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SMOKELESS TOBACCO USE: OUT OF THE PARK!
BACKGROUNDER*
February 2016
For three decades, North American public health authorities – including the U.S. Surgeon
General, the U.S. National Cancer Institute and the Canadian Cancer Society – have known
that smokeless tobacco use is hazardous to health and can lead to long-term nicotine
addiction. Smokeless tobacco contains at least 28 cancer-causing chemicals and causes
oral, pancreatic and esophageal cancer. Use of smokeless tobacco is also associated with
other health problems including lesions in the mouth and tooth decay:

According to the U.S. National Cancer Institute, at least 28 cancer-causing chemicals
have been identified in smokeless tobacco.1 The U.S. National Toxicology Program has
͏ρῢ̳ΠΎρ΋͏͋ ρΦήΝ͏Π͏ρρ ϋή̳̀́́ή ̳ρ ̳ ΏΝΧήϲΧ ΋ϦΦ̳Χ ̳́ν́ΎΧή΁͏ΧΉ͟2 The U.S. National
Cancer Institute and the International Agency for Research on Cancer both report that
use of smokeless tobacco causes oral, pancreatic and esophageal cancer.3

Smokeless tobacco use is associated with leukoplakia, a disease of the mouth
characterized by white patches and oral lesions on the cheeks, gums, and/or tongue.
Leukoplakia can sometimes lead to oral cancer. Studies have found that more than half
of daily users of smokeless tobacco had lesions or sores in the mouth, and that these
sores are commonly found in the part of the mouth where users place their chew or
dip.4

Chewing tobacco has also been linked to tooth decay. A study by the National
Institutes of Health and the Centers for Disease Control and Prevention found chewing
tobacco users were four times more likely than non-users to have decayed dental root
surfaces.5

Smokeless tobacco use during youth can lead to a lifetime of nicotine addiction.6 A
ρϋϦ͋ϸ ΎΧ ϋ΋͏ !Φ͏νΎ̳́Χ ͫήϦνΧ̳Π ή͙ Έν͏ϱ͏ΧϋΎϱ͏ ͵͏͋Ύ́ΎΧ͏ ͙ήϦΧ͋ ϋ΋̳ϋ ΏρΧϦ͙͙ Ϧρ͏ Φ̳ϸ ̀͏ ̳
gateway form of nicotine dosing among males in the United States that may lead to
ρϦ̀ρ͏μϦ͏Χϋ ́Ύ΁̳ν͏ϋϋ͏ ρΦήΝΎΧ΁Ή͟7 Another study found that adolescent boys who use
smokeless tobacco products have a higher risk of becoming cigarette smokers within
four years.8
Founding Agencies
Canadian Cancer Society Ontario Division
Heart and Stroke
Foundation of Ontario
Non-Smokers’
Rights Association
Ontario Medical Association
Supporting Agencies
Association of Local
Public Health Agencies
Cancer Care Ontario
Ontario Association of Children’s Aid Societies
Ontario Association of Naturopathic Doctors
Ontario Federation of Home
and School Associations
Ontario Physical and Health
Education Association
Ontario Public Health
Association
Physicians for a
Smoke-Free Canada
Registered Nurses
Association of Ontario
The Ontario College
of Family Physicians
Major League Baseball has recently taken some steps to limit smokeless use. But as
many players still use the product, health agencies in Toronto have joined with the City
of Toronto, professional and amateur sports groups to work toward a complete ban of
smokeless tobacco use, both at the Rogers Centre and also in other professional and
amateur sports facilities in Toronto:
150 Bloor Street West
Suite 900
Toronto, Ontario
M5S 3C1
t: 416.340.2992
f: 416.340.2995
email: ocat@oma.org
www.ocat.org

U.S. cities where Major League Baseball (MLB) clubs support the implementation of
city-wide bans on the use of smokeless tobacco in professional and amateur sports
facilities include Boston, Los Angeles, and New York City.

The current Collective Agreement in place between Major League Baseball and the
MLB Players Association expires on December 1, 2016. A complete ban on smokeless
tobacco use in all MLB facilities could be included as part of the next Collective
Agreement.
…/2
-2
In Ontario, the 2015 Ontario Student Drug Use and Health Survey reports that smokeless tobacco (chewing
tobacco, dipping tobacco, or snuff) is used by about 6% of students in grades 7-12: this represents an estimated
58,200 students in all of Ontario. This percentage represents an increase from 4.6% in 2011. The highest rates of
use were found in Eastern Ontario (9.4%) and the lowest rate in Toronto (3%).9 Among male students, the
prevalence of smokeless tobacco use is similar to cigarette smoking.10

Use of chewing tobacco has also been frequently reported in amateur hockey, despite ongoing efforts and policies
on the part of amateur hockey associations in Ontario and elsewhere in Canada designed to eliminate the practise.
