Smokeless Tobacco

Long after the Marlboro Man quit hawking cigarettes on television, baseball players were still chewing Red Man, "dipping" Skoal, and encouraging millions of young television viewers to develop another, more dangerous habit - using smokeless tobacco.

When cigarette ads were forced off the airwaves in 1971, the smokeless tobacco industry launched a massive promotional campaign to take up the slack. Smokeless tobacco producers pumped millions of dollars into television ads featuring sports stars and country-western singers. Their mission: to change the stigma of chewing tobacco and snuff. What was once considered low-brow, socially unacceptable and dirty had to become desirable.

They were amazingly successful. The use of chewing tobacco and moist snuff skyrocketed at a time when smoking in the United States and other industrialized countries was on the decline. Between 1970 and 1979, production and sales of the fine cut tobacco used in moist snuff increased 188 percent, according to the National Cancer Institute. Sales of snuff are now increasing at the rate of seven to 11 percent every year.

The World Health Organization (WHO) describes it as a "new threat to society," estimating that there are now 12 million users of snuff and loose-leaf chewing tobacco in the United States.

Relatively few companies control the smokeless tobacco industry in the United States. U.S. Tobacco, which produces the two best-selling brands on the market, leads the pack in sales. Its Skoal, Skoal Bandits and Copenhagen brands alone account for approximately 27 percent of the smokeless tobacco market. Liggett & Myers, Lorillard, Brown & Williamson, and Culbro, Incorporated share the rest of the market.

Smokeless tobacco was left out of the initial debate that raged over smoking and health, and its producers attempted to capitalize on the windfall. In 1985 the industry spent over $22 million on advertising. Skoal Bandits ads told the public to "take a pouch instead of a puff." Print ads referred to it as "good clean chewing tobacco," or "clean enjoyment."

"Advertisements for smokeless tobacco imply that the habit is less harmful than smoking," noted Dr. Christopher Squier in an American Cancer Society report. "Unfortunately, this impression is common among the public and even among health professionals."

By 1981 several major studies had surfaced linking chew and snuff to oral cancer. Each year, the studies linking smokeless tobacco to various diseases grew more damning. Finally in August, 1986, amidst pressure from public interest and health groups, smokeless tobacco ads were banned from electronic media in the United States, and mandatory labels warning of oral cancer, tooth decay and gum disease were required on all packages.

Now advertisers have switched to new tactics. Instead of claiming that smokeless tobacco is a safe alternative to cigarettes, ads are increasingly aimed at young people. Smokeless tobacco ads feature swarthy out doorsmen and athletes, despite the 1985 Smokeless Tobacco Council voluntary code which prohibits the use of "active athletes" in advertisements.

And according to the Federal Trade Commission, advertisers are increasingly using sports events and rock concerts as forums to distribute free samples of the to bacco as well as t-shirts and tote-bags bear ing the logo of tobacco brands. Only two states - Minnesota and Utah - have banned free distribution of smokeless tobacco products. Free samples are also available through special mail-in offers in magazines such as Field and Stream, Outdoor Life, and Sporting News, despite state laws prohibiting minors from using smokeless tobacco. "Spitting contests" held at fairs and festivals have different age categories, including preschoolers. Youth groups around the country have started "chewing clubs," and some public schools set aside special areas where students can chew tobacco.

Industry innovation seems to have offset the decline in consumption health professionals hoped would result from the 1986 ad ban and warning label requirements. In fact, sales of snuff and chewing tobacco have continued to rise dramatically among young people. Twelve surveys from the past seven years have found that 8 to 36 percent of male high school and college students in the United States are regular users of smokeless tobacco, especially snuff. The National Institutes of Health estimated that at least three million of all U.S. users are underage 21. Surveys in Massachusetts, Texas, Oregon and Oklahoma indicate that approximately 30 percent of teenage males are "chewing" or "dipping."

One shocking study conducted by the U.S. Centers of Disease Control found that 17 percent of five-year-old girls and 10 percent of five-year-old boys in Alaska used smokeless tobacco and had been using i t for an average of about a year. More than 30 percent of 11-year-olds were regular users. A survey of kindergarten children in Arkansas found that 21 percent had used smokeless tobacco. Fourteen U.S. states still allow sales of smokeless tobacco to minors.

Like cigarette producers, the smokeless tobacco industry is also looking outside the U.S. for new markets. "We're investing our good, hard-earned dollars in what we call `mining,' laying a good foundation, in certain areas of the U.K., France, Italy," said U.S. Tobacco president Nicholas Buonicanti (a former Miami Dolphins linebacker) in 1985. Other targets included Sweden, Latin America. Tar-van, China, and Japan. Smokeless tobacco is "now being promoted cynically and aggressively around the world," says a WHO study group.

With the increased use comes increased dangers. "The problem ," says Allen Greenberg, an attorney formerly with the Public Citizen Health Research Group, "smokeless tobacco is not only addictive but also deadly." Snuff and chew are linked to many serious health problems: cancers of the cheek and gum; oral leukoplakia (precancerous lesions); cancers of the esophagus, larnyx and pancreas; and tooth decay and gum disease.

In India. where more than 40 percent of cancers are in the oral cavity, there is an extremely high rate of tobacco use. J.J. Pindburg, who conducted long-term epidemiological studies in India in the 1960s, found that oral cancer and leukoplakia occurred almost exclusively in Indians who had a tobacco habit. Another study found that Indian women who chewed tobacco had a higher percentage of stillborn babies than those who didn't use tobacco.

In the United States, the American Cancer Society estimates that oral cancer accounts for 27,000 deaths each year. Of these, a large percentage are thought to be caused from tobacco use. Risks of developing cancers increase with the duration of smokeless tobacco use.

In addition, surveys have shown that young people who use smokeless tobacco often "graduate" to cigarettes. "Many smokeless tobacco users are young people who may experience deleterious health effects from long-term snuff use or may try other forms of tobacco," says the National Cancer Institute.

But despite the number of studies indicting smokeless tobacco, it was the widely publicized case of Sean Marsee, a high school athlete and regular user of Copenhagen snuff, that first awakened America to its dangers. Marsee began using snuff at the age of 12. At age 18 he was diagnosed as having tongue cancer in the spot where the "quid" touched his tongue. In 1984, after a series of disfiguring operations including partial removal of his tongue, Marsee died. He was 19 years old. In one of the few lawsuits against smokeless tobacco producers, Marsee's mother sued U.S. Tobacco. Although the suit was ultimately unsuccessful, it sparked widespread debate on the safety of smokeless tobacco and spurred Congress into taking action.

Today, the World Health Organization, the Surgeon General, the American Medical Association, the American Cancer Society, the American Dental Association and the American Heart and Lung Association have joined ranks to battle smokeless tobacco. In June of this year a WHO study group called for a "pre-emptive ban" on the production, importation, and sale of smokeless tobacco all over the world, in order to "prevent a new public health epidemic from a new form of tobacco use." For areas already afflicted, WHO is urging litigation against the industry, prohibition of sales to minors, total advertising bans, and involvement of health personnel and teachers in the fight.

Progress is visible, if slow. Smokeless tobacco has been completely banned in Ireland, Hong Kong, New Zealand and Israel. The U.K. has prohibited electronic advertising, and is now debating whether to ban smokeless tobacco sales altogether. The battle is uphill, but there is strong determination to convince youth throughout the world that a pinch between the cheek and gum could be all it takes to end up dead. p