E-Cigarettes fail to help cancer patients quit smoking

Author: Anna Azvolinsky, PhD

Among cancer patients who smoke, electronic cigarette (e-cigarette) users had greater nicotine dependence compared with traditional cigarette smokers, and e-cigarettes did not help patients quit smoking, according to the results of a study published in Cancer.


E-cigarettes have been touted as possible tools for smoking cessation.

According to the study authors, these are the first published results on e-cigarette use and smoking cessation among cancer patients and put into question the potential benefits of using e-cigarettes as part of a smoking cessation program for cancer patients.

Those diagnosed with cancer who continue to smoke are advised to quit. The uptick in the use of e-cigarettes has raised the question of whether these newer types of cigarettes can facilitate or hamper the ability to quit smoking for good.

In the new study, Jamie Ostroff, PhD, of the Memorial Sloan Kettering Cancer Center in New York, examined 1,074 cancer patients who smoked and were enrolled in a tobacco treatment program between 2012 and 2013 at the cancer center.

Using a complete case analysis, e-cigarette users were equally likely to still smoke as those who did not use e-cigarettes (odds ratio of 1). Using an intention-to-treat analysis, e-cigarette users were twice as likely to be smoking at the time of follow-up (odds ratio = 2, P < .01).

The 7-day abstinence from smoking was 44.4% for e-cigarette users compared with 43.1% for non-users.

Patients who were e-cigarette users at study enrollment were likely to be more nicotine-dependent and had more prior attempts at quitting smoking compared to traditional cigarette smokers. E-cigarette users were also more likely to be diagnosed with lung cancer or cancers of the head and neck.

The researchers observed a threefold increase in e-cigarette use, from 10.6% to 38.5% from 2012 and 2013. “Consistent with recent observations of increased e-cigarette use in the general population, our findings illustrate that e-cigarette use among tobacco-dependent cancer patients has increased within the past 2 years,” said Ostroff in a statement.

Follow-up data on cessation was available from 59.5% of the patients on study. Moreover, a significantly higher percentage of e-cigarette users quit the tobacco treatment program or were lost to follow-up compared to those who did not use e-cigarettes (66.3% vs 32.4%, P < .01).

Fifty-seven percent of the patients on study were female, mean age was 56 years, and 69.2% of the patients had tried to quit smoking at least twice prior to enrolling in this study. About one-third of the patients reported a high dependence on nicotine. The highest percentage of patients had thoracic cancer (19.8%), 14.9% had breast cancer, 9.7% had head and neck cancer, and 8% had genitourinary cancer.

First introduced in the United States in 2007, e-cigarettes are battery powered cigarette-like devices that mimic the same sensory experience as traditional cigarettes and provide nicotine for the user.

Still, further studies of broader geographic cohorts and controlled study conditions, are needed. The current study relied on patient responses to assess cessation and was only conducted at a single cancer center.

Controlled research is needed to evaluate the potential harms and benefits of e-cigarettes as a potential cessation approach for cancer patients. In the meantime, said Ostroff, oncologists should advise all smokers to quit smoking traditional combustible cigarettes, encourage patients to use US Food and Drug Administration (FDA)-approved cessation medications, refer patients for smoking cessation counseling, and provide education about the potential risks and lack of known benefits of long-term e-cigarette use.

September, 2014|Oral Cancer News|

Baseball, youth, and smokeless tobacco

Authors: Richard Pieters, M.D. & Anthony Giambardino, D.M.D.

The headlines first came with baseball Hall of Famer Tony Gwynn. His all-too-early death at 54 was attributed to the long-term use of smokeless tobacco. Now it’s former Red Sox pitcher Curt Schilling, who revealed on Aug. 20 that he was diagnosed in February with mouth cancer. “I do believe without a doubt, unquestionably,” said Schilling when making his condition public, “that chewing [tobacco] is what gave me cancer … I did it for 30 years. It was an addictive habit.” His physician agreed.

Many of us who grew up with the game are used to seeing players chewing tobacco, but a new generation of children watching in the stands and on television may be seeing smokeless tobacco used for the first time. They are the ones most influenced by what baseball players do both on and off the field. And that behavior by professional athletes can be more powerful in shaping behavior than any advertising campaign by the tobacco industry.

Although cigarette smoking in the U.S. continues to decline, a report from the U.S. Centers for Disease Control and Prevention (CDC) indicates that the use of smokeless tobacco has held steady over the past nine years. CDC says 14.7% of high-school boys, and 8.8% of all high-school students, reported using smokeless products in 2013.

