• 3/1/2002
  • West Virginia
  • Fran Berger
  • HealthScout Reporter

A pinch between the cheek and gum can cause oral cancer, experts know. But researchers in West Virginia have found the kids who stick a wad in their mouth don’t know the dangers.

A recent survey of 808 public school students in the Mountaineer State found that use of chewing tobacco increased with age, with more than a third using smokeless tobacco monthly or daily by 11th grade — and many didn’t realize the substance could lead to disease.

“West Virginia is usually No. 1 in the U.S. when it comes to use of smokeless tobacco,” says Dr. Lynne J. Goebel, the study’s lead author. “We’ve heard from doctors in rural areas that some people are using smokeless tobacco to help ease teething pain, rubbing it on babies’ gums, and parents are giving it to kids as a reward for good grades,” she says. Smokeless tobacco is “highly addictive. People who use smokeless tobacco have sustained nicotine levels,” she says, explaining that with smoking, you’re exposed for five minutes. But you have “a chew in your mouth for up to 30 minutes. Some sleep with it in their mouth.”

Goebel and her team compared 648 non-users with 160 male users of smokeless tobacco in the fifth, eighth and 11th grades in West Virginia public schools. Women were excluded, based on the small percentage who indulge.
Seven percent of the fifth graders said they used smokeless tobacco. That rose to 22 percent in eighth grade and topped at 32 percent in the 11th grade. The most frequent grade for initiation was the seventh. Ten percent reported use as early as first or second grade. Of the users, only 74 percent knew smokeless tobacco is harmful. That contrasted with 91 percent of non-users who were aware of the dangers. Users were also four times more likely to believe smokeless tobacco was safer than cigarettes, Goebel reports.

And that belief is dead wrong, says James R. Giebfried, director of tobacco treatment services and of the Massachusetts Quitline of the American Cancer Society. “Smokeless tobacco delivers a high dosage of nicotine,” he says. The average dose for snuff, a fine-grain tobacco placed between the cheek and gum, contains 3.6 milligrams of nicotine. “Chew” contains 4.6 milligrams, compared with a cigarette at 1.8 milligrams. “You can see that the addiction capabilities are much greater.”

And there are long-term health risks. “Leukoplakia, white sores or patches in the mouth which can turn cancerous, have been found in 73 percent of daily users. That’s significant,” Giebfried says. Smokeless tobacco can also cause gum recession, bone loss around the teeth, abrasion of the teeth and bad breath. It may also play a role in cardiovascular diseases and high blood pressure, says Giebfried.

What makes kids use smokeless tobacco? Goebel says her team was surprised to discover that young users seemed to be influenced a great deal by relatives living outside the home. “One hypothesis to explain this fact is that uncles and cousins living nearby may act as both peers and family members, they exert a stronger influence than brothers and fathers,” she says. And, she adds, it’s a macho thing. “Among some West Virginians, family and friends see the ability to tolerate tobacco without becoming nauseated as a sign of manhood. Our study showed that family permitting use in the home was strongly correlated with use of smokeless tobacco,” she says.

Then there’s the media. “It’s in the magazines. NASCAR, which is very big here, [has smokeless tobacco] as the sponsors of the cars. It’s glorifying the use. Our study showed that users more often described themselves as ‘cool, macho and attractive,’ consistent with the image portrayed in ads,” Goebel says.

The study is published in the current issue of the journal Nicotine and Tobacco Research. Goebel cautions that since smokeless tobacco holds a unique place in Appalachian culture, her study’s findings cannot be generalized to the entire country.

“Parents should be aware that smokeless tobacco is harmful and causes cancer,” says Goebel. “They should discourage use in children, not allow use at home, and develop programs that would prevent the use that begins in kindergarten and continue through all 12 grades.” Goebel also says raising the price of smokeless tobacco would help, but the legislature in West Virginia is not likely to do that. “We’ve had trouble passing excise tax on smokeless tobacco. No one wants to be responsible for adding another tax, even though that would help,” she explains.