"UUBDINFOU SMOKELESS TOBACCO USE: OUT OF THE PARK! BACKGROUNDER* February 2016 For three decades, North American public health authorities – including the U.S. Surgeon General, the U.S. National Cancer Institute and the Canadian Cancer Society – have known that smokeless tobacco use is hazardous to health and can lead to long-term nicotine addiction. Smokeless tobacco contains at least 28 cancer-causing chemicals and causes oral, pancreatic and esophageal cancer. Use of smokeless tobacco is also associated with other health problems including lesions in the mouth and tooth decay: According to the U.S. National Cancer Institute, at least 28 cancer-causing chemicals 1 have been identified in smokeless tobacco. The U.S. National Toxicology Program has 2 ͏ρῢ̳ΠΎρ΋͏͋ ρΦήΝ͏Π͏ρρ ϋή̳̀́́ή ̳ρ ̳ ΏΝΧήϲΧ ΋ϦΦ̳Χ ̳́ν́ΎΧή΁͏ΧΉ͟ The U.S. National Founding Agencies Cancer Institute and the International Agency for Research on Cancer both report that Canadian Cancer Society 3 use of smokeless tobacco causes oral, pancreatic and esophageal cancer. Ontario Division Heart and Stroke Foundation of Ontario Smokeless tobacco use is associated with leukoplakia, a disease of the mouth Non-Smokers’ Rights Association characterized by white patches and oral lesions on the cheeks, gums, and/or tongue. Ontario Medical Association Leukoplakia can sometimes lead to oral cancer. Studies have found that more than half of daily users of smokeless tobacco had lesions or sores in the mouth, and that these Supporting Agencies sores are commonly found in the part of the mouth where users place their chew or 4 Association of Local dip. Public Health Agencies Cancer Care Ontario Chewing tobacco has also been linked to tooth decay. A study by the National Ontario Association of Children’s Aid Societies Institutes of Health and the Centers for Disease Control and Prevention found chewing Ontario Association of tobacco users were four times more likely than non-users to have decayed dental root Naturopathic Doctors surfaces.5 Ontario Federation of Home and School Associations 6 Ontario Physical and Health Smokeless tobacco use during youth can lead to a lifetime of nicotine addiction. A Education Association ρϋϦ͋ϸ ΎΧ ϋ΋͏ !Φ͏νΎ̳́Χ ͫήϦνΧ̳Π ή͙ Έν͏ϱ͏ΧϋΎϱ͏ ͵͏͋Ύ́ΎΧ͏ ͙ήϦΧ͋ ϋ΋̳ϋ ΏρΧϦ͙͙ Ϧρ͏ Φ̳ϸ ̀͏ ̳ Ontario Public Health Association gateway form of nicotine dosing among males in the United States that may lead to Physicians for a 7 ρϦ̀ρ͏μϦ͏Χϋ ́Ύ΁̳ν͏ϋϋ͏ ρΦήΝΎΧ΁Ή͟ Another study found that adolescent boys who use Smoke-Free Canada smokeless tobacco products have a higher risk of becoming cigarette smokers within Registered Nurses Association of Ontario four years.8 The Ontario College of Family Physicians Major League Baseball has recently taken some steps to limit smokeless use. But as many players still use the product, health agencies in Toronto have joined with the City of Toronto, professional and amateur sports groups to work toward a complete ban of smokeless tobacco use, both at the Rogers Centre and also in other professional and amateur sports facilities in Toronto: U.S. cities where Major League Baseball (MLB) clubs support the implementation of city-wide bans on the use of smokeless tobacco in professional and amateur sports facilities include Boston, Los Angeles, and New York City. 150 Bloor Street West Suite 900 The current Collective Agreement in place between