The CDC further states that smokeless tobacco contains 28 carcinogens, which can cause gum disease, stained teeth and tongue, a dulled sense of taste and smell, slow healing after a tooth extraction, and, worst of all, oral cancer.

Smokeless tobacco is not harmless. According to the National Institute on Drug Abuse, it delivers more nicotine than cigarettes and stays in the bloodstream longer. Clearly, tobacco use is both a serious medical problem and an oral-health problem.

In a letter to baseball commissioner Bud Selig following the death of Tony Gwynn, nine leading healthcare organizations, including the American Medical Assoc. and the American Dental Assoc., stated that “use of smokeless tobacco endangers the health of major-league ballplayers. It also sets a terrible example for the millions of young people who watch baseball at the ballpark or on TV and often see players and managers using tobacco.”

Oral cancer continues to be a serious problem in the U.S. More than 30,000 new cases are diagnosed each year, and the five-year survival rate is only around 50%. While a batting average of .500 would be considered outstanding in baseball, 50/50 odds aren’t very good in the game of life.

The connection between oral health and overall health is well-documented. What happens in the mouth can affect the entire body. Physicians are now being trained to examine the mouth and work with dentists to make patients more aware of the importance of oral health as it affects their overall health and well-being.

Programs such as the Mass. Dental Society’s Connect the Dots, in which physicians and dentists work together in the community, and the Mass. Medical Society’s establishment of a Committee on Oral Health mark the beginning of a growing relationship between physicians and dentists to promote oral health in the Commonwealth.

But oral cancer isn’t the only health risk from smokeless tobacco. Users have an increased risk of heart disease, high blood pressure, heart attacks, and strokes. Many health issues are preventable, especially those related to tobacco use. The medical and dental professions can play a key role by providing education and screening for oral cancer.

Major-league baseball players have an important opportunity to contribute to this educational process by aiding in prevention efforts, particularly aimed at impressionable young people. For the past four years, the Mass. Dental Society, in partnership with NESN and the Boston Red Sox, has produced TV campaigns on the dangers of smokeless tobacco.

The Mass. Medical Society and the Mass. Dental Society are committed to reducing tobacco use in all its forms and welcome the continued participation of the Red Sox and all of major-league baseball. In 2014, chewing tobacco continues to be as much a symbol of baseball as the actual action on the field.

For the health of our children, shouldn’t this image of our national pastime now be considered past its time? The cases of Tony Gwynn and Curt Schilling should serve as a warning to us all.

Dr. Richard Pieters, a radiation oncologist at UMass Memorial Medical Center in Worcester, is president of the Mass. Medical Society. Dr. Anthony Giamberardino practices general dentistry in Medford and is president of the Mass. Dental Society.

September, 2014|Oral Cancer News|

Scientists say that E-Cigarettes and Snuff are not harmless

Author: Eliza Gray


New research casts doubt on nicotine’s safety—even if you aren’t smoking

New research from the American Heart Association journal Circulation shows that patients who stopped using smokeless tobacco after a heart attack had improved life expectancy—similar to that of people who quit smoking. The finding offers new information about the dangers of smokeless tobacco, the risks of which are not as well understood as cigarettes’.

“That was a big surprise for us,” said Dr. Gabriel Arefalk, lead researcher and a cardiologist at Uppsala University Hospital in Uppsala, Sweden. “For smoking, it has been known for decades now that people benefit from discontinuation, especially after having suffered a heart attack, but for snus we had no idea what to expect.

”The researchers reviewed data on 2,474 heart attack survivors under 75 in Sweden who used snus (oral snuff) from 2005 to 2009. About 675 quit. During the two years of follow-up, 69 of those who continued using snus died, compared with only 14 quitters. Based on this data, researchers determined that those who quit snus had almost half the mortality risk of those who didn’t quit, which is similar to the benefit of smoking cessation, according to a release from the American Heart Association.

Dr. Arefalk, who is also a clinician, said the researchers wanted to study the problem because they didn’t know what to tell patients about the risks of using snus after a heart attack. He cautioned that the study was small and far from enough to determine a causal relationship, but added “It’s the best evidence we’ve got so far, so from our perspective at our clinic, [the advice to patients] is probably that you should discontinue all kinds of tobacco,” if you’ve had a heart attack, Dr. Arefalk told TIME

The study is one more piece of evidence that ads to our understanding that smokeless tobacco carries its own risk. Though the study was about snus, it has implications for other kinds of nicotine delivery systems, including e-cigarettes.

