e-Cigarette Use Tied to Tobacco Use in Teenagers

Author: Diana Swift

e-Cigarette smoking appears to promote progression to traditional cigarette smoking and may be helping form a new population of smokers, according to a prospective study published online September 8 in JAMA Pediatrics.

Brian A. Primack, MD, PhD, from the Division of General Internal Medicine, University of Pittsburgh School of Medicine in Pennsylvania, and colleagues analyzed data on 694 young nonsmokers who were attitudinally nonsusceptible to smoking at baseline. The very small proportion (2.3%) who already used e-cigarettes at baseline proved more likely to progress to smoking or to being open to it.

The cohort, which was more than 75% non-Hispanic white, consisted of 374 females. The mean age of the 16 baseline e-cigarette users was 19.5 years compared with 20 years for nonusers.

Study data came from waves 2 and 3 of the US-based Dartmouth Media, Advertising, and Health Study, a national survey of adolescents and young adults aged 16 to 26 years who were recruited via random digit dialing using landline (66.7%) and cellular (33.3%) telephone numbers.

The survey, conducted from October 1, 2012, to May 1, 2014, started tracking e-cigarette use at wave 2 (2012 – 2013), which served as the baseline, whereas wave 3 (2013 – 2014) served as follow-up for the current study.

Eligible participants had to be never-smokers and attitudinally nonsusceptible to smoking at baseline. This was assessed with these questions: “If one of your friends offered you a cigarette, would you try it?” and “Do you think you will smoke a cigarette sometime in the next year?” Response options included “definitely yes,” “probably yes,” “probably no,” and “definitely no.” Those who responded “definitely no” to both measures were considered nonsusceptible nonsmokers.

After a year, 11 of 16 baseline e-cigarette users (68.8%) and 128 of 678 participants nonusers (18.9%) progressed to traditional combustible cigarette smoking. After controlling for demographic covariates such as age, sex, and maternal education level, baseline e-cigarette use was independently associated with both progression to smoking (adjusted odds ratio [AOR], 8.3; 95% confidence interval, 1.2 – 58.6) and progression to susceptibility (AOR, 8.5; 95% CI, 1.3 – 57.2) among initially nonsusceptible nonsmokers.

“These findings support regulations that decrease the accessibility and appeal of e-cigarettes to nonsmoking adolescents and young adults,” Dr Primack and associates write.

Conceding that some might see the small percentage of baseline e-smokers as not translating into a substantial public health risk, the researchers caution that e-cigarette use is on the rise. “[D]ata published in 2015 suggest that large numbers of youth are initiating e-cigarette use and that as many as half of these individuals do not smoke traditional combustible cigarettes. Therefore, it will be important to continue surveillance among youth of both e-cigarette use and overlap with use of other tobacco products.”

Noting that many youth may be dual users of cigarettes and e-cigarettes, the authors say nicotine exposure may drive initial e-cigarette users to use cigarettes as a more efficient nicotine delivery device. In addition, nicotine content aside, “e-cigarettes may behaviorally accustom individuals to powerful cigarette smoking cues such as inhalation, exhalation, and holding the cigarette.”

Furthermore, e-cigarettes, which expose users to potentially harmful aerosolized substances other than nicotine, are not subject to regulations limiting cigarette smoking, such as age limits for sale, flavoring and marketing restrictions, clean air laws, taxes, and labeling requirements, which may increase their accessibility to youth. “For example, e-cigarettes are marketed on television, representing the first time in more than 40 years that a smoking-related device is advertised on this medium,” the investigators write.

In an accompanying editorial, Jonathan D. Klein, MD, MPH, an adolescent medicine specialist and an associate executive director of the American Academy of Pediatrics in Elk Grove Village, Illinois, noted that a recent Centers for Disease Control and Prevention report found that e-cigarette use in the National Youth Tobacco Survey increased from 4.5% in 2011 to 13.4% in 2014, affecting more than 2.2 million students. “The article by Primack et al is one more piece of evidence that the effect of e-cigarettes on youth is happening now in real time,” he writes, adding that “these data provide strong longitudinal evidence that e-cigarette use leads to smoking, most likely owing to nicotine addiction.”

