— Snuff head

Dear Snuff head,

Smokeless tobacco, or "spit tobacco," refers to chewing tobacco and snuff, better known as "dip." Smokeless tobacco contains nicotine, which is absorbed through the gums and lining of the mouth. The nicotine dose in smokeless tobacco is at least double that of the amount in cigarettes, making smokeless tobacco more addictive than smoking cigarettes.

Smokeless tobacco causes tooth decay, gingivitis, and recession of the gums. It also causes oral cancers, and long-term use increases risks for cancers of the cheek and gums.

Yes, most smoking cessation programs focus on cigarette smokers. In many ways, however, the strategies and suggestions are transferable or adaptable to quitting smokeless tobacco, as well. For example:

• Self-help booklets, videotapes, and "quit kits" offer privacy, low cost, and flexibility.
• Primary care physicians can either work out plans for quitting or can offer referrals.
• Nicotine replacement therapies (NRTs), such as gum to chew, a patch to apply to the skin, or lozenges to suck on, release controlled doses of nicotine into the bloodstream, reducing cravings and withdrawal symptoms associated with nicotine dependency. Then use of the patch, gum, or lozenge is gradually tapered to reduce nicotine craving and eventually wean oneself from the need for the NRT, too. Current research, however, does suggest that NRTs work best for smokers. While the U.S. Food and Drug Administration (FDA) has not specifically approved NRTs for people to quit using smokeless tobacco, many smokeless tobacco users find these over-the-counter products helpful. For smokeless tobacco users, research suggests that the patch works more effectively than the gum since chewing the NRT gum may feel too much like chewing smokeless tobacco to let the user comfortably break the habit. Before starting on NRTs, consult your health care practitioner.
• Behavior modification programs conducted in groups build in support for quitting. Although the majority of group participants want to quit smoking cigarettes, the skills taught in this course can be applied to dipping or chewing, as well.
• Hypnosis and/or acupuncture works for some people. However, there is little evidence to support their effectiveness in the majority of users.

Two elements of quitting are exclusive to smokeless tobacco users. First, a stronger need is present to initially replace the oral fixation associated with the use of chewing tobacco or dip, so oral substitutes, such as gum or candy, are usually helpful. Also, commercial substitutes sold in round containers resembling snuff tins contain a variety of flavored herbal blends. (There is little information available about the potential side effects of this non-nicotinic snuff. In some cases, such herbal blends were able to successfully decrease withdrawal symptoms, but were less effective at reducing cravings than other cessation options.)

The second distinction has to do with the payoff of quitting. When someone stops using smokeless tobacco, s/he experiences fewer mouth sores and/or gum problems. This obvious improvement in oral health, combined with the feelings of mastery and well-being, motivates people to continue their cessation commitment.

Becoming comfortable with a tobacco-free life is a process that takes time and commitment. A good "quit tobacco" program includes some of these tips:

• Maintaining perspective, since it takes time and commitment to change a familiar, addictive behavior.
• Providing rewards, even a big red star on a calendar for each day, week, and/or month that someone stays off tobacco, can make a difference.
• Reinforcing one's commitment and successes, however small, when talking with others by using positive statements can help.
• Allowing others to give support and encouragement for efforts can have an impact.
• Avoiding "triggers," those certain times, places, and/or situations that are associated with dipping or chewing tobacco, is another way of taking control.
• Planning and using healthier choices for coping with stress can replace the use of tobacco.
• Remaining committed to the goal by keeping in mind any personal reasons for quitting up front and center.

Perhaps the biggest tangible incentive for quitting smokeless tobacco is the noticeable amount of money saved. A person who uses a can of dip or a pouch of chewing tobacco a day can save over $1,000.00 USD/year. That's a big chunk of change! A person can save it to use for a trip or vacation, season tickets to a sporting event, a subscription to the theatre or a concert series, or a donation to a cancer research institute or an organization that helps children whose health is negatively compromised by secondhand smoke.

Additional resources include:

National Cancer Institute (NCI) at 1.800.4.CANCER (422-6237)

American Cancer Society (ACS) at 1.800.ACS.2345 (227-2345)

Office on Smoking and Health of the Centers for Disease Control and Prevention

American Lung Association at 1.800.LUNGUSA (586-4872)

The organizations listed above provide information, but a significant factor in a person's success is his/her own readiness to quit.

Alice

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