The FDA is currently taking comment from experts over the next few weeks as the agency tries to determine the best rules to regulate the nascent e-cig industry, which is approaching nearly $2 billion in U.S. annual sales. And though there isn’t yet enough information or scientific research to back this up, common sense says that e-cigs, which do not burn and contain fewer chemicals than regular tobacco cigarettes, must be better for a smoker’s health. Yet, some cardiologists, as TIME learned, are reluctant to see electronic cigarettes as harm-reduction tools.

For starters, nicotine is not a benign substance, especially when it comes to cardiovascular health. As Dr. Steven Nissen, Department Chair of Cardiovascular Medicine at the Cleveland Clinic, put it, nicotine has “profound effects on the heart.” The highly addictive drug can lead to surges in heart rate, constriction in the blood vessels, and spikes in blood pressure—the very effects that heart medications are designed to counteract.“To come up with new diabolically clever way to addict Americans to nicotine is a terrible idea,” says Dr. Nissen. “[E-cigarette companies] are pitching very hard that they can make smoking safer. [But] nicotine is an addictive drug, no matter if you smoke it or ‘aerosolize’ it. Why you would want to addict another generation to nicotine is beyond me. Public health suggests we should fight electronic cigarettes the same way we fought tobacco.”

Another concern, beyond the possible impact of nicotine, are concerns about small, potentially toxic, particles and what they can do to the sensitive cardiovascular system, says Dr. Aruni Bhatnagar, a professor of medicine at the University of Louisville and spokesperson on electronic cigarettes for the American Heart Association

Dr. Bhatnagar is studying the toxic effects of e-cig vapor on mice. Like all doctors, he is careful to point out that we don’t know enough about these devices. But he says that wishful thinking about harm reduction could be especially problematic when it comes to cardiovascular health. The risk of cardiovascular disease for a person who smokes only 2-3 cigarettes a day is already 80 percent of the risk to a pack-a-day smoke. “Very low levels of smoke are very dangerous for cardiovascular tissues. Cancer is more linear—you have to smoke a large amount for a very long period of time to get lung cancer,” he says. “But reducing harmful levels is not going to mitigate the cardiovascular risk. That is why we are greatly concerned about e-cigarettes when it comes to the high sensitivity of cardiovascular tissues to a low level of these pollutants

”Electronic cigarette manufacturers and their customers often point to the low levels of particles in electronic cigarette smoke as compared to the appropriate levels of air pollution determined by agencies like OSHA. But, Dr. Bhatnagar says, these claims can be misleading because the thresholds take into account the necessity of polluting the air to some degree—they aren’t an endorsement of a safe level of pollution. From a cardiovascular perspective, he says: “There is no threshold, there is no level of these particles that you can say is safe.”

For now: Smokers—and snuffers, and e-cig smokers—beware.


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

June, 2014|Oral Cancer News|

Liquid nicotine for E-cigarettes found to be extremely toxic

Author: Matt Richtel


A dangerous new form of a powerful stimulant is hitting markets nationwide, for sale by the vial, the gallon and even the barrel.

The drug is nicotine, in its potent, liquid form — extracted from tobacco and tinctured with a cocktail of flavorings, colorings and assorted chemicals to feed the fast-growing electronic cigarette industry.

These “e-liquids,” the key ingredients in e-cigarettes, are powerful neurotoxins. Tiny amounts, whether ingested or absorbed through the skin, can cause vomiting and seizures and even be lethal. A teaspoon of even highly diluted e-liquid can kill a small child.

But, like e-cigarettes, e-liquids are not regulated by federal authorities. They are mixed on factory floors and in the back rooms of shops, and sold legally in stores and online in small bottles that are kept casually around the house for regular refilling of e-cigarettes.

Evidence of the potential dangers is already emerging. Toxicologists warn that e-liquids pose a significant risk to public health, particularly to children, who may be drawn to their bright colors and fragrant flavorings like cherry, chocolate and bubble gum.

“It’s not a matter of if a child will be seriously poisoned or killed,” said Lee Cantrell, director of the San Diego division of the California Poison Control System and a professor of pharmacy at the University of California, San Francisco. “It’s a matter of when.”

Reports of accidental poisonings, notably among children, are soaring. Since 2011, there appears to have been one death in the United States, a suicide by an adult who injected nicotine. But less serious cases have led to a surge in calls to poison control centers. Nationwide, the number of cases linked to e-liquids jumped to 1,351 in 2013, a 300 percent increase from 2012, and the number is on pace to double this year, according to information from the National Poison Data System. Of the cases in 2013, 365 were referred to hospitals, triple the previous year’s number.