Ε΋͏ Ͷ̳ϋΎήΧ̳Π Hή́Ν͏ϸ ͯ͏̳΁Ϧ͏ ΋̳ρ ̳ ΏΧή Ϧρ͏͟ κήΠΎ́ϸ ̳ϋ Ύϋρ ͙̳́ΎΠΎϋΎ͏ρ ̳Χ͋ ̳ϋ ͙̳Χ ͏ϱ͏ΧϋρΈ ̳Χ Ώ̳ΠΠ ρκήνϋρ͟ ̳̀Χ ΎΧ ΕήνήΧϋή
will extend the message about the dangers of chewing tobacco use to young hockey players in Toronto and across
Ontario.
*Thanks to the US Campaign for Tobacco-Free Kids for contributions to this backgrounder.
1
Ͷ̳ϋΎήΧ̳Π C̳Χ́͏ν ͠ΧρϋΎϋϦϋ͏Ά ΏΏΦήΝ͏Π͏ρρ Εή̳̀́́ή ̳Χ͋ C̳Χ́͏νΆ͟ !́́͏ρρ͏͋ Ώ͏κϋ͏Φ̀͏ν 9Ά 2014Ή
http://www.cancer.gov/cancertopics/factsheet/Tobacco/smokeless#r1. See also: NIH, NCI, Smoking and Tobacco Control
Monograph 2: Smokeless Tobacco or Health: An International Perspective, September 1992,
http://cancercontrol.cancer.gov/tcrb/monographs/2/m2_complete.pdf.
2
HHS, Public Health Service, National Toxicology Program, Report on Carcinogens, Twelfth Edition, June 2011,
http://ntp.niehs.nih.gov/pubhealth/roc/roc12/index.html
3
Ͷ̳ϋΎήΧ̳Π C̳Χ́͏ν ͠ΧρϋΎϋϦϋ͏Ά ΏΏΦήΝ͏Π͏ρρ Εή̳̀́́ή ̳Χ͋ C̳Χ́͏νΆ͟ !́́͏ρρ͏͋ Ώ͏κϋ͏Φ̀͏ν 9Ά 2014Ή
http://www.cancer.gov/cancertopics/factsheet/Tobacco/smokeless#r1. See also: International Agency for Research on Cancer. A
Review of Human Carcinogens: Personal Habits and Indoor Combustions. IARC Monographs on the Evaluation of Carcinogenic Risks
to Humans, Volume 100E (2012).
4
H̳ϋρϦΝ̳ΦΎΆ D & Ώ͏ϱ͏νρήΧΆ HΆ Ώͼν̳Π ΏκΎϋ Εή̳̀́́ήΈ !͋͋Ύ́ϋΎήΧΆ Έν͏ϱ͏ΧϋΎήΧ ̳Χ͋ Εν͏̳ϋΦ͏ΧϋΆ͟ ͶΎ́ήϋΎΧ͏ & Εή̳̀́́ή ΋͏ρ͏̳ν́΋ 21-44, 1999
5
TήΦ̳νΆ ΏͯΆ ΏC΋͏ϲΎΧ΁ Εή̳̀́́ή Ιρ͏ ̳Χ͋ D͏Χϋ̳Π C̳νΎ͏ρ !ΦήΧ΁ ΙΉΏΉ ͵͏ΧΆ͟ ͫήϦνΧ̳Π ή͙ ϋ΋͏ !Φ͏νΎ̳́Χ D͏Χϋ̳Π !ρρή́Ύ̳ϋΎήΧΆ 1999Ά 130Έ 160Ή
6
Institute for Social Research, The University of Michigan, Monitoring the Future,
http://monitoringthefuture.org/pressreleases/00cigpr.pdf; American Academy of Pediatrics, Dangers of Smokeless Tobacco,
http://www.healthychildren.org/English/health-issues/conditions/tobacco/Pages/Dangers-of-Chew.aspx; CDC, Smokeless Tobacco
Facts, http://www.cdc.gov/tobacco/data_statistics/fact_sheets/smokeless/smokeless_facts/index.htm.
7
ΕήΦ̳νΆ ΏͯΆ ΏΏΧϦ͙͙ Ιρ͏ ̳Χ͋ ΏΦήΝΎΧ΁ ͠Χ ΙΉΏΉ ͵͏ΧΈ ͠ΦκΠΎ̳́ϋΎήΧρ ͙ήν H̳νΦ ΋͏͋Ϧ́ϋΎήΧΆ͟ !ͫΈH 23(3)Ά 2002Ή
8
ΕήΦ̳νΆ ΏΆ Ώ͠ρ Ϧρ͏ ή͙ ρΦήΝ͏Π͏ρρ ϋή̳̀́́ή ̳ νΎρΝ ͙̳́ϋήν ͙ήν ́Ύ΁̳ν͏ϋϋ͏ ρΦήΝΎΧ΁; Ε΋͏ ΙΉΏΉ ͏Ϸκ͏νΎ͏Χ́͏Ά͟ ͶΎ́ήϋΎΧ͏ & Εή̳̀cco Research
5(4):561-569, August 2003.
