The term smokeless tobacco refers to snuff, chewing tobacco, and other forms of tobacco that are placed in the mouth or nose and not ignited.1 An estimated 11 to 22 million Americans use smokeless tobacco regularly. The average user is between the ages of 18 and 30 years.1 Smokeless tobacco is a cause for concern among pediatricians because, despite the well-documented hazards to health, its use is increasing rapidly among children and adolescents.
Smokeless tobacco is a proven human carcinogen.2 As early as 1761, the British physician John Hill described cases of cancer in snuff users.3 Hill wrote "No man should venture upon snuff who is not sure that he is not liable to cancer, and no man can be sure of that." (In eighteenth century Britain, snuff was taken intranasally and caused cancer of the nasal cavity. Today, a pinch of snuff is typically tucked into place between the lip and the gum.) More recently, it has been confirmed that snuff is a major cause of oral cancer in this country, and a fourfold increase in risk of cancer of the mouth and pharynx has been reported among women who regularly used snuff.4 Among women who had used snuff for 50 years or more, the risk of cancer of the gingival and buccal mucosa was elevated 47-fold above background.4 These risks were independent of cigarette smoking.
Laboratory confirmation of the carcinogenicity of smokeless tobacco has been provided by identification of N-nitrosonornicotine and other carcinogenic nitrosamines in extremely high concentrations in both snuff and chewing tobacco.5
- Copyright © 1985 by the American Academy of Pediatrics