Dr Klein also points to mounting concerns among health experts that e-cigarettes will also renormalize smoking, delay or prevent cessation, and cause former smokers to become re-addicted. He says the evidence suggests that e-cigarette users are less likely to quit smoking traditional cigarettes than nonusers In spite of such data and evidence of harm from e-smoking devices. He states that the US Food and Drug Administration has failed to assert authority and oversight over these alternative products.

“We do not need more research on this question; we have the evidence base, and we have strategies that work to protect nonsmokers from e-cigarettes and other forms of tobacco,” Dr Klein writes. “What we still need is the political will to act on the evidence and protect our youth.”

This study was supported by grants from the National Cancer Institute and the National Center for Advancing Translational Sciences. The authors and Dr Klein have disclosed no relevant financial relationships.

JAMA Pediatr. Published online September 8, 2015. Article full text, Editorial full text

*This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

February, 2016|Oral Cancer News|

Researchers Find Hookah Smoking Can Lead to Serious Oral Conditions – Equivalent To Smoking 100 Cigarettes

Author: PR Newswire

CHICAGO, Oct. 28, 2015 /PRNewswire/ — According to the Centers for Disease Control and Prevention, 2.3 million Americans smoke tobacco from pipes, and many of those who smoke waterpipes, or hookahs, believe it’s less harmful than cigarettes. However, research published in The Journal of the American Dental Association (JADA) suggests hookah smoking is associated with serious oral conditions including gum diseases and cancer.

“We found that waterpipe smoking is associated with serious health problems affecting the head and neck region,” said study author Teja Munshi, B.D.S., M.P.H of Rutgers University. “The public needs to know they are putting themselves at risk. They should be made aware of the dangers of smoking hookahs.”

The authors conducted a literature review that focused on waterpipe smoking and head and neck conditions. They found waterpipe smoking to be associated with gum diseases, dry socket, oral cancer and esophageal cancer among other conditions. According to the World Health Organization, smoking a hookah is the equivalent of smoking 100 cigarettes, based on the duration and number of puffs in a smoking session.

“This study sheds light on the common misconception that smoking from a waterpipe is somehow safer than smoking a cigarette,” said JADA Editor Michael Glick, D.M.D. “Whether you are smoking a cigarette, an e-cigarette, a cigar, or tobacco from a waterpipe, smoking is dangerous not only to your oral health but to your overall health.”

The American Cancer Society is hosting The Great American Smokeout on November 19, 2015, an annual event that encourages smokers of all kinds to give up the habit. The event asks smokers to quit even for just one day to take a step toward a healthier life.

Millions of Americans still use traditional methods of smoking, but emerging trends in the smoking industry, such as hookah smoking and e-cigarettes pose dangers as well. E-cigarettes are devices that turn liquid into a vapor containing nicotine. In an editorial in the September 2015 issue of JADA, authors warned readers of the potential dangers of e-cigarettes, indicating that oral health effects of their use has been inadequately investigated.

“Additional research is needed on the impact smoking has on overall health, but it’s clear that smoking of all kinds has the potential to be dangerous,” said Dr. Glick.

Dentists have an important role in advising patients of the dangers of smoking. The American Dental Association has long been a proponent of educating the public about its hazards and has urged for continued research into the adverse health effects of tobacco use. For more information on smoking and its oral health effects, visit


This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

October, 2015|Oral Cancer News|

Smokeless tobacco use on the rise among high school athletes

Author: Jeron Rennie

A new Centers for Disease Control and Prevention (CDC) report shows a trend they don’t want to see.

A Morbidity and Mortality Weekly Report (MMWR) shows that from 2001-2013, smokeless tobacco use increased significantly among high school athletes, but not with non-athletes.

The report also found there was lower use of combustible tobacco products among athletes than non-athletes. The CDC said that could be due, in part, to an awareness of the negative consequences on athletic performance. However, they say the use of smokeless tobacco suggests they find those products as being harmless.

“When you see it in the media and you see all those athletes that you’re looking up to as a younger student and trying to reach some of the goals that they’ve reached,” said Freeborn County Drug-Free Coalition Prevention Coordinator Lana Howe. “It definitely plays a large impact on you as a youth.”