9
C͏Χϋν͏ ͙ήν !͋͋Ύ́ϋΎήΧ ̳Χ͋ ͵͏Χϋ̳Π H͏̳Πϋ΋Ά ΏD͏ϋ̳ΎΠ͏͋ ͼΏDΙHΏ FΎΧ͋ΎΧ΁ρΈ DνϦ΁ Ιρ͏ !ΦήΧ΁ ͼΧϋ̳νΎή ΏϋϦ͋͏ΧϋρΆ 1977-2015͟ C!͵H
Research Document Series No. 41, p. 67, 2015. http://www.camh.ca/en/research/news_and_publications/ontario-student-druguse-and-health-survey/Documents/2015%20OSDUHS%20Documents/2015OSDUHS_Detailed_DrugUseReport.pdf
10
Ibid, p. 274.
HEALTH HARMS FROM SMOKELESS TOBACCO USE
Public health authorities including the Surgeon General and the National Cancer Institute
have found that smokeless tobacco use is hazardous to health and can lead to nicotine
addiction. Smokeless tobacco contains at least 28 cancer-causing chemicals and causes
oral, pancreatic and esophageal cancer. Use of smokeless tobacco is also associated
with other health problems including lesions in the mouth and tooth decay.
• Nearly 30 years ago, an expert advisory committee to the U.S. Surgeon General found
that, “After a careful examination of the relevant epidemiologic, experimental, and
clinical data, the committee concludes that the oral use of smokeless tobacco
represents a significant health risk. It is not a safe substitute for smoking cigarettes. It
can cause cancer and a number of non-cancerous oral conditions and can lead to
nicotine addiction and dependence.”1
• According to the National Cancer Institute, at least 28 cancer causing chemicals have
been identified in smokeless tobacco.2 The U.S. National Toxicology Program
established smokeless tobacco as a “known human carcinogen.”3
• The National Cancer Institute and the International Agency for Research on Cancer
report that use of smokeless tobacco causes oral, pancreatic and esophageal cancer.4
• Smokeless tobacco use is associated with leukoplakia, a disease of the mouth
characterized by white patches and oral lesions on the cheeks, gums, and/or tongue.
Leukoplakia can sometimes lead to oral cancer. Studies have found that more than
half of daily users of smokeless tobacco had lesions or sores in the mouth, and that
these sores are commonly found in the part of the mouth where users place their
chew or dip.5
• Chewing tobacco has also been linked to dental caries (tooth decay). A study by the
National Institutes of Health and the Centers for Disease Control and Prevention found
chewing tobacco users were four times more likely than non-users to have decayed
dental root surfaces.6
• Smokeless tobacco use during youth can lead to a lifetime of nicotine addiction.7 A
study in the American Journal of Preventive Medicine found that “snuff use may be a
gateway form of nicotine dosing among males in the United States that may lead to
subsequent cigarette smoking.”8 Another study found that adolescent boys who use
smokeless tobacco products have a higher risk of becoming cigarette smokers within
four years.9
Although smokeless tobacco use does not carry all of the same health harms as smoking,
the health effects of using smokeless tobacco are well established. Considering that
smokeless tobacco products still contain varying levels and types of carcinogens10 and
carry health risks, the only way to reduce an individual tobacco users’ health risks to the
maximum extent possible is to quit using tobacco entirely with evidence-based treatments
1400 I Street NW · Suite 1200 · Washington, DC 20005
Phone (202) 296-5469 · Fax (202) 296-5427 · www.tobaccofreekids.org
Health Harms from Smokeless Tobacco Use / 2
that have been scientifically documented to help people quit using tobacco (e.g., nicotine
gum and patch, telephone-based behavioral counseling/quitlines).11
Campaign for Tobacco-Free Kids, September 9, 2014 / Ann Boonn
More information on smokeless tobacco can be found at
http://www.tobaccofreekids.org/facts_issues/fact_sheets/toll/products/smokeless/.
1
U.S. Department of Health and Human Services (HHS), The Health Consequences of Using Smokeless Tobacco: A
Report of the Advisory Committee to the Surgeon General, Bethesda, MD 20892, NIH Publication No. 86-2874, April
1986, http://profiles.nlm.nih.gov/NN/B/B/F/C/.
2
National Cancer Institute, “Smokeless Tobacco and Cancer,” Accessed September 9, 2014.
http://www.cancer.gov/cancertopics/factsheet/Tobacco/smokeless#r1. See also: NIH, NCI, Smoking and Tobacco
Control Monograph 2: Smokeless Tobacco or Health: An International Perspective, September 1992, http://cancercontrol.cancer.gov/tcrb/monographs/2/m2_complete.pdf.
