• 7/13/2004
  • Collins, Jensen
  • University of Michigan School of Journalism

Everyone knows quitting is hard, but what about switching?

Some scientists and researchers are suggesting that an effective way to quit smoking may be switching to smokeless tobacco, an alternative that anti-tobacco groups decry as hazardous and reckless.

Smokeless tobacco includes moist snuff, dry snuff, plug or twist tobacco and chewing tobacco. Moist snuff, by far the most popular form of smokeless tobacco, is taken in small pinches and placed between the gums and lips, where it delivers the nicotine that the user craves into the bloodstream. Chewing tobacco has been described by many as a particularly disgusting habit, but the suggestion that it can save your life? “That’s something that the anti-tobacco groups in this country are not too happy about,” said Dr. Brad Rodu, professor of pathology and senior scientist at the University of Alabama/Birmingham Cancer Center. “They are not willing to accept the science involved.”

Rodu, who has been publishing research about smokeless tobacco since 1994, said that smokeless tobacco is an acceptable alternative to smoking. His university received a five year grant in 1999 from tobacco companies to research smokeless tobacco products. He said this grant money connection to the tobacco industry was well documented in all of his reports, and the grant included a clause that stated the companies could not revoke the grant if the findings were unfavorable to them. He put forth his “harm reduction strategy” in his book, For Smokers Only: How Smokeless Tobacco Can Save Your Life. Rodu said he is not the only one who adheres to the efficacy of smokeless tobacco to get people off cigarettes. “There are a growing number of public health experts that believe this is a viable strategy,” he said.

There is also a growing number who think the notion is not only wrong, but also irresponsible. “You may get rid of some tobacco related lung cancer,” said Dr. Raymond Boyle, researcher with the Health Partners Research Foundation, “but what about all the kids picking up smokeless? There is a cost either way. ”Boyle is co-author of a 1998 University of Minnesota study focusing on the use of smokeless tobacco by young females. He found that smoking is widely perceived as harmful, but smokeless tobacco has not necessarily had that reputation. “Smokeless tobacco just wasn’t considered as big a deal,” Boyle said of his findings. “It wasn’t on the radar of concern.”

But some, including those at the Oral Cancer Foundation, argue that the risks involved in using smokeless tobacco are a big deal. Brian Hill, the Foundation’s executive director and original founder in 2000, said that of the 30,000 cases of oral cancer each year, 75 percent of those are caused by tobacco—both smokeless and smoking. Nine thousand individuals in the US die each year from oral cancer. The worldwide death rates are staggeringly larger. “The logic is that if you switch to smokeless tobacco, then some of the death rates from tobacco will go down,” Hill said. “But other cancers will increase, such as oral cancers. There is also new information that tobacco carcinogens regardless of whether inhaled or not, play a role in other cancers that you would normally not consider when thinking of tobacco. These studies show that tobacco users get more cervical cancer and have poorer outcomes from breast cancer among other things. There is much work still to be done and not everything is known about tobacco’s far-reaching effects in the human body. I believe that Rodu’s premise, while attractive on the outside, ignores many of these other consequences of tobacco use, and only looks at lung cancer and heart disease. ” He states further, ” There is new information in the last two years regarding heart disease and the role of chronic inflammation in its occurrence. Studies have shown that even periodontal disease which can manifest itself as a long-term chronic inflammatory process, can affect the occurrence of heart disease. Who would have thought that 10 years ago? Chewing tobacco has been shown to produce periodontal disease in the users of the product. But Dr. Rodu’s work does not consider these possibilities which may reduce the positive spin that he would like to put on spit tobacco, and the potential reduction of other tobacco related disease.”

Smokeless tobacco has been linked with cancers of the mouth, gum (periodontal) diseases and tooth loss. Rodu admitted that there are risks in using smokeless tobacco, but those risks never come close to the dangers of smoking. With 46 million smokers (as compared with 5 million smokeless tobacco users) and over 400,000 lung cancer deaths per year in this country, Rodu said that the smoking problem needs to come first. According to Boyle, this is good news for smokeless tobacco manufacturers. “They are very happy to offer this as a suitable alternative,” he said. “They have no problem taking this financial opportunity.”

Others also say that smokeless tobacco companies are cashing in on the nation’s anti-smoking campaigns. “The fact is that tobacco companies changed their marketing,” said Hill, an oral cancer survivor himself. “The tobacco lawsuits won’t let them advertise or sell brand A, so they’ll sell brand or type B instead. It’s good marketing. Tobacco companies will just move their advertising and marketing dollars to a different product.”