Examples come from across the country. Last month, a 2-year-old girl in Oklahoma City drank a small bottle of a parent’s nicotine liquid, started vomiting and was rushed to an emergency room.

That case and age group is considered typical. Of the 74 e-cigarette and nicotine poisoning cases called into Minnesota poison control in 2013, 29 involved children age 2 and under. In Oklahoma, all but two of the 25 cases in the first two months of this year involved children age 4 and under.

In terms of the immediate poison risk, e-liquids are far more dangerous than tobacco, because the liquid is absorbed more quickly, even in diluted concentrations.

“This is one of the most potent naturally occurring toxins we have,” Mr. Cantrell said of nicotine. But e-liquids are now available almost everywhere. “It is sold all over the place. It is ubiquitous in society.”

The surge in poisonings reflects not only the growth of e-cigarettes but also a shift in technology. Initially, many e-cigarettes were disposable devices that looked like conventional cigarettes. Increasingly, however, they are larger, reusable gadgets that can be refilled with liquid, generally a combination of nicotine, flavorings and solvents. In Kentucky, where about 40 percent of cases involved adults, one woman was admitted to the hospital with cardiac problems after her e-cigarette broke in her bed, spilling the e-liquid, which was then absorbed through her skin.

The problems with adults, like those with children, owe to carelessness and lack of understanding of the risks. In the cases of exposure in children, “a lot of parents didn’t realize it was toxic until the kid started vomiting,” said Ashley Webb, director of the Kentucky Regional Poison Control Center at Kosair Children’s Hospital.

The increased use of liquid nicotine has, in effect, created a new kind of recreational drug category, and a controversial one. For advocates of e-cigarettes, liquid nicotine represents the fuel of a technology that might prompt people to quit smoking, and there is anecdotal evidence that is happening. But there are no long-term studies about whether e-cigarettes will be better than nicotine gum or patches at helping people quit. Nor are there studies about the long-term effects of inhaling vaporized nicotine.

Unlike nicotine gums and patches, e-cigarettes and their ingredients are not regulated. The Food and Drug Administration has said it plans to regulate e-cigarettes but has not disclosed how it will approach the issue. Many e-cigarette companies hope there will be limited regulation.

“It’s the wild, wild west right now,” said Chip Paul, chief executive officer of Palm Beach Vapors, a company based in Tulsa, Okla., that operates 13 e-cigarette franchises nationwide and plans to open 50 more this year. “Everybody fears F.D.A. regulation, but honestly, we kind of welcome some kind of rules and regulations around this liquid.”

Mr. Paul estimated that this year in the United States there will be sales of one million to two million liters of liquid used to refill e-cigarettes, and it is widely available on the Internet. Liquid Nicotine Wholesalers, based in Peoria, Ariz., charges $110 for a liter with 10 percent nicotine concentration. The company says on its website that it also offers a 55 gallon size. sells a gallon at 10 percent concentrations for $195.


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

April, 2014|Oral Cancer News|

New study shows a rise in smokeless tobacco sales, especially among youth

Source: UMass Medical School Communications (
Author: Sandra Gray


The number of smokeless tobacco products sold in Massachusetts is soaring, as are the levels of nicotine packed into many of them, according to a new analysis from UMass Medical School and the Massachusetts Department of Public Health (DPH).

“Nationwide, cigarette smoking control has been very successful and we have experienced a steady decline, but that success is being offset by the increased use of smokeless tobacco products, especially by youth,” said UMMS statistical scientist Wenjun Li, PhD. Dr. Li, associate professor of medicine in the Division of Preventive and Behavioral Medicine, co-authored the paper with colleagues from the DPH.

Published in the journal Tobacco Control, the study examines ten years of product data (from 2003 to 2012) that Massachusetts law requires tobacco manufacturers provide to the DPH. Notable findings include a nearly 30 percent increase in the number of moist snuff products and a nearly sixfold increase in the number of snus products sold in Massachusetts; these increases correlate with rising use among high school students.

Nationwide, more than one in eight males in the 12th grade uses smokeless tobacco. In Massachusetts, use among high school students has more than doubled since 2001. A wide variety of smokeless tobacco products on the market include newer inventions like dissolvable lozenges, snus and moist snuff, many of them flavored and colorfully packaged to appeal to youth, along with more traditional forms used by adults including chewing tobacco and dry snuff.

Researchers were particularly interested in unionized, or free nicotine, the form that is most easily absorbed in the mouth. The amount of free nicotine and how it is delivered in both smokable and smokeless tobacco products is associated with a product’s addictive potential—and is determined by modifiable design features as well as the amount of nicotine contained naturally in the tobacco leaf.