The CDC said using smokeless tobacco can, however, adversely impact athletic performance and lead to disease and early death since they contain nicotine, toxins and carcinogens.

Several athletes with a history of smokeless tobacco use have been diagnosed with, or died from, oral cancer.

September, 2015|Oral Cancer News|

Boston votes to ban chewing tobacco from ballparks, including Fenway

Author: Marissa Payne


Baseball in Boston is about to change. On Wednesday, the City Council voted unanimously to make its baseball parks and stadiums, including historic Fenway, tobacco-free zones. And yes, the ordinance covers the kind of tobacco you chew, a longtime favorite of many MLB players.

“This action will save lives by reducing the number of young people who begin to use smokeless tobacco because they followed the example of the Major Leaguers they idolize,” Matthew Myers, president of the Campaign for Tobacco-Free Kids said in a statement sent to The Washington Post. “We thank Mayor Marty Walsh, the City Council and Boston’s health community for their leadership on this important issue.”

Red Sox owner John Henry was also supportive of the legislation.

“It’s a great thing,” Henry said (via when Mayor Walsh first proposed the legislation last month. “I’m very supportive.”

The ban doesn’t just apply to players, but also fans, and it covers all stadiums from major-league to organized amateur games. Those found in violation of the ordinance face a $250 fine, Boston’s Fox affiliate reports.

Boston is now the second major U.S. city to ban tobacco at its baseball stadiums. San Francisco, which banned the substance in April, was the first. Both cities had very good reasons to nix the chew.

Smokeless tobacco, like cigarettes, contains the addictive substance nicotine and its users can become more at-risk for illnesses such as cancer, gum disease and heart disease, according to the Mayo Clinic.

“You can call chewing tobacco by whatever name you want — smokeless tobacco, spit tobacco, chew, snuff, pinch or dip — but don’t call it harmless,” a Mayo Clinic brochure says.

The most dangerous side effects of chewing tobacco rose to fame last year when two former major league players connected their cancers to the habit.

“I do believe without a doubt, unquestionably, that chewing is what gave me cancer,” former MLB pitcher Curt Schilling said at the WEEI/NESN Jimmy Fund Radio Telethon last year. “I did [it] for about 30 years. It was an addictive habit. … I lost my sense of smell, my taste buds for the most part. I had gum issues, they bled, all this other stuff. None of it was enough to ever make me quit. The pain that I was in going through this treatment, the second or third day it was the only thing in my life that … I wish I could go back and never have dipped. Not once. It was so painful.”

An even more dire warning came from the experience of San Diego Padres slugger Tony Gwynn. His cancer of the mouth and salivary glands killed him last year at the age of 54. Before his death, he too blamed his disease on smokeless tobacco.

“Of course, it caused it,” Gwynn once said. “I always dipped on my right side.”

Despite the health concerns, however, many MLB players, including several Red Sox players, continued to use chewing tobacco.

An informal Boston Globe survey last month found that 21 of the 58 Red Sox players who were invited to spring training last year indicated they used smokeless tobacco. This is despite the team already discouraging the substance’s use by offering players other things to chew on, including gum and sunflower seeds.

With the new ordinance, however, those players will now be forced to find new, possibly safer habits, which the Boston City Council and tobacco-free advocates hope trickle down to their young fans.

While cigarette use among youths in the United States is declining, smokeless tobacco use has remained steady. According to the Centers for Disease Control and Prevention, more than five out of every 100 high school students reported using smokeless tobacco in 2014. Nearly two out of ever 100 middle schoolers said they used the substance.

Boston and San Francisco aren’t the only city’s that see a problem either.

In June, a member of the Los Angeles City Council proposed legislation to also ban tobacco at area baseball stadiums.

“It’s about protecting the health of our players and the health of our kids,” Councilman Jose Huizar told the Los Angeles Times. “America has a great pastime, but chewing smokeless tobacco shouldn’t be part of that.”

*This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

September, 2015|Oral Cancer News|

Teen E-Cig Users More Likely to Smoke


Newswise — As e-cigarette usage among high school students continues to climb, a recent study from The Journal of the American Medical Association reveals an unsettling trend: that adolescent e-cigarette users are more likely than their non-vaping peers to initiate use of combustible tobacco products such as cigarettes, cigars and hookahs. The reason may lie in a common denominator between e-cigarettes and their combustible counterparts: nicotine.

