Spit: Tobacco’s Deadliest Little Secret Niki Sue Mueller Program Director Wyoming Through With Chew

What is Spit (Smokeless) Tobacco? Snuff is finely ground or shredded tobacco. Typically, the user places a pinch or dip between the cheek and gum Chewing tobacco is available in loose leaf and plug with the user putting a wad of tobacco inside the cheek Smokeless is not harmless!

What is in Spit Tobacco? contains 28 carcinogens The most harmful are the tobacco- specific nitrosamines (TSNAs) that are formed during the growing, curing, fermenting, and aging of tobacco. cancer-causing substances include N-nitrosamine acids, volatile N- nitrosamines, benzo(a)pyrene, volatile aldehydes, formaldehyde, acetaldehyde, crotonaldehyde, hydrazine, arsenic, nickel, cadmium, benzopyrene, and polonium–210. (NCI-2003)

Health Effects Spit Tobacco users are 50 times more likely to get oral cancer than non-users Spit tobacco use may cause cancer of the esophagus, larynx, stomach and pancreas and can form within five years of regular use Leukoplakia is a white, leathery patch which forms in the mouth and is considered a pre-cancerous lesion (S.T.O.P Guide, 1997; Hatsukami, D.& Seversen, Nicotine and Tobacco Research, 1999)

Big Tobacco Enters Smokeless Market PM USA is test marketing a smoke-free and spit-free tobacco pouch product, called Taboka, designed especially for adult smokers interested in smokeless tobacco alternatives to smoking Camel Snus, the first smokeless- tobacco product to be rolled out by a major U.S. tobacco company

Harm Reduction Strategy Harm reduction is a term used by the tobacco industry referring to a “strategy that encourages tobacco users who cannot or will not quit smoking to switch to an alternative nicotine-delivery product that is potentially less harmful than their regular product,” (Robins R, ed. The Seduction of Harm Reduction: Proceedings from the September 2004 Summit. Sacramento, CA: Department of Health Services; 2005)

U.S. Smokeless Tobacco’s “Graduation Strategy” UST document exhibited in the Marsee vs. UST lawsuit in 1986 All roads lead to Copenhagen

“Graduation Strategy” “New users of smokeless tobacco... are most likely to begin with products that are milder tasting, more flavored and/or easier to control in the mouth. After a period of time, there is a natural progression of product switching to brands that are more full-bodied, less flavored, have more concentrated ‘tobacco taste’ than the entry brand.”

“Graduation Party” UST Sponsors College Parties

Industry Quotes “Moist smokeless tobacco is the only growing segment of the tobacco industry” from the UST website “Cherry Skoal is for somebody who likes the taste of candy, if you know what I am saying.” Quoted in Wall Street Journal article on UST’s marketing strategies by a former UST sales representative, Bob Deets

UST’s Use Of Heroes To Promote ST

Promoting Use of ST On Airplanes

Rodeo and Football Were Used to Promote Spit Tobacco in Advertising Walt Garrison was a pro football player in the early 70’s Early association of alternative to smoking promotions

UST Capitalizing on “Smoke Free Environments”

ST Sent to Soldiers

CHICAGO, October 16, 2006—Rates of spit tobacco use by high school males are nothing to smile about, reports Oral Health America’s National Spit Tobacco Education Program (NSTEP). Research by the independent group finds that nationally about one out of seven high school males currently use spit (or smokeless) tobacco products, and in some states that number is one out of four. Spit tobacco excise taxes, which can reduce use by children, are arguably low, also resulting in a national “D” grade. Male HS use: Kansas “D” Excise tax: Kansas “F”

Kansas Use Rates Male High School Use Rate: 17.4 Female High School Use Rate: 3.8 Tobacco Industry Advertising in Kansas per year: million dollars

Why Tax Matters Increasing tax is the single best way to reduce tobacco use Most effective is to base tax on price, not weight UST has been effective in 8 states to get a weight based tax

Goal of Comprehensive Tobacco Control Programs: is to reduce disease, disability and death related to tobacco use by: Preventing initiation among youth Promote quitting Identifying and eliminating the disparities related to tobacco use and its effects among different population groups Eliminating nonsmokers’ exposure to ETS

CDC Guidelines Nine main guidelines Recommends states establish programs that are comprehensive, sustainable and accountable Evidence based

Wyoming Through With Chew’s Comprehensive Approach Building partnerships Promote cessation Media advocacy Counter advertising Prevent youth initiation Educate the public Policy change

Building Partnerships Health care providers State organizations Decision makers Employers/workplace Faith based Communities Native American populations

Promote Cessation Know your state protocol Use all possible opportunities to promote cessation

Increase Awareness Participate in Through With Chew Week Counter advertising Media advocacy Educate why price matters Health effects Changing social norms Get on the agenda at statewide conferences

Counter Advertising

No Bull Poster

Save The Date! February 17-23, 2008

Policy Change Opportunities Brief intervention among health care providers Tobacco free workplaces Tobacco free schools Tobacco free community events Reducing tobacco advertising and sponsorship

Business Toolkit

Native American Populations Design materials so that they are culturally appropriate Work with Native American communities to determine their specific needs

In Summary A comprehensive approach is the best way to reduce use rates Work to allocate funds to smokeless tobacco programming through statewide Department of Health Local communities may have to work to educate on their specific spit tobacco challenges

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National Spit Tobacco Summit You are invited! March in Oklahoma City, OK Presentations from national experts We can make a difference!