They found that while nicotine levels varied, free nicotine increased for several manufacturers. Li and DPH lead author and research analyst Doris Cullen,MA, believe that these as-yet inexplicable variations in nicotine content support the argument that free nicotine levels are controlled in the manufacturing process, and suggests that manufacturers are manipulating products’ addictive potential.

“The current success in tobacco control is very likely undermined without government surveillance, regulation and widespread public disclosure of nicotine levels in these products,” said Cullen.

“Smokeless products are easier for youth to access and use than cigarettes, and harder for parents to monitor,” said Li. “Even though they have less nicotine than cigarettes, more of that nicotine is readily absorbed, making snus and moist snuff a gateway to nicotine addiction and, possibly, future smoking.”

While the study did not focus on smokeless tobacco marketing, he noted that packaging products to look like candy also suggests that the tobacco industry is specifically targeting youth.

“This study supports that the tobacco industry’s manipulation of product design extends to smokeless products,” said corresponding author Lois Keithly, PhD, director of the DPH’s Massachusetts Tobacco Cessation and Prevention Program. “Considering the potential risk for nicotine addiction associated with the use of smokeless tobacco products, and the aggressive marketing of these products, it is critical to continue and expand surveillance of smokeless products at the state and national levels.”


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

March, 2014|Oral Cancer News|

Cigarettes, More Addictive than Ever Before

Source: The New York Times
Published: January 23, 2014
By: The Editorial Board

It was a shock to learn from the latest surgeon general’s report that, because of changes in the design and composition of cigarettes, smokers today face a higher risk of lung cancer and chronic obstructive pulmonary disease than smokers in 1964, despite smoking fewer cigarettes. It is equally shocking to learn now that some of today’s cigarettes may be more addictive than those smoked in past years, most likely because the manufacturers are designing them to deliver more nicotine to the lungs to induce and sustain addiction. That devious tactic requires a strong response by regulators.

A report published last week in the journal Nicotine and Tobacco Research found that while the nicotine content of cigarettes has remained relatively stable for more than a decade, the amount of that nicotine delivered to the machines researchers use as surrogates for smokers has been rising. The researchers, from the Massachusetts Department of Public Health and the University of Massachusetts Medical School, analyzed data from four manufacturers as required by state law. The findings varied among the companies and brands, but the overall trend led the researchers to conclude that changes in cigarette design have increased the efficiency of delivering nicotine to a smoker’s lungs. Young people who experiment with smoking may thus become addicted more easily and existing smokers may find it harder to quit.

Those provocative findings will need to be verified by other experts but are consistent with the surgeon general’s report. That report, issued on Jan. 17, found that some of today’s cigarettes are more addictive than those from earlier decades, based on the findings of a Federal District Court judge in 2006 who had access to industry documents spelling out how cigarettes were designed to make them more addictive. The industry’s tactics included designing filters and selecting cigarette paper to maximize the ingestion of nicotine and adding chemicals to make cigarettes taste less harsh and easier to inhale deeply.

Nicotine itself, in addition to its addictive qualities, has harmful effects on the human body. The surgeon general’s report concluded that nicotine activates biological pathways that increase the risk for disease, adversely affects maternal and fetal health during pregnancy, and can have lasting adverse consequences for brain development in fetuses and adolescents. At high doses, nicotine is toxic and sometimes lethal. A rapid increase in nicotine blood levels can also raise heart rate and blood pressure and narrow arteries around the heart.

Still, the main problem is that nicotine addicts people to smoking, which exposes them to a host of toxic ingredients. Regulators will need to find ways to block the designs, ingredients and marketing strategies that increase the amount of nicotine taken in by smokers.


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


January, 2014|Oral Cancer News|

The danger in smokeless tobacco products

Source: (Uganda, Africa)
Author: Racheal Ninsiima

Tobacco use is the single most preventable cause of death among adults and is a significant factor for several mouth, throat, lung and heart diseases.

It is also a major contributor to morbidity. Globally, the World Health Organisation (WHO) estimates that tobacco causes about 71% of lung cancer, 42% of chronic respiratory diseases, 20% of global tuberculosis incidence and nearly 10% of cardiovascular diseases. But the issue of smokeless products that contain tobacco has for long been ignored.

According to Dr Sheila Ndyanabangi, the tobacco control focal point person at the ministry of Health, schoolchildren are also consuming the products. This is because sometimes the ingredients are written in foreign languages which may not be understood by the consumers.