While the study hints that more research is needed to determine if this association is merely casual, it’s important to note that while e-cigarettes don’t contain tobacco, the battery-powered devices do deliver nicotine in aerosol form.

“Nicotine’s addictive properties are a risk for any age group, but with adolescents, the stakes are even higher,” says Dr. K. Vendrell Rankin, director of Texas A&M University Baylor College of Dentistry’s Tobacco Treatment Services.

For teens, mental health as well as key emotional and cognitive systems are at stake.

“Major cognitive functions and attention performance are still in the process of developing during adolescence,” says Rankin, also a professor and associate chair in public health sciences at TAMBCD. “Nicotine increases the risk of developing psychiatric disorders and lasting cognitive impairment and is associated with disturbances in working memory and attention. Reliance on nicotine to manage negative emotions and situations impairs the development of coping skills.”

In addition to affecting the emotional and cognitive development of teens, nicotine is highly addictive. In fact, the younger a person is when they begin using nicotine, the more likely they are to become addicted and the stronger the addiction may become. According to the American Lung Association, of adults who smoke, 68 percent began smoking at age 18 or younger.

In other words, the younger users are when they try or start using nicotine, the more nicotine receptors they will have and the more they may struggle with nicotine cravings throughout  their lives.

“Everybody has a certain amount of nicotine receptors in the brain,” Rankin says. “When you start smoking, vaping or supplying nicotine to them, they multiply. If you stop smoking or vaping, the receptors don’t go away.”

Nicotine use very quickly escalates into addiction, even when dealing with tobacco-free, odorless “vaping” associated with e-cigarettes. That’s because nicotine in any form triggers the release of neurotransmitters such as adrenaline and dopamine, which dramatically impacts a number of body systems. Dopamine floods the brain, and nicotine cravings increase.

This includes spit, or smokeless tobacco, which in the past was promoted as a replacement to smoking. The result: The creation of a large group that began using spit tobacco as a smoking replacement but eventually became dual users.

“We are seeing the same phenomena with the e-cigarette,” says Rankin. To better understand the similar association between e-cigarettes and combustible tobacco product use among teens, Rankin says further research could be replicated on a national level, as the study published in The Journal of the American Medical Association focused on Los Angeles high school students.

E-cigarette companies currently advertise their products to a broad audience that includes 24 million youths, and proposed U.S. Food and Drug Administration regulations would not limit e-cigarette marketing. Bold marketing tactics, celebrity endorsements, endless flavor choices and a plethora of online videos instructing users on how to mix their own e-cigarette liquid, or “e-juice,” have only added fuel to the fire. There currently are no federal laws in place to restrict minors from purchasing e-cigarettes.

There is a glimmer of hope on the horizon. In April, the FDA released the details of a proposal to extend its tobacco authority to e-cigarettes, including minimum age and identification restrictions intended to prevent sales to minors. A final ruling is slated for summer 2015.

In the meantime, many Texas cities have set their own regulations and ordinances banning the sale of e-cigarettes to minors. Any e-cigarette regulation in Texas will have to occur city by city, Rankin says, since the state doesn’t have comprehensive smoke-free laws.

“I don’t think e-cigarettes are going to drop off,” Rankin says. “It’s the newest — or most popular — kid on the block right now.”

*This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

August, 2015|Oral Cancer News|

Professional Rodeo Competitors Join Fight Against Oral Cancer

Author: Melissa Allison


The number of oral cancer deaths related to tobacco use is on the rise nationwide according to the Oral Cancer Foundation. Brian Hill is the founder of the OCF and a survivor of the disease.

Kiser-OCFCody Kiser encourages the youth to not start using tobacco to help secure good health. Oral Cancer Foundation


“Up until about (the year) 2000 this was primarily a disease of older men who had smoked a lot or chewed tobacco during their lifetime,” Hill said. “About that point in time we started to see a shift in the cause of the disease.”

Hill said tobacco is still a primary cause of oral cancers and adds that the oral human papillomavirus type 16 (HPV16) is new etiology that has forced the number of cases to accelerate.