3
HHS, Public Health Service, National Toxicology Program, Report on Carcinogens, Twelfth Edition, June 2011,
http://ntp.niehs.nih.gov/pubhealth/roc/roc12/index.html
4
National Cancer Institute, “Smokeless Tobacco and Cancer,” Accessed September 9, 2014.
http://www.cancer.gov/cancertopics/factsheet/Tobacco/smokeless#r1. See also: International Agency for Research on
Cancer. A Review of Human Carcinogens: Personal Habits and Indoor Combustions. IARC Monographs on the
Evaluation of Carcinogenic Risks to Humans, Volume 100E (2012).
http://monographs.iarc.fr/ENG/Monographs/vol100E/mono100E-8.pdf
5
Hatsukami, D & Severson, H, “Oral Spit Tobacco: Addiction, Prevention and Treatment,” Nicotine & Tobacco Research
1:21-44, 1999.
6
Tomar, SL, “Chewing Tobacco Use and Dental Caries Among U.S. Men,” Journal of the American Dental Association, 1999, 130: 160.
7
Institute for Social Research, The University of Michigan, Monitoring the Future, http://monitoringthefuture.org/pressreleases/00cigpr.pdf; American Academy of Pediatrics, Dangers of Smokeless
Tobacco, http://www.healthychildren.org/English/health-issues/conditions/tobacco/Pages/Dangers-of-Chew.aspx; CDC, Smokeless Tobacco Facts, http://www.cdc.gov/tobacco/data_statistics/fact_sheets/smokeless/smokeless_facts/index.htm.
8
Tomar, SL, “Snuff Use and Smoking In U.S. Men: Implications for Harm Reduction,” AJPH 23(3), 2002.
Tomar, S, “Is use of smokeless tobacco a risk factor for cigarette smoking? The U.S. experience,” Nicotine & Tobacco
Research 5(4):561-569, August 2003.
9
10
Stepanov, I, et al., “Tobacco-specific nitrosamines in new tobacco products,” Nicotine and Tobacco Research 8(2):
309-313, 2006.
11
Henley, SJ, et al., “Tobacco-related disease mortality among men who switched from cigarettes to spit tobacco,” Tobacco Control 16:22-28, 2007.
SMOKELESS TOBACCO AND KIDS
Since 1970, smokeless tobacco has gone from a product used primarily by older men to one used
predominantly by young men and boys. This trend has occurred as smokeless tobacco promotions have
increased dramatically and a new generation of smokeless tobacco products has hit the market. Far from
being a “safe” alternative to cigarette smoking, smokeless tobacco use causes cancer and increases the
risk of developing other health problems, including nicotine addiction and the potential to move on to
combustible tobacco products.
Smokeless Tobacco Use
Although cigarette smoking in the U.S. has been on the decline, the latest survey from the Centers for
Disease Control and Prevention showed that the use of smokeless tobacco among youth has held steady
since 1999. In 2013, 14.7 percent of high-school boys and 8.8 percent of all high-school students
1
reported current use of smokeless tobacco products. Each year, about 535,000 kids ages 12-17 use
2
smokeless tobacco for the first time.
In 16 states, smokeless tobacco use among high school boys is higher than the national rate, with the
highest boys’ rates in Alabama (23.1%), Arkansas (24.2%), Kentucky (22.3%), Montana (21.6%), North
3
Dakota (22.0%), Oklahoma (21.2%), Tennessee (20.9%), West Virginia (27.4%) and Wyoming (21.9%).
Smokeless tobacco use didn’t used to be so prevalent among the younger population. In 1970, men 65
and older were almost six times as likely as those aged 18 to 24 to use spit tobacco regularly, but by
4
1991, young men were 50 percent more likely than the oldest men to be regular users. This pattern held
especially true for moist snuff, the most popular type of smokeless tobacco. From 1970 to 1991, the
regular use of moist snuff by 18 to 24 year old men increased almost ten-fold, from less than one percent
to 6.2 percent. Conversely, use among men 65 and older decreased by almost half, from four percent to
5
2.2 percent.
With the new generation of smokeless tobacco products that are made to be easier to conceal, easier to
use, and lower priced, the popularity of these products among young people is likely to continue.
New Companies, Old Players
In the past, cigarette companies only sold cigarettes and smokeless tobacco companies only sold
smokeless tobacco. Today, however, companies sell a wide range of tobacco products, with one
company declaring itself a “total tobacco company.” The U.S. Smokeless Tobacco Company (UST), now
a subsidiary of Altria, the parent company of Philip Morris USA (makers of Marlboro cigarettes), is the
biggest smokeless tobacco company in the U.S. and controls more than half (55.2%) of the moist snuff
6
tobacco market (with leading premium brands Skoal and Copenhagen). Reynolds American, Inc.
(makers of Camel cigarettes) owns the second largest smokeless tobacco company in the U.S., American
Snuff Company (formerly Conwood Tobacco Company), the makers of Grizzly and Kodiak, which holds
7
more than one-third of the moist snuff market. Other cigarette companies have also test-marketed their
own smokeless tobacco products.
Marketing Smokeless Tobacco to Kids
Not surprisingly, tobacco marketing plays an important role in attracting users – particularly youth. The
2012 Surgeon General’s report, Preventing Tobacco Use among Youth and Young Adults, found that the
“integration of product design with marketing helped to reverse the mid-twentieth century decline in
smokeless tobacco use and spurred a rapid increase in smokeless tobacco use by adolescents and
8
young adult males.”