What is smokeless tobacco?
There are two basic forms of smokeless tobacco: snuff and chewing tobacco. An article ‘smokeless tobacco and how to quit’ on the website, says snuff is finely ground tobacco packaged in cans and is sold either dry or moist. The nicotine in the snuff is absorbed through the tissues of the mouth as it is placed between the cheek and gum.

Snuff is designed to be both “Smoke-free” and “spit-free” and is marketed as a discreet way to use tobacco. Chewed tobacco comes along as long strands of tobacco leaves that are chewed by the user who thereafter spits out the brown liquid (saliva mixed with tobacco).

Types of smokeless tobacco
Mouth fresheners:
The commonest is Kuber. It is a highly addictive tobacco drug disguised as a mouth freshener and packed in sachets similar to tea leaves. Kuber may be added to tea or simply licked. According to Dr Ndyanabangi, Kuber, rich in nicotine, is widely consumed by secondary school students and taxi drivers.

Results of a research conducted by the Uganda Youth Development Link (UYDEL) in 2011 revealed that Kuber also contains drugs like cocaine and marijuana which may lead to hormonal change, impaired brain development, mental health disorders and heart problems.
Kuber is often chewed with mairungi leaves, sucked or taken with hot water as a beverage resulting in a drowsy feeling. Kuber is sold in shops and supermarkets.

Many people value chocolate as a delicacy. However, tobacco is one of the sweeteners added to some brands of chocolate, especially dark chocolate. Among the ingredients are: cocoa, sugar, cocoa butter, tobacco, soya lecithin, milk and gluten.

Menthol products:
Dr Ndyanabangi says people ought to be careful with menthol products such as toothpaste, mouthwash and gum; they may also contain tobacco. In some, menthol is used as a sweetener to make them useable and disguise the smell of tobacco. Other products include nicotine lollipops, wafers and water. Currently in the US, tablets are being investigated for any form of tobacco.

Nevertheless, the fact still stands; smokeless tobacco is as lethal as cigars. Dr Prossy Mugyenyi, the manager at the Centre for Tobacco Control in Africa (CTCA), says the tobacco in these smokeless products acts as a receptor and the person keeps demanding more and more.

“Just like a person becomes addicted to smoking and becomes a chain smoker, so do these smokeless products make one addictive to the tar and nicotine in them,” Mugyenyi says.

No safe tobacco
According to Dr Jackson Orem, head of the Uganda Cancer Institute, there is no safe form of tobacco and at least 28 chemicals in smokeless tobacco have been found to cause cancer. Smokeless tobacco products raise the incidence of cancer, especially oral cancers like mouth, tongue and throat.

In addition, Mugyenyi says excessive exposure of one’s body to tobacco increases the risk of heart disease, stroke, teeth loss, gum disease and aneurysm (abnormal widening of a portion of an artery due to weakness in the wall of the blood vessel). However, despite the prevalent risk, Uganda does not have a comprehensive tobacco control law. The WHO Framework Convention on Tobacco Control (FTCT) to which Uganda has been signatory since 2003 is not enforced.

“There is a lot of illicit trade in the tobacco industry and the fines of Shs 20,000 to Shs 30,000 stipulated in the statutory instrument of 2004 to ban smoking in public places are not punitive enough and neither are they being enforced,” Ndyanabangi says.

Tobacco use and baseball


Like cigarettes, smokeless tobacco (snuff and chewing tobacco), cause mouth cancer, gum disease, and heart disease. Yet many think that chewing tobacco is safe or less so than smoking. This is not true!

In 1986, the Surgeon normal closed that the use of smokeless tobacco “is not a safe substitute for smoking cigarettes. It can cause cancer and a whole of noncancerous conditions and can lead to nicotine addiction and dependence.” Since 1991, the National Cancer institute (Nci) has officially recommended that the group avoid and desist the use of all tobacco products, including smokeless tobacco. Nci also recognizes that nitrosamines, found in tobacco products, are not safe at any level.
Chewing tobacco and baseball have a long tight affiliation, rooted in the cultural confidence among players and fans that baseball players chew tobacco and it is just part of the grand old game. This mystique is slowing changing with campaigns by ballplayers who have had or have seen friends with mouth cancer caused by chewing tobacco use.

Jeff Bagwell
Jeff Bagwell, retired first baseman with the Houston Astros and Joe Garagiola, a previous baseball player and commentator, campaign against tobacco use among children and addicted adults. In 1993, when Bagwell was 25-years-old, his dentist discovered leukoplakia, a whitish pre-cancerous sore in his mouth where he continually located chewing tobacco. About 5% of leukoplakias institute into cancer. Fortunately this did not happen to Jeff Bagwell due to the early detection by his dentist.