According to an October 2014 study by Johns Hopkins researchers the HPV16 causes cancers of the mouth and throat and that any form of tobacco use increases the risk of the virus. The research suggests as few as three cigarettes a day can increase the risk of infection by almost one-third.

Hill created the foundation in 1999 to promote change by educating the public about risk factors that contribute to the disease. Among those risks is the use of spit tobacco.

“The world of rodeo has been the realm of sponsorship by the tobacco industry for decades,” Hill said. “With the nicotine content in a can of dip equaling approximately that of 80 cigarettes, this addiction can be one of the hardest to break. We hope to educate parents and youth about the dangers before they even get started.”

The OCF is turning to professional rodeo competitors to serve as positive role models during a national campaign.

Cody Kiser is a professional bareback bronc rider from Reno, Nevada.  He was in Delta, Utah recently where he competed at the Millard County Fairgrounds. Kiser told parents at the rodeo that nearly 15 percent of high school boys in the United States use smokeless tobacco.

“My dad was a cowboy, so I know what it’s like looking up to cowboys as heroes for my whole life. Health and fitness have always been incredibly important to my family. My dad was a positive role model in my life growing up in that regard, and the idea of using spit tobacco never appealed to me,” Kiser said. “Right now, I’m pursuing rodeo as a passion of mine, and if at the same time I can do some good in the world and set the right example for young kids who might look up to me, then I’m honored and eager to do so.”

Kiser said cowboys have a reputation that is second only to baseball players for being users of tobacco in the world of sports.  He wants to change that reputation throughout the country and in Utah, where rodeo is popular.

“From my point of view, Utah seems to be on the front lines of health and fitness,” he said.  “I’ve been very impressed with Utah as far as a healthy lifestyle, people who don’t smoke and chew so it’s good to see in Utah that they don’t do that as much.”

*This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

Smoking rates are down, but a different type of tobacco use is on the rise

Author: Anna Almendrala

First, the good news: Smoking rates are down significantly in 26 states. The bad news? The use of smokeless tobacco (also known as dip, snuff or chew) is up in four states, while using both cigarettes and smokeless tobacco is up significantly in five states.

“Although overall cigarette smoking prevalence has declined significantly in recent years in many states, the overall use of smokeless tobacco and concurrent cigarette and smokeless tobacco has remained unchanged in most states and increased in some states,” summed up researchers for the Centers for Disease Control, which published the data in their weekly Morbidity and Mortality report.

From 2011 to 2013, four states showed increased smokeless tobacco use: Louisiana, Montana, South Carolina and West Virginia. Only two states — Ohio and Tennessee — exhibited decreases. In terms of total use, Massachusetts and the District of Columbia reported the lowest numbers of smokeless tobacco, at 1.5 percent, in 2013. In contrast, West Virginia reported the highest use, at 9.4 percent, with Wyoming and Montana coming in second and third, at 8.8 percent and 8 percent, respectively.

Breaking down tobacco use by state helps health officials create more targeted state and local tobacco policies, explained CDC researcher Kimberly Nguyen in an email to HuffPost.

“It’s important to note that the states with lower tobacco use prevalence typically have more robust tobacco control programs and greater adoption of evidence-based population level interventions,” she wrote.



The findings are significant because past research has shown that people using both products are more addicted to nicotine and less likely to want to quit both habits than those who just smoke cigarettes. It also suggests that the public may have misperceptions about the safety of smokeless tobacco — namely, that it is a safer alternative to cigarettes — thanks to advertising campaigns.

The findings are significant because past research has shown that people using both products are more addicted to nicotine and less likely to want to quit both habits than those who just smoke cigarettes. It also suggests that the public may have misperceptions about the safety of smokeless tobacco — namely, that it is a safer alternative to cigarettes — thanks to advertising campaigns.

In reality, smokeless tobacco is addictive because of the nicotine it contains, and it can cause oral, esophageal and pancreatic cancer, according to the NIH’s National Cancer Institute. It may also cause other diseases like gum disease, oral lesions and precancerous patches in the mouth called leukoplakia. In no way should it be considered an aid to help people quit smoking, notes the NCI.