From 1998 to 2011 (the most recent year for which data are available), the total advertising and marketing
expenditures of the top-five smokeless tobacco companies in the U.S. more than tripled. In 2011, these
smokeless tobacco companies spent $451.7 million to advertise and market their products—an increase of
9
more than 80 percent from 2005 expenditures ($250.8 million). Some of these funds pay for smokeless
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Phone (202) 296-5469 · Fax (202) 296-5427 · www.tobaccofreekids.org
Smokeless Tobacco & Kids / 2
10
tobacco ads in magazines with high youth readership, such as Sports Illustrated and Rolling Stone. In
fact, in the few years after signing the Smokeless Tobacco Master Settlement Agreement (STMSA),
despite its restrictions placed on youth advertising, UST increased its expenditures in magazines with a
11
significant number of youth readers by 161 percent, from $3.6 million to $9.4 million.
Tobacco companies have used a variety of strategies to entice youth to use smokeless tobacco: sweet
and kid-friendly flavors, sponsorships of events popular with youth, advertisements with youth-oriented
messages, and affordable prices.
Flavors. Smokeless tobacco products are being sold in a variety of kid-friendly flavors. Internal
company documents show that UST intentionally used flavors to hook new spit-tobacco users (meaning
kids) years ago. As one document states:
New users of smokeless tobacco -- attracted to the category for a variety of
reasons -- 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
12
more concentrated ‘tobacco taste’ than the entry brand.
Following this strategy, between 1983 and 1984, UST introduced Skoal Bandits and Skoal Long Cut,
designed to “graduate” new users from beginner strength to stronger, more potent products. A 1985
internal UST newsletter indicates the company’s desire to appeal to youth: “Skoal Bandits is the
13
introductory product, and then we look towards establishing a normal graduation process.” In 1993,
cherry flavoring was added to UST’s Skoal Long Cut, another starter product. A former UST sales
representative revealed that “Cherry Skoal is for somebody who likes the taste of candy, if you know what
14
I’m saying.” “Candy” is an appropriate comparison, given a recent chemical analysis showing that the
same flavor chemicals used in sweet-flavored moist snuff tobacco products are also used in popular candy
15
and drink products such as LifeSavers, Jolly Ranchers, and Kool-Aid. UST has continued its efforts to
grow and expand its brands. For instance, one study found that between 2000 and 2006, UST increased
the number of its sub-brands by 140 percent, creating a larger variety of products, including flavors, with
16
which to “cast a wide net” and appeal to as many potential users as possible.
According to Nielsen scanner data, sales of flavored moist snuff across all companies increased 72
percent between 2005 and 2011; and in 2011, flavored products (which now include flavors such as
apple, peach, vanilla, berry blend, and citrus blend, in addition to wintergreen and spearmint/mint)
17
accounted for more than half (56.1%) of all moist snuff sales.
Sponsorships. Smokeless tobacco products have been marketed to young people through a number of
channels, including sporting events like auto racing and rodeos that are widely attended by kids. UST
used to sponsor many professional motorsports and rodeo and bull riding events. As the general
18
manager of the College Finals said, “U.S. Tobacco is the oldest and best friend college rodeo ever had.”
However, the state tobacco settlement agreements and 2009 Family Smoking Prevention and Tobacco
Control Act (Tobacco Control Act) now limit smokeless tobacco companies’ ability to continue to do
brand-name sponsorships of events and teams. The Tobacco Control Act also prohibits free sampling of
smokeless tobacco except under very narrow circumstances. In addition, some cities, including Boulder
and Greeley, CO, have prohibited free tobacco product giveaways, making it even more difficult for
companies like UST to lure new users at these events.
Advertisements. For years, tobacco companies have used advertisements as a way to market their
smokeless tobacco products to youth and young adults. As one example, back in 1999, UST ran a fullcolor advertising insert for its Rooster brand smokeless tobacco in San Diego State University’s college
paper, the Daily Aztec. The ad offered a sweepstakes for an all expenses paid trip to the Playboy mansion
and, in direct violation of California law, included a $1.00 coupon. State enforcement efforts related to the
ad forced UST to pay a fine of $150,000 and pay for a parallel ad insert opposing smokeless tobacco use.
Continuing its efforts to lure and maintain young users, in 2001, UST ran a magazine ad for its Rooster
brand in Rolling Stone with the phrase, “Cock-A-Doodle Freakin’ Do.” Less than a year later, ads for
Rooster appeared in Sports Illustrated, bearing the same image as before, but with the phrases, “Where’s
The Chicks?,” and “Birds of a Feather Party Together.” After UST received criticism for both the ads’
blatant appeal to youth and a Massachusetts Department of Public Health report finding that UST
Smokeless Tobacco & Kids / 3
19
increased its advertising in magazines targeting youth after the STMSA , the company stopped using
20
those ads and suspended its advertising in four magazines.
