for violations and that this is communicated in written and oral form to students, staff and visitors.
  • Vote for public smoking restrictions as an important component of the social environment that supports healthy behavior, reducing the number of opportunities to smoke, and making smoking less socially acceptable.
  • Support tax increases on tobacco products so young people cannot afford them.

Teens

  • If your friends smoke, ask them in a caring way to quit or at least not to smoke around you.
  • Peers, siblings, and friends are powerful influences on you and others. Understand that the most common situation for first trying a cigarette is with a friend who already smokes.

Families

Work together to uphold restrictions on tobacco advertising and promotions.

Sources and Resources

The Health Consequences of Involuntary Exposure to Tobacco Smoke: Children are Hurt by Secondhand Smoke. A Report of the Surgeon General, U.S. Department of Health and Human Services, 2006

CDC. Tobacco Use, Access & Exposure to Tobacco Among Middle & High School Students, US 2004 MMWR. Vol. 54(12) April 2005.

American Legacy Foundation. 2004 National Youth Tobacco Survey. 2005

CDC. Cigarette Use Among High School Students – United States, 1991-2003. Morbidity and Mortality Weekly Report 2004; 53(23): 499-502.

King C, Siegel M. The Master Settlement Agreement with the Tobacco Industry and Cigarette Advertising in Magazines. New England Journal of Medicine 2001; 345: 504-511.

© 2016 American Academy of Otolaryngology – Head and Neck Surgery

As many as 20 percent of high school boys and two percent of high school girls continue to use smokeless tobacco, according to the Centers for Disease Control and Prevention. Despite public education campaigns sponsored by medical societies, organized baseball, and individuals, 12 to 14 million American users, one third are under age 21, and more than half of those developed the habit before they were 13. Peer pressure is just one of the reasons for starting the habit. Serious users often graduate from brands that deliver less nicotine to stronger ones. With each use, you need a little more of the drug to get the same feeling.

There has been some progress. The organizer of America’s fastest growing sport, National Association for Stock Car Auto Racing (NASCAR) has dropped its long-time affiliation with Winston tobacco. NASCAR president Mike Helton says a total tobacco ban is an issue that’s on our radar for next year.

And there have been setbacks in the fight against smoking tobacco. New marketing campaigns that feature flavored smokeless products have won over new young users. Journalistic coverage of Dr. Brad Rodu and his support of smokeless tobacco as a substitute for cigarettes has diluted the Academy’s No Smokeless Tobacco Use message that has been an official campaign for this Academy since 1989. In a November 10, 2005 study; New Cigarette Brands with Flavors That Appeal to Youth: Tobacco Marketing Strategies; Health Affairs, November/December 2005, Volume 24, number 6, funded by the American Legacy Foundation and the National Cancer Institute noted that candy flavors were also added to smokeless tobacco products, cigars and cigarette rolling papers.

Gregory Connolly, senior author of the study and a professor of the practice of public health at the Harvard School of Public Health noted, Tobacco companies are using candy-like flavors and high tech delivery devices to turn a blowtorch into a flavored popsicle, misleading millions of youngsters to try a deadly product. Although the study focuses primarily on cigarettes, it noted that the addiction to smokeless tobacco or chew is as strong if not stronger than to cigarettes. Additional research has shown that there continues to be substantial evidence that smokeless tobacco is deadly. A December 18, 2003 study by Patricia Richter, Ph.D and Francis Spierto, Ph.D, two CDC researchers released by the Center for the Advancement of Health reported that the most popular brands of smokeless tobacco contain the highest amounts of nicotine that can be readily absorbed by the body. According to Richter, “Consumers need to know that smokeless tobacco products, including loose-leaf and moist snuff, are not safe alternatives to smoking,” Richter says. “The amount of nicotine absorbed per dose from using smokeless tobacco is greater than the amount of nicotine absorbed from smoking one cigarette.”

Kicking Tobacco Means Kicking It All

In November 11, 2005 Reuters story, “Oral Tobacco Not Safe Substitute for Smoking,” Dr. Stephen Hecht and colleagues from the University of Minnesota Cancer Center in Minneapolis related data from their current research that compared the levels of cancer-causing nitrosamines in popular smokeless tobacco products and medicinal nicotine products such as the nicotine patch, nicotine gum and nicotine lozenges.

The results clearly showed that the levels of cancer-causing nitrosamines are far higher in smokeless tobacco products than they are in medicinal nicotine products, Hecht said during a press briefing. While smokeless tobacco has demonstrably less carcinogens and toxins than cigarette smoke, said Hecht, smokeless tobacco still has remarkably high levels of carcinogenic tobacco-specific nitrosamines – levels that are 100 to 1,000 times higher than in any other consumer product that is designed for oral consumption. In a separate study, the team evaluated carcinogen biomarker levels in individuals using these products. They had 54 users of popular U.S. smokeless tobacco products use their usual brand for two weeks and then had them switch to either Swedish snus or a nicotine patch for four weeks.

The team found that carcinogen levels in urine were statistically significantly lower after the switch from U.S. smokeless tobacco brands to snus or to the nicotine patch. When comparing snus users to patch users, levels of cancer-causing compounds were significantly lower in patch users, indicating that medicinal nicotine is safer than snus, Hecht said. These results conflict with some prior studies that suggested that smokeless tobacco including moist snuff may be a less harmful habit than cigarette smoking because many of the carcinogens in cigarette smoke are either reduced or absent in smokeless tobacco. The bottom line, Dr.Hecht said, is that smokeless tobacco products are dangerous.

The evidence suggests, he continued, that smokeless products are in fact a cause of oral cancer and pancreatic cancer in humans. The current evidence does not support smokeless tobacco as a substitute for cigarette smoking.

© 2016 American Academy of Otolaryngology – Head and Neck Surgery