“Smokeless tobacco use can also increase risks for early delivery and stillbirth when used during pregnancy, cause nicotine poisoning in children, and may increase the risk for death from heart disease and stroke,” Nguyen added. “Smokeless tobacco is not a safe alternative to smoking.”

The CDC researchers aren’t sure why smokeless tobacco use is going up, but the report notes a few possible reasons.

“These increases could be attributable to increases in marketing of smokeless tobacco, the misperception that smokeless tobacco is a safe alternative to cigarettes, and the lower price of smokeless tobacco products relative to cigarettes in most states,” wrote the researchers. “In addition, the tobacco industry has marketed smokeless tobacco as an alternative in areas where smoking is otherwise prohibited.”

Just last month, the Food & Drug Administration rejected tobacco producer Swedish Match AB’s request to remove cancer warnings from their smokeless tobacco product, Snus, and replace the warnings with the claim that it is safer than cigarettes. And last week, the FDA also rejected a petition from R.J. Reynolds Tobacco Company and American Snuff Company to similarly alter the labels on their smokeless products.

To combat rising rates of smokeless tobacco use, the CDC recommend that states increase their spending on anti-tobacco programs, which include increasing the price on products, restricting tobacco advertising, increasing anti-tobacco graphics and commercials, and helping users quit their addictions. Indeed, while states will bring in more than $25 billion in settlement payments and tobacco taxes in 2015, they’re also projected to spend less than two percent of that revenue on such programs — much less than the CDC-recommended levels for each state.

Asia’s deadly secret: the scourge of the betel nut

Author: staff

It is used by almost a tenth of the world’s population. It gives people a buzz equivalent to six cups of coffee and is used variously as a symbol of love, marriage and a cure for indigestion and impotence.

But it is also leading tens of thousands to an early grave.

The culprit? The humble betel nut.

Found across Asia, these nuts are harvested from the Areca palm and are chewed for their warming glow and stimulating properties.

Such is its effectiveness, that alongside nicotine, alcohol and caffeine, betel nuts are believed to be one of the most popular mind-altering substances in the world.

Although used by women and children, the nuts are especially popular among working-age men, who chew to stay awake through long hours of driving, fishing or working on construction sites.

But the short-lived benefits come at a terrible cost.

High rates of oral cancer are destroying the lives of many who buy betel nuts, often decades after their first taste.

Now in Taiwan, where the nuts are affectionately known as ‘Taiwan’s chewing gum’, the government is taking action to curb this centuries-old habit and reduce the thousands of lives lost each year.

Dangerous combination


Regular betel nut chewers stand out from the crowd with their red-stained lips and teeth

The betel nut is a key part of many Asian cultures and can be consumed dried, fresh or wrapped up in a package known as a quid.

Although the exact preparation varies across countries and cultures, the quid is usually a mixture of slaked lime, a betel leaf and flavourings such as cardamom, cinnamon and tobacco.

Worryingly, the International Agency for Research on Cancer lists each ingredient, with the exception of cardamom and cinnamon, as a known carcinogen – or cancer-causing agent.

The slaked lime is seen as a particular problem as it causes hundreds of tiny abrasions to form in the mouth. This is thought to be a possible entry point for many of the cancer-causing chemicals.

“About half of the men here still don’t know that betel nuts can cause oral cancer,” says Prof Hahn Liang-jiunn, an oral cancer specialist at the National Taiwan University Hospital.

“[This is despite] Taiwan’s incidence or mortality rates for oral cancer ranking among the top two or three in the world.”

‘I started chewing because everyone else did’

Like most people, Qiu Zhen-huang, 54, was completely unaware of the risks.

A former gravel company worker, he chewed for ten years. Twenty years after quitting, he developed the disease.

“I started chewing betel nut because everyone at work did it,” says Mr Qiu.
“We shared it with each other to build good relations.”

Three years ago, a small hole developed in his left cheek and in just three months, the tumour grew to the size of a golf ball and completely changed his life.

“Whatever I ate flowed out. I had a gauze pad over it. It hurt,” he said.

“It affected me a lot. I was so ashamed I avoided going out.”