Rolling Stone, July 3, 2001
Sports Illustrated, May 6, 2002
Sports Illustrated, April 4, 2002
More recently, Reynolds’ “tellin’ it like it is” campaign for Grizzly uses sarcastic phrases as advice about
how to be “manly” or “macho.” Users were even encouraged to submit their own phrases. Grizzly is
21
currently the most popular smokeless tobacco brand among 12-17 year olds.
Car and Driver, January 2014
Maxim, May 2014
Rolling Stone, October 10, 2013
In May 2014, after five years out of magazines, Altria began placing Skoal ads in publications popular
with boys and young men, including Sports Illustrated, Car and Driver, and Maxim. After years as the
most popular moist snuff brand, Skoal is now the third most popular among 12-17 year olds, behind
22
Copenhagen and Grizzly. And in January 2015, Altria restarted the first ads for Copenhagen in
magazines such as Popular Mechanics, GQ, Car and Driver, and Maxim, since 2008.
Pricing. Higher prices are one of the most effective ways to reduce
tobacco use, and its corollary is also true: low prices can promote or
initiate tobacco use. Tobacco companies have been using price
promotions and other strategies successfully to make smokeless tobacco
products more affordable. Skoal and Copenhagen – both more
expensive, premium brands – were the most popular products through
the mid-2000s, even among youth, until bargain-priced Grizzly arrived.
Within five years, Grizzly became the most popular brand among 12-17
23
year olds, a position it held until 2013. One convenience store retailer
stated, “What is driving sales for us has been the influx of new brands
that retail for under $3. We’re looking at a massive demand on these
24
brands.”
In an effort to regain their market share, UST and Altria, makers of Skoal
and Copenhagen, have tried to convince states to change their tax
structures to make them more favorable towards the premium brands to
2009 Direct mail piece. Source:
www.trinketsandtrash.org.
Smokeless Tobacco & Kids / 4
the detriment of bargain brands. In addition, Altria cut prices on Copenhagen and Skoal products in 2009
and in 2011 introduced a “value” extension of its Skoal brand. Convenience store retailers reported,
“…Skoal launched its Skoal Xtra brand, which pretty much cut the price in half. And Copenhagen was at
$5-$6 a roll, and now it’s in the $4.50 range. As the price has come down, consumers have responded by
25
increasing purchases.” By 2013, Copenhagen became the most popular moist snuff brand among 12-17
26
year olds.
New Smokeless Tobacco Products
For years, tobacco companies have marketed smokeless tobacco products as a way to use tobacco in
places or situations when smoking is not allowed or is not socially acceptable, and that practice continues
today. Seeing the downward trend in smoking rates and the increasing popularity of smokeless tobacco
products, cigarette companies have released their own smokeless tobacco products that draw on the brand
names of their popular cigarettes to attract new users. R.J. Reynolds’s Camel Snus and Philip Morris USA’s
Marlboro Snus are now sold nationally, and other cigarette companies had tried their hand at snus brands.
Snus are small, teabag-like pouches containing tobacco and other flavorings that users place between their
upper gum and lip. Because these products do not require spitting, their use can be easily concealed. One
high school student admitted using Camel Snus during class, saying, “It’s easy, it’s super-discreet…and
27
none of the teachers will ever know what I’m doing.”
R.J. Reynolds began test-marketing its own new line of dissolvable tobacco products, again under the
28
Camel brand name, in three cities in January 2009 and in two different test cities beginning March 2011.
Camel Orbs are pellets of ground tobacco resembling tic tacs, Camel Strips are flat sheets of ground
tobacco that work like dissolvable breath strips, and Camel Sticks are toothpick-like sticks of ground
tobacco. The Indiana Poison Center issued a warning that the products’ resemblance to non-tobacco
products put children at risk for accidental poisoning. In 2013, Reynolds announced that it would be
29
scaling back efforts on its dissolvable products, but they continue to be sold in limited test markets. The
Tobacco Products Scientific Advisory Committee of the U.S. Federal Drug Administration issued a study
on these and other dissolvable tobacco products and found, among other things, “that the available
evidence, while limited, leads to a qualitative
judgment that availability of DTPs [dissolvable
tobacco products] could increase the number of
30
users of tobacco products.”
Altria, Inc., the parent company of Marlboro-maker
PM USA and Skoal-maker UST, has been testmarketing flavored Marlboro Sticks and Skoal
Camel Snus
Camel Dissolvables
Sticks, both toothpick-type sticks coated in
tobacco, since March 2011 in various places in
Kansas. In response, the Kansas Department of
Health and Environment (KDHE) issued a warning
Skoal Sticks
about the products, stating, “As the state’s health
agency, KDHE is particularly concerned about the
potential appeal of these new tobacco sticks to youth. The packages are so small that they could easily
be concealed in a shirt or pants pocket and youth could use tobacco sticks in front of parents or teachers
while appearing to have a simple toothpick in their mouth. We are also concerned about the risk of young
31
children accidentally ingesting these products.” By placing the new brand extensions both with
cigarettes (Marlboro Sticks) and with smokeless tobacco products (Skoal Sticks), the company seems to
32
be testing which market is more viable for their product.