Major League Baseball and the Toronto, Ontario M5S 3C1 MLB Players Association expires on December 1, 2016. A complete ban on smokeless t: 416.340.2992 tobacco use in all MLB facilities could be included as part of the next Collective f: 416.340.2995 Agreement. email: [email protected] www.ocat.org …/2 - 2 - In Ontario, the 2015 Ontario Student Drug Use and Health Survey reports that smokeless tobacco (chewing tobacco, dipping tobacco, or snuff) is used by about 6% of students in grades 7-12: this represents an estimated 58,200 students in all of Ontario. This percentage represents an increase from 4.6% in 2011. The highest rates of use were found in Eastern Ontario (9.4%) and the lowest rate in Toronto (3%).9 Among male students, the prevalence of smokeless tobacco use is similar to cigarette smoking.10 Use of chewing tobacco has also been frequently reported in amateur hockey, despite ongoing efforts and policies on the part of amateur hockey associations in Ontario and elsewhere in Canada designed to eliminate the practise. Ε΋͏ Ͷ̳ϋΎήΧ̳Π Hή́Ν͏ϸ ͯ͏̳΁Ϧ͏ ΋̳ρ ̳ ΏΧή Ϧρ͏͟ κήΠΎ́ϸ ̳ϋ Ύϋρ ͙̳́ΎΠΎϋΎ͏ρ ̳Χ͋ ̳ϋ ͙̳Χ ͏ϱ͏ΧϋρΈ ̳Χ Ώ̳ΠΠ ρκήνϋρ͟ ̳̀Χ ΎΧ ΕήνήΧϋή will extend the message about the dangers of chewing tobacco use to young hockey players in Toronto and across Ontario. *Thanks to the US Campaign for Tobacco-Free Kids for contributions to this backgrounder. 1 Ͷ̳ϋΎήΧ̳Π C̳Χ́͏ν ͠ΧρϋΎϋϦϋ͏Ά ΏΏΦήΝ͏Π͏ρρ Εή̳̀́́ή ̳Χ͋ C̳Χ́͏νΆ͟ !́́͏ρρ͏͋ Ώ͏κϋ͏Φ̀͏ν 9Ά 2014Ή http://www.cancer.gov/cancertopics/factsheet/Tobacco/smokeless#r1. See also: NIH, NCI, Smoking and Tobacco Control Monograph 2: Smokeless Tobacco or Health: An International Perspective, September 1992, http://cancercontrol.cancer.gov/tcrb/monographs/2/m2_complete.pdf. 2 HHS, Public Health Service, National Toxicology Program, Report on Carcinogens, Twelfth Edition, June 2011, http://ntp.niehs.nih.gov/pubhealth/roc/roc12/index.html 3 Ͷ̳ϋΎήΧ̳Π C̳Χ́͏ν ͠ΧρϋΎϋϦϋ͏Ά ΏΏΦήΝ͏Π͏ρρ Εή̳̀́́ή ̳Χ͋ C̳Χ́͏νΆ͟ !́́͏ρρ͏͋ Ώ͏κϋ͏Φ̀͏ν 9Ά 2014Ή http://www.cancer.gov/cancertopics/factsheet/Tobacco/smokeless#r1. See also: International Agency for Research on Cancer. A Review of Human Carcinogens: Personal Habits and Indoor Combustions. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, Volume 100E (2012). 4 H̳ϋρϦΝ̳ΦΎΆ D & Ώ͏ϱ͏νρήΧΆ HΆ Ώͼν̳Π ΏκΎϋ Εή̳̀́́ήΈ !͋͋Ύ́ϋΎήΧΆ Έν͏ϱ͏ΧϋΎήΧ ̳Χ͋ Εν͏̳ϋΦ͏ΧϋΆ͟ ͶΎ́ήϋΎΧ͏ & Εή̳̀́́ή ΋͏ρ͏̳ν́΋ 21-44, 1999 5 TήΦ̳νΆ ΏͯΆ ΏC΋͏ϲΎΧ΁ Εή̳̀́́ή Ιρ͏ ̳Χ͋ D͏Χϋ̳Π C̳νΎ͏ρ !ΦήΧ΁ ΙΉΏΉ ͵͏ΧΆ͟ ͫήϦνΧ̳Π ή͙ ϋ΋͏ !Φ͏νΎ̳́Χ D͏Χϋ̳Π !ρρή́Ύ̳ϋΎήΧΆ 1999Ά 130Έ 160Ή 6 Institute for Social Research, The University of Michigan, Monitoring the Future, http://monitoringthefuture.org/pressreleases/00cigpr.pdf; American Academy of Pediatrics, Dangers of Smokeless Tobacco, http://www.healthychildren.org/English/health-issues/conditions/tobacco/Pages/Dangers-of-Chew.aspx; CDC, Smokeless Tobacco Facts, http://www.cdc.gov/tobacco/data_statistics/fact_sheets/smokeless/smokeless_facts/index.htm. 7 ΕήΦ̳νΆ ΏͯΆ ΏΏΧϦ͙͙ Ιρ͏ ̳Χ͋ ΏΦήΝΎΧ΁ ͠Χ ΙΉΏΉ ͵͏ΧΈ ͠ΦκΠΎ̳́ϋΎήΧρ ͙ήν H̳νΦ ΋͏͋Ϧ́ϋΎήΧΆ͟ !ͫΈH 23(3)Ά 2002Ή 8 ΕήΦ̳νΆ ΏΆ Ώ͠ρ Ϧρ͏ ή͙ ρΦήΝ͏Π͏ρρ ϋή̳̀́́ή ̳ νΎρΝ ͙̳́ϋήν ͙ήν ́Ύ΁̳ν͏ϋϋ͏ ρΦήΝΎΧ΁; Ε΋͏ ΙΉΏΉ ͏Ϸκ͏νΎ͏Χ́͏Ά͟ ͶΎ́ήϋΎΧ͏ & Εή̳̀cco Research 5(4):561-569, August 2003. 9 C͏Χϋν͏ ͙ήν !͋͋Ύ́ϋΎήΧ ̳Χ͋ ͵͏Χϋ̳Π H͏̳Πϋ΋Ά ΏD͏ϋ̳ΎΠ͏͋ ͼΏDΙHΏ FΎΧ͋ΎΧ΁ρΈ DνϦ΁ Ιρ͏ !ΦήΧ΁ ͼΧϋ̳νΎή ΏϋϦ͋͏ΧϋρΆ 1977-2015͟ C!