Each year, 5,400 Taiwanese men like Mr Qiu are diagnosed with oral cancer or pre-cancerous lesions and an estimated 80 to 90% of those also chew betel nuts.

An early symptom includes white or red lesions inside the mouth, but this can rapidly progress to grotesque flesh-eating tumours.

Unlike other cancers, these are difficult to hide, leaving sufferers physically and psychologically devastated.

“It’s miserable for them,” says Prof Hahn.

“Sometimes, even after surgery, they still can’t perform basic functions, including expressing emotions through their face because the lower jaw also has to be cut depending on the scale of the cancer.”

Tackling the scourge

The Taiwanese government is offering subsidies in return for cutting down betel nut palms

The Taiwanese government is offering subsidies in return for cutting down betel nut palms

Luckily for Qiu Zhen-huang, his cancer was treated and his cheek reconstructed.

But the Taiwanese government is helping people detect the disease much sooner by providing around one million free screenings and funding programs to help people quit betel nuts for good.

In 2013, these measures helped cut the usage rate among men by nearly half.

The government is also trying to reduce the domestic supply of betel nuts by offering subsidies to farmers to cut down their trees and plant alternative crops.

Other countries such as India and Thailand have also launched campaigns to discourage betel nut chewing.

But there is still a way to go. At a recent presentation to elementary school children of fishing industry workers, nearly all raised their hands when asked whether their parents or relatives chewed betel nuts.

And as the cancer can take up to 20 years to appear, the current changes will have come too late for many people – a fact that Mr Qiu keeps close to his heart.

“I’m one of the luckier ones.”

March, 2015|Oral Cancer News|

Great American Spit Out warns of new tobacco lures

Author: Kate Santich, Orlando Sentinel

As anti-tobacco advocates celebrate today’s Great American Spit Out — the “chew” equivalent of the Great American Smoke Out — health officials warn that new dissolvable and flavored varieties of smokeless-tobacco products are targeting teens in a mission to get them hooked.

Newly released data from state health researchers show that, while cigarette smoking among Florida youth has reached an all-time low, smokeless tobacco use has been virtually unchanged for the past decade: roughly 5.5 percent among high school students statewide.

And it’s nearly 9 percent in some counties, including Lake.

“The tobacco industry is targeting us,” said Magi Linscott, a Pensacola-area 18-year-old named National Youth Advocate for 2014 by the Campaign for Tobacco-Free Kids. “They’re trying to get a new generation of addicts.”

Recent product developments include colorfully packaged, kid-friendly flavors of tobacco-infused candy, mints, gum, breath strips and flavored toothpicks — all containing nicotine. Depending on the type, they are designed to be held in the mouth, chewed, or sucked until they dissolve and the juices swallowed.

Along with more traditional chew, snuff and a teabag-like pouch of finely ground tobacco called snus (“snoose”), smokeless products may lure users with a false sense of safety. Shannon Hughes, Tobacco Free Florida bureau chief, said young people — and their parents — may not realize the dangers of the products, which increase the risk of oral cancer by 80 percent.

“Adults think, ‘Well, at least they’re not smoking,'” Hughes said. “Yes, cigarettes do cause more systemic damage to the body. But smokeless tobacco dramatically increases the risk of oral cancer, which is horribly disfiguring, and a horrible way to die. The bottom line is: There’s no safe level of tobacco use.”

The Spit Out — aimed at raising awareness of the problem — is part of a national “Through with Chew Week.” But because no single agency sponsors the campaign, it lacks the name recognition of the Smoke Out, officials admit.

Still, Hughes and others said, the proliferation of smokeless products makes the message especially urgent.

Chew and snuff have long been popular among baseball players and in rural communities, where their use is sometimes a rite of passage. Among local high-school students surveyed last year, only 3.1 percent of those in Orange County said they currently used smokeless tobacco, while the rate was 4.2 in Osceola, 5.3 in Seminole and 8.9 percent in Lake.

Use is vastly more common for males than females and for whites than blacks or Hispanics.

“It’s part of the culture in certain areas,” Hughes said. “And it can be easier to conceal,” especially with the newer forms. It is also cheaper than cigarettes.