Although the total amount spent on advertising by the manufacturers of smokeless tobacco reached all time highs in 2001, according to the Federal Trade Commission Smokeless Tobacco Report issued in 2003, smokeless tobacco companies and cigarette companies are separate entities. There is no direct evidence that a decrease in cigarette sales brings an increase in smokeless tobacco sales. But, according to the manufacturers, the smokeless tobacco industry has been on the rise for the last 25 years, becoming more profitable throughout the anti-smoking campaign. It is the only domestic segment of the tobacco industry that has grown.

Smokeless tobacco is often referred to as spit tobacco, because the user must periodically spit out the excess saliva and juices produced by the product in the mouth. There is no smoke to inhale with smokeless tobacco, and according to Rodu that means it is less harmful. “Smokeless tobacco is 98 percent safer than smoking,” said Rodu. “The science clearly proves this.” Rodu admits that smokeless tobacco and smoking are equally addictive, but said that the addiction to nicotine should not be the issue.

“Nicotine is why people smoke, but it’s not the killing agent,” said Rodu. “As humans use it, nicotine is no more dangerous than caffeine.” Despite this apparent endorsement, officials at smokeless tobacco companies said that they are not advertising their product as a safe alternative to smoking. “We have not done any marketing of that kind,” said Mike Bazinet, spokesperson for United States Smokeless Tobacco, the largest manufacturer of smokeless tobacco products in this country. The company produces Skoal and Copenhagen moist snuffs, among other smokeless tobacco products.
When asked if smokeless tobacco use was safer than smoking, Bazinet said, “We are not making that claim. We can only point to what the research says.”

But according to Boyle, the marketing of smokeless tobacco as being less dangerous than smoking is longstanding and subtle. “The smokeless folks have always taken the approach that theirs is a reduced harm product,” Boyle said. “Just the use of the word ‘smokeless’ is meant to denote reduced harm.”

And in less than 20 years, according to the National Spit Tobacco Education Program, the demographic of smokeless tobacco users changed dramatically. The market was dominated by men over 45, but now most users are young men aged 18-25. A 2001 survey conducted by the University of Michigan showed a slight increase in smokeless tobacco usage by high school aged children from 2000 to 2001, which is significant since smoking in that age group has consistently declined since 1997. “It went from old men chewing shredded tobacco to young people doing moist snuff,” said Sue Dodd, the national director of the Spit Tobacco Education Program. Her organization has been working to sever ties between smokeless tobacco and Major League Baseball, an organization long associated with chewing tobacco use. “Here’s a product you can use when you can’t smoke,” said Dodd. “The more restrictive it becomes for people to smoke, the more they turn to smokeless tobacco.”

Smokeless tobacco use has always been regional and cultural. It is yet to gain real popularity in urban, northern areas like New York and Washington D.C., but it is very common in the south and midwest. Still, smokeless tobacco education in these areas is not consistent with its use. “The programs I’ve done have targeted smoking as opposed to smokeless,” said Judy Lyle, a staff nurse and health educator at Murray State University in Murray, Kentucky. “I haven’t found a good smoking cessation program that addresses it.” Even for national programs, it can be difficult to get smokeless tobacco recognized as a health risk. “All I want is people to use the word tobacco instead of cigarettes,” said Dodd, “then I’m happy.”

Rodu said that the current “quit or die” strategy to combat smoking has failed, and he is only offering an effective substitute for a group he calls “inveterate smokers,” or those who are unable or unwilling to quit. According to him, the emphasis should be on helping the smoker put out the cigarettes, not vilifying the tobacco company. “Fifteen years ago there was an error made,” said Rodu. “All tobacco products were to be seen as equally evil, and that is a gross mistake.”

Mistake or not, many are not yet willing to condone the use of any form of tobacco as acceptable. “I stongly agree that nicotine is as harmless as caffine. It’s strongly adictive qualities far outweight anything produced by caffine. As to spit tobacco, it’s a question of which poison would you like to take,” said Hill. “In my mind, it’s still poison. And as to Dr Rodu’s statement that this is the best alternative to the hopelessly addicted, he has conveniently left out prescription nicotine products that are stronger and more effective than the over-the-counter quit smoking aids that are available to consumers. These products are available from your primary care physician and dentists for those who really wish to quit. They provide a level of nicotine which is equal to that of cigarettes or spit tobacco, without any of the carcinogens. Combined with a gradual reduction their use and in the resulting nicotine levels over months, these medical alternatives can break the addiction cycle for tobacco users. I’m not satisfied that the due diligence has been done on this idea of switching to spit tobacco, and given the source of significant funding to come up with the data, I am suspicious of the findings. After all it’s not like the tobacco industry hasn’t lied to the American public before, or funded studies that essentially found exactly what they were looking for to substantiate their argument. If you want this to be reviewed properly, let the FDA make the decision…. I doubt the tobacco companies would like to put their studies under that agency’s microscope.”

Initial source (from Fedstats): Monitoring the Future National Survey, conducted by the University of Michigan Institute for Social Research, 2001.