My dad uses tobacco — the type you "dip" or put in between the cheek and gum and spit out. I am trying to get him to stop and need some solid facts about the harm this type of tobacco use can do to the body. There is lots of information out there on smoking, but I am having a hard time finding information on this. Please help!

—Concerned Son

Dear Concerned Son,

Encouraging a family member or friend to stop using an addictive substance can be difficult and take patience. However, making sure you’re familiar with the evidence and noted consequences may be an effective way to start. Smokeless tobacco (ST) isn't a safe substitute for cigarette smoking and has several health risks, including nicotine addiction, cancer, oral health problems, and, for those who are using while pregnant, child development issues. In addition to talking with your father about the potential effects and health risks of smokeless tobacco use, you may also want to consider sharing available resources regarding tobacco cessation as well.

Smokeless tobacco, also known as oral tobacco, spit or spitting tobacco, dip, chew, or snus, comes in the forms of chewing tobacco and snuff. Chewing tobacco can come in many forms, be it as the leaves themselves, twists, or bricks. It can be both chewed or just left in the mouth and is typically tucked in the cheek or lower lip. Snuff, on the other hand, is comprised of tobacco that is cut finely or powdered and may be moist or dry. Similar to chewing tobacco, it can be placed in the cheek or gums, but some people choose to inhale the dry snuff. It's available in many forms, such as lozenges, loose leaves or powder, or pouches that can be similar to tea bags. 

Like cigarettes, smokeless tobacco is highly addictive because of the stimulant drug, nicotine. Its use has been associated with increased heart rate, higher blood pressure, and increased levels of nicotine in the blood. If a person tries to stop using ST products, they may experience withdrawal symptoms because of their dependence on nicotine, which makes it harder to quit (even if they're motivated and committed to trying because of the health consequences). The nicotine from smokeless tobacco products may remain in the membrane of the mouth after use, and studies have shown that the amount of nicotine absorbed by way of smokeless tobacco can be up to twice the amount absorbed from cigarettes.  

Similar to other tobacco products, chewing tobacco has a number of negative health effects associated with its use. There are approximately 28 to 30 carcinogens found in smokeless tobacco that have been linked to cancer. The most prevalent carcinogens in smokeless tobacco are tobacco-specific nitrosamines (TSNA), which develop during the production of smokeless tobacco and include N-nitrosamine acids, aldehydes, uranium, and other heavy metals. Because of the abundance of carcinogens in smokeless tobacco, people who use ST products are at higher risk of developing cancer (specifically, oral, throat, and pancreatic cancer) than those who don’t. ST products are associated with eukoplakia and erythroplakia, which are referred to as oral potentially malignant disorders (OPMDs). These are sores that appear where the tobacco was placed in the mouth, and they've been associated with cancer. Other oral health issues such as gingivitis, gum recession, tooth loss, yellowed teeth, bad breath, soft tissue lesions, tobacco pouch lesions, and, if areca nut is an ingredient, oral submucous fibrosis (OSF) are also consequences of smokeless tobacco use. Lastly, if a person is pregnant and gives birth, the heavy metals found in ST products such as lead and cadmium can lead to birth defects and stunt infant brain development.

As you prepare to share the risks of smokeless tobacco use with your father, consider reviewing Nicotine Anonymous or, which are resources that provide support and community for those trying to quit, along with information of their own. It can be helpful to know that while you can provide him with information, there isn't anything you can do to make your father quit. It's possible that he may not want to make any changes, but sharing resources may help him decide to take action or at least know he can reach out to you in the future if he changes his mind. Fighting a nicotine addiction may be an uphill battle, and your father is lucky to have you as a support. Good luck to both of you!


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