These new products concern public health organizations for numerous reasons: they may lure even
more kids into smokeless tobacco use and addiction; because of their novelty; because of the
misconception that they are a harmless form of tobacco use; and because they can be consumed much
less conspicuously than either cigarettes or existing spit tobacco products at home, in school and in other
locations. Furthermore, cigarette smokers who might ultimately quit because of the social stigma
associated with smoking, the inconvenience caused by smoking restrictions at work and elsewhere, or a
Smokeless Tobacco & Kids / 5
desire to protect their family and friends from secondhand smoke may instead switch to smokeless
*
tobacco products and end up perpetuating and increasing their nicotine addiction.
Harms from Smokeless Tobacco Use
Public health authorities including the Surgeon General and the National Cancer Institute have found that
smokeless tobacco use is hazardous to health and can lead to nicotine addiction. Smokeless tobacco
contains at least 28 cancer-causing chemicals and causes oral, pancreatic and esophageal cancer. Use
of smokeless tobacco is also associated with other health problems including lesions in the mouth and
tooth decay. More specifically:
•
•
Nearly 30 years ago, an expert advisory committee to the U.S. Surgeon General found that, “After a
careful examination of the relevant epidemiologic, experimental, and clinical data, the committee
concludes that the oral use of smokeless tobacco represents a significant health risk. It is not a safe
substitute for smoking cigarettes. It can cause cancer and a number of non-cancerous oral
33
conditions and can lead to nicotine addiction and dependence.”
According to the National Cancer Institute, at least 28 cancer causing chemicals have been identified
34
in smokeless tobacco. The U.S. National Toxicology Program established smokeless tobacco as a
35
“known human carcinogen.”
•
The National Cancer Institute and the International Agency for Research on Cancer report that use of
36
smokeless tobacco causes oral, pancreatic and esophageal cancer.
•
Smokeless tobacco use is associated with leukoplakia, a disease of the mouth characterized by white
patches and oral lesions on the cheeks, gums, and/or tongue. Leukoplakia can sometimes lead to
oral cancer. Studies have found that more than half of daily users of smokeless tobacco had lesions
or sores in the mouth, and that these sores are commonly found in the part of the mouth where users
37
place their chew or dip.
•
Chewing tobacco has been linked to dental caries (tooth decay). A study by the National Institutes of
Health and the Centers for Disease Control and Prevention found chewing tobacco users were four
38
times more likely than non-users to have decayed dental root surfaces.
•
Smokeless tobacco contains nitrosamines—proven and potent carcinogens. A study by the
American Health Foundation for the Commonwealth of Massachusetts found that the level of cancer
causing tobacco specific nitrosamines (TSNAs) in U.S. oral moist snuff brands were significantly
higher than comparable Swedish Match brands. These data suggest that it is possible for smokeless
40
tobacco companies to produce oral snuff with significantly lower TSNA levels.
•
A 2009 study found that moist snuff tobacco contained a considerable number of carcinogenic
polycyclic aromatic hydrocarbons (PAHs) in varying amounts, depending on the product and brand.
Because of this variation, the researchers concluded that tobacco companies could minimize the
41
levels of PAHs in their products.
•
A study in the American Journal of Preventive Medicine found that “snuff use may be a gateway form
of nicotine dosing among males in the United States that may lead to subsequent cigarette smoking.”
Further, the study found that “the prevalence of smoking was substantially higher among men who
had quit using snuff than among those who had never used snuff, suggesting that more than 40
42
percent of men who had been snuff users continued or initiated smoking.”
•
A study from Nicotine & Tobacco Research found that adolescent boys who use smokeless tobacco
43
products have a higher risk of becoming cigarette smokers within four years.
•
A 2008 study showed how smokeless tobacco manufacturers changed free nicotine levels—and thus
the addictiveness of products—by manipulating pH levels in smokeless tobacco products over time.
For instance, between 2000 and 2006, Conwood Smokeless Tobacco Company (now American Snuff
Company, a Reynolds American subsidiary) increased the free nicotine level by 31.1 percent across
*
39
Under the Family Smoking Prevention and Tobacco Control Act, tobacco companies must prove the validity of any
health claims to the U.S. Food and Drug Administration before using them in promotional materials. Additionally, any
new smokeless tobacco products must go through independent testing regarding either their inherent harmfulness or
their likely impact on overall tobacco use levels or public health before entering the market.
Smokeless Tobacco & Kids / 6
all its brands. This change supports manufacturers’ graduation strategy of starting new users at low
nicotine levels and then building brand loyalty with fully addicted users with high nicotine levels.
Researchers found that established, addicted, long-term smokeless tobacco users preferred products
with the highest levels of free nicotine, whereas those who used smokeless tobacco with lower free
44
nicotine content tended to be fairly new users.