But the American Cancer Society warns that because U.S. tobacco sellers are not required to list what’s in their products, it’s hard to know exactly how hazardous the smokeless varieties can be.

The World Health Organization has identified at least 28 carcinogens in smokeless tobacco, and along with the heightened risk of oral cancer, there’s a 60 percent increase in the risk of esophageal and pancreatic cancers compared to non-users. The products also raise the risk of heart disease and fatal strokes and may impact reproductive health, Hughes said.

“And because youth are often most concerned with the immediate impact,” she said, “we point out that smokeless tobacco use can cause tooth decay, permanent discoloration of teeth and gingivitis leading to tooth loss.”

Perhaps most disconcerting is the increased likelihood of stepping up to more lethal forms of tobacco. Researchers found smokeless-tobacco users tend to experiment with smoking and are more likely to become addicted. The younger the user, scientists say, the more sensitivity to nicotine.

February, 2015|Oral Cancer News|

Levels of cancer-causing chemicals in smokeless tobacco products influence carcinogen exposure

Author: staff

Higher levels of cancer-causing chemicals called tobacco-specific nitrosamines in smokeless tobacco products led to greater exposure to these carcinogens even after taking into account how much or how long the product was used, according to a study published in Cancer Prevention Research, a journal of the American Association for Cancer Research.

“Our results show that although the pattern of tobacco use—for example, amount of dip and number of dips—can influence the level of smokeless tobacco users’ exposure to tobacco-specific nitrosamines, the actual amount of these chemicals in the products also makes a significant difference,” said Dorothy K. Hatsukami, PhD, the Forster Family professor in cancer prevention in the Department of Psychiatry at the University of Minnesota in Minneapolis.

“The majority of smokeless tobacco users in the United States are not aware of the levels of cancer-causing chemicals in their smokeless tobacco products or of the tremendous variability in the levels of these chemicals across brands sold in this country,” continued Hatsukami. “At a minimum, the FDA [U.S. Food and Drug Administration] should provide smokeless tobacco consumers information about the different levels of cancer-causing chemicals in different brands of smokeless tobacco and, ideally, require levels of tobacco-specific nitrosamines be substantially reduced, if not eliminated, in all products. Levels of these chemicals in smokeless tobacco products could be readily reduced by changing manufacturing practices.”

Levels of exposure to tobacco-specific nitrosamines are associated with disease risk, according to Hatsukami. Prior studies have shown that smokeless tobacco users in the United States experience about two to three times greater risks for oral cancer compared with those who do not use these products, she said. Pancreatic cancer has also been linked to smokeless tobacco use.

“Now that the FDA has the authority to establish product standards—that is, mandate the reduction of harmful and potentially harmful constituents in tobacco products—there has been greater interest in understanding how levels of tobacco-specific nitrosamines in products relate to exposure,” said Hatsukami.

To study this, Hatsukami; Stephen Hecht, PhD, the Wallin professor of cancer prevention in the Department of Laboratory Medicine and Pathology at the University of Minnesota; and their colleagues analyzed data from 391 adults from Minneapolis/St. Paul; Eugene, Oregon; and Morgantown, West Virginia, who used smokeless tobacco products daily. The smokeless tobacco brands used by different participants varied in nicotine and tobacco-specific nitrosamine content. Participants could not be current users of other tobacco or nicotine products.

At two assessment sessions, approximately one week apart, demographic information, smokeless tobacco-use history, and urine samples were collected from participants. Urine samples were analyzed for biomarkers of exposure to nicotine and the tobacco-specific nitrosamines N’-nitrosonornictoine (NNN) and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK).

Analysis showed that levels of biomarkers of NNN and NNK in users’ urine samples were independently positively correlated with the number of years of daily smokeless tobacco use, number of tins of smokeless tobacco used each week, mean daily dip duration, and levels of NNN and NNK in the smokeless tobacco products used. For every one unit (µg/g wet weight) increase of NNK and NNN in the smokeless tobacco product used, the estimated increase of the corresponding biomarkers was 32 percent and 12 percent, respectively.

The study was supported by the National Cancer Institute. Hatsukami declares no conflicts of interest. Hecht served as an expert witness in a smokeless tobacco trial 10 years ago.

December, 2014|Oral Cancer News|