͵H Research Document Series No. 41, p. 67, 2015. http://www.camh.ca/en/research/news_and_publications/ontario-student-drug- use-and-health-survey/Documents/2015%20OSDUHS%20Documents/2015OSDUHS_Detailed_DrugUseReport.pdf 10 Ibid, p. 274. HEALTH HARMS FROM SMOKELESS TOBACCO USE Public health authorities including the Surgeon General and the National Cancer Institute have found that smokeless tobacco use is hazardous to health and can lead to nicotine addiction. Smokeless tobacco contains at least 28 cancer-causing chemicals and causes oral, pancreatic and esophageal cancer. Use of smokeless tobacco is also associated with other health problems including lesions in the mouth and tooth decay. • Nearly 30 years ago, an expert advisory committee to the U.S. Surgeon General found that, “After a careful examination of the relevant epidemiologic, experimental, and clinical data, the committee concludes that the oral use of smokeless tobacco represents a significant health risk. It is not a safe substitute for smoking cigarettes. It can cause cancer and a number of non-cancerous oral conditions and can lead to nicotine addiction and dependence.”1 • According to the National Cancer Institute, at least 28 cancer causing chemicals have been identified in smokeless tobacco.2 The U.S. National Toxicology Program established smokeless tobacco as a “known human carcinogen.”3 • The National Cancer Institute and the International Agency for Research on Cancer report that use of smokeless tobacco causes oral, pancreatic and esophageal cancer.4 • Smokeless tobacco use is associated with leukoplakia, a disease of the mouth characterized by white patches and oral lesions on the cheeks, gums, and/or tongue. Leukoplakia can sometimes lead to oral cancer. Studies have found that more than half of daily users of smokeless tobacco had lesions or sores in the mouth, and that these sores are commonly found in the part of the mouth where users place their chew or dip.5 • Chewing tobacco has also been linked to dental caries (tooth decay). A study by the National Institutes of Health and the Centers for Disease Control and Prevention found chewing tobacco users were four times more likely than non-users to have decayed dental root surfaces.6 • Smokeless tobacco use during youth can lead to a lifetime of nicotine addiction.7 A study in the American Journal of Preventive Medicine found that “snuff use may be a gateway form of nicotine dosing among males in the United States that may lead to 8 subsequent cigarette smoking.” Another study found that adolescent boys who use smokeless tobacco products have a higher risk of becoming cigarette smokers within 9 four years. Although smokeless tobacco use does not carry all of the same health harms as smoking, the health effects of using smokeless tobacco are well established. Considering that 10 smokeless tobacco products still contain varying levels and types of carcinogens and carry health risks, the only way to reduce an individual tobacco users’ health risks to the maximum extent possible is to quit using tobacco entirely with evidence-based treatments 1400 I Street NW · Suite 1200 · Washington, DC 20005 Phone (202) 296-5469 · Fax (202) 296-5427 · www.tobaccofreekids.org Health Harms from Smokeless Tobacco Use / 2 that have been scientifically documented to help people quit using tobacco (e.g., nicotine 11 gum and patch, telephone-based behavioral counseling/quitlines).