Rick Bender, The Man Without a Face
In 1988 Rick Bender, a 25 year old minor league baseball player advanced a large sore on the side of his tongue that would not go away for months. He began using ‘spitting tobacco’ when he was 12. After finding his dentist and then a biopsy by a specialist, he was diagnosed with mouth cancer.

Surgeons successfully removed the cancerous cells from Bender’s mouth and throat, taking a chunk of his tongue and the lymph nodes on the right side of his neck in the process. But removing the cancer also caused nerve damage that puny the use of his right arm, his throwing arm, which ended his baseball career. Later an infection occurred to the right side of Bender’s jaw after radiation therapy. As a result, it deteriorated and doctors had to remove his right jaw.

As a follow Rick Bender calls himself “the man without a face” and lectures on the dangers of ‘spitting tobacco’ throughout the nation. Bender visits schools and colleges over the country to dispel what he sees as the myths about chewing tobacco. He also addresses major and minor league baseball players each year at spring training.

Robert Leslie
Sonoma County has it own tragic baseball related, smokeless tobacco, and mouth cancer story. In June of 1998, Robert Leslie died at the young age of 31 from mouth cancer after years of chewing smokeless tobacco. He had been diagnosed four years prior and had bravely counseled youths against the use of smokeless tobacco after that point. Leslie, who was a star pitcher at Rancho Cotate High School, turned to coaching after a brief attempt at playing expert baseball. He was a popular coach at Casa Grande High School. He believed, rightly so, that the cancer had resulted from years of stuffing wads of smokeless tobacco between his gums and lower lip. He advocated against the use of chewing tobacco prior to his death. He is missed.

History Of Tobacco Use and Baseball
Tobacco has a long association with baseball. From the earlier beginnings of baseball in the late 1800′s, baseball players chewed tobacco to keep their mouths moist in dusty dirt parks of that era. Drinking water was thought to make one feel too heavy. Players also used tobacco spit to soften leather gloves and to give the spitball its wild gyrations canada viagra.

Chewing tobacco’s popularity among baseball players rose and fell with the times, most often trading places with cigarettes and cigars. The wrongful confidence that chewing tobacco caused the spread of tuberculosis lead to its reduction in use during the end of the nineteenth century. during the beginning of the twentieth century, it again rose to major use until after Wwii when cigarettes became more popular in the U.S.

During the 1950s, cigarettes reached their most prominence when teams legitimately had sponsored brands. For example, Giant’s fans (New York Giants that is) smoked only Chesterfield Cigarettes to show their team loyalty. during this era, baseball cards were often packaged with cigarettes. As a kid, I remember having my Dad buy Lucky Strikes so I could get the baseball cards.

In 1962, the Surgeon General’s record highlighted the cause and follow between smoking and heart disease and smoking and cancer. Believing that chewing tobacco was a safer product, baseball players took up smokeless tobacco again. Since then, smokeless tobacco has dominated the sport of baseball, from the major leagues down to the high school level. And similar to the targeted cigarette marketing of the 1950s, smokeless tobacco producers have promoted tobacco chewing straight through baseball players, even providing free samples in major and minor league clubhouses.

All tobacco, including smokeless tobacco, contains nicotine, which is addictive. The whole of nicotine absorbed from smokeless tobacco is 3 to 4 times the whole delivered by a cigarette. Nicotine is absorbed more slowly from smokeless tobacco than from cigarettes, but more nicotine per dose is absorbed from smokeless tobacco than from cigarettes. Also, the nicotine stays in the bloodstream for a longer time.

By giving players free samples of chew tobacco, the smokeless tobacco manufacturers were getting players hooked to the addictive drug nicotine in a tobacco goods that contains 28 cancer-causing substances. Even today, I saw a full-page magazine ad from R.J. Reynolds Tobacco Co. With a free coupon for Camel Snus. It was advertised as “Spitfree” and “Sold Cold” in large bold print, while in small print a warning stated, “this goods may cause gum disease and tooth loss.”

Big League Chew, a chewing gum aimed at children, is a goods that uses the deep association between baseball and chewing tobacco. Introduced in 1980, Big League Chew consists of shredded bubble gum, which resembles loose chewing tobacco. It is packaged in an aluminum foil pouch, similar to the containers of chewing tobacco, with the cartoon image of a baseball player on the outside. While candy cigarettes, other symbolic tobacco goods aimed at children, fell out of favor years ago, Big League Chew continues to be popular with kids.