Despite all the evidence of the harms of smokeless tobacco, in April 1999, a spokesperson for UST,
quoted in the Providence Journal, claimed that it has not been “scientifically established” that smokeless
tobacco is “a cause of oral cancer.” The Rhode Island Attorney General subsequently filed a legal action
against UST for violating the multi-state settlement agreement’s provisions prohibiting false statements
about the health effects of tobacco products. As a result, UST was required to formally acknowledge that
the Surgeon General and other public health authorities have concluded that smokeless tobacco is
addictive and can cause oral cancer and to pay $15,000 to the Attorney General’s office for efforts to
prevent Rhode Island youths from using tobacco.
Campaign for Tobacco-Free Kids, March 19, 2015 / Ann Boonn
Types of Spit Tobacco
• Oral (moist) snuff is a finely cut, processed tobacco, which the user places between the cheek and
gum that releases nicotine which, in turn, is absorbed by the membranes of the mouth.
• Snus (or pouches) is a tea-bag like packet of moist snuff tobacco and flavorings, placed between the
upper gum and lip. The product design does not require the user to spit, unlike traditional moist snuff.
• Dissolvable tobacco products are made of ground tobacco and flavorings, shaped into pellets, strips,
or other forms, that the user ingests orally. These products do not require spitting.
• Looseleaf chewing tobacco is stripped and processed cigar-type tobacco leaves, loosely packed to
form small strips. It is often sold in a foil-lined pouch and usually treated with sugar or licorice.
• Plug chewing tobacco consists of small, oblong blocks of semi-soft chewing tobacco that often contain
sweeteners and other flavoring agents.
• Nasal snuff is a fine tobacco powder that is sniffed into the nostrils. Flavorings may be added during
fermentation, and perfumes may be added after grinding.
More information on smokeless tobacco is available at
http://www.tobaccofreekids.org/facts_issues/fact_sheets/toll/products/smokeless/.
1
U.S. Centers for Disease Control and Prevention (CDC), “Youth Risk Behavior Surveillance—United States, 2013,”
Morbidity and Mortality Weekly Report (MMWR) 63(4), June 13, 2014, http://www.cdc.gov/mmwr/pdf/ss/ss6304.pdf.
2
Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Behavioral Health Statistics
and Quality, National Survey on Drug Use and Health (NSDUH), 2013,
http://www.samhsa.gov/data/NSDUH/2013SummNatFindDetTables/DetTabs/NSDUH-DetTabsSect4peTabs1to162013.htm#tab4.10a. 3
Other states with boys’ smokeless use rates higher than the national rate include Georgia (15.7%), Louisiana (18.5%), Mississippi (18.5%), Missouri (18.0%), Ohio (15.1%), South Dakota (16.9%), and Vermont (15.0%). CDC,
“Youth Risk Behavior Surveillance—United States, 2013,” MMWR 63(4), June 13, 2014,
http://www.cdc.gov/mmwr/pdf/ss/ss6304.pdf.
4
CDC, “Surveillance for Selected Tobacco-Use Behaviors—United States, 1900-1994,” MMWR 43(SS-03),
November 18, 1994.
5
CDC, “Surveillance for Selected Tobacco-Use Behaviors – United States, 1900-1994,” MMWR 43(SS-03),
November 18, 1994.
6
Altria Group, Inc., Form 10-K, 2014 Annual Report, filed February 25, 2015, http://edgar.sec.gov/Archives/edgar/data/764180/000076418015000022/a2014form10-kq42014.htm.
7
Reynolds American, Inc., Form 10-K, 2014 Annual Report, filed February 10, 2015, http://edgar.sec.gov/Archives/edgar/data/1275283/000119312515040558/d821365d10k.htm.
8
HHS. Preventing Tobacco Use Among Youth and Young Adults: A Report of the Surgeon General, 2012, at 539.
9
Federal Trade Commission (FTC), Smokeless Tobacco Report for 2011, 2013, http://www.ftc.gov/reports/federaltrade-commission-smokeless-tobacco-report-2011. Data for top 5 manufacturers only: Altria Group, Inc.; North
Atlantic Trading Company, Inc.; Reynolds American, Inc.; Swedish Match North America, Inc.; and Swisher
International Group, Inc..
Smokeless Tobacco & Kids / 7
10
Morrison, MA, et al., “Under the Radar: Smokeless Tobacco Advertising in Magazines With Substantial Youth
Readership,” American Journal of Public Health (AJPH) 98:543-548, 2008. See also, Sports Illustrated, July 30, 2001, and December 11, 2009; Rolling Stone, June 10, 2010, and December 5, 2013.
11
Massachusetts Department of Public Health, Smokeless Tobacco Advertising Expenditures Before and After the
Smokeless Tobacco Master Settlement Agreement: A Report of the Massachusetts Department of Public Health, May 2002, http://archives.lib.state.ma.us/bitstream/handle/2452/49479/ocm50878863.pdf.
12
Connolly, G, “The Marketing of Nicotine Addiction by One Oral Snuff Manufacturer,” Tobacco Control 4(1):73-79,
1995.
13
Connolly, G, “The Marketing of Nicotine