Luckily, the love affair between baseball and smokeless tobacco seems to be subsiding. In 1993, minor league baseball banned all use of tobacco products among its teams. As follow fewer major leaguers are now coming up from those ranks using tobacco products. Campaigns are manufacture headway discouraging tobacco use and encouraging substitute habits like chewing gum or munching on sunflower seeds. Remember previous Giants employer Dusty Baker, setting an example for young players by stopping tobacco use and chewing sunflower seeds in the dugout?

Still an estimated 7.6 million Americans age 12 and older (3.4 percent) have used smokeless tobacco in the past month, and smokeless tobacco use is most common among young adults ages 18 to 25.

So if you use tobacco, please stop. It is the best thing you can do for your health. There are many tobacco cessation programs and nicotine change treatments. And make sure to have regular cancer screening examinations with your dentist. Early detection is indispensable for preventing mouth cancer.

Exposure to Nicotine and Carcinogens among South Western Alaskan Native Cigarette Smokers and Smokeless Tobacco User

Source: AACR Journals

Background Prevalence of tobacco use, both cigarette smoking and smokeless, including iqmik (homemade smokeless tobacco prepared with dried tobacco leaves mixed with alkaline ash), and tobacco-related cancer is high in Alaska Native people (AN). To investigate possible mechanisms of increased cancer risk we studied levels of nicotine and tobacco-specific nitrosamines (TSNA) in tobacco products and biomarkers of tobacco toxicant exposure in South Western AN people. Methods Participants included 163 cigarette smokers (CS), 76 commercial smokeless tobacco (ST), 20 iqmik, 31 dual CS and ST (DT) and 110 non-tobacco (NT) users. Tobacco use history, samples of tobacco products used and blood and urine samples were collected. Results Nicotine concentrations were highest in cigarette tobacco and TSNAs highest in commercial ST products. AN participants smoked on average 7.8 cigarettes per day (CPD). Nicotine exposure, assessed by several biomarker measures, was highest in iqmik users, and similar in ST and CS. TSNA exposure was highest in ST users, and polycyclic aromatic hydrocarbon exposure highest in CS. Conclusions Despite smoking fewer CPD, AN CS had similar daily intake of nicotine compared to the general US population. Nicotine exposure was greatest from iqmik, likely related to high pH due to preparation with ash suggesting high addiction potential compared to other ST products. TSNA exposure was much higher with ST compared to other product use, possibly contributing to high rates of oral cancer. Impact Our data help understanding high addiction risk of iqmik use and cancer-causing potential of various forms of tobacco use among AN people.

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

April, 2012|Oral Cancer News|

Dentists key to quitting ‘smokeless tobacco’


The National Institute for Health and Clinical Excellence (NICE) is recommending a key role for dental professionals in their public health intervention proposals to help stop the use of smokeless tobacco by people of South Asian Origin.

Dentists, dental nurses and dental hygienists may be asked to play a leading role as part of new proposals to stop the use of smokeless tobacco in the UK.

NICE has published a consultation on their proposals, which recommends a key intervention and education role for dental professionals.

It is also recommending more training for dental professionals to help them gain a greater understanding of smokeless tobacco including terminology, symptoms and approaches to successful intervention.

Smokeless tobacco is associated with a number of health problems including nicotine addiction, mouth and oral cancer, periodontal disease, heart attacks and strokes, problems in pregnancy and following childbirth and late diagnosis of dental problems as smokeless tobacco products can often mask pain.

Smokeless tobacco is mainly used by ‘people of South Asian origin’, which includes people with ancestral links to Bangladesh, India, Nepal, Pakistan or Sri Lanka.

The draft guidance recommends that dental professionals take specific actions including:
• Asking patients about their smokeless tobacco use and record the outcome in their patient notes
• Making users aware of the potential health risks and advise them to stop, using a brief intervention
• Referring users who want to quit the habit to tobacco cessation services that use counsellors trained in behavioural support
• Recording the person’s response to any attempts to encourage or help them to stop using smokeless tobacco in the patient notes.

Chief executive of the British Dental Health Foundation, Dr Nigel Carter, said: ‘Smokeless tobacco is a little known area for many health professionals in the UK so the current draft public health guidance is a positive step to bring greater knowledge and understanding.

‘The evidence that does exist indicates that South Asian women – the main users of smokeless tobacco – are approaching four times more likely to suffer from mouth cancer. Quite rightly, dental professionals have been identified as major players to help reduce these risks and prevent the serious health conditions caused by smokeless tobacco.

‘The British Dental Health Foundation supports NICE’s draft proposals and encourages all dental professionals to include the intervention of smokeless tobacco usage as part of their continuing professional development.’

March, 2012|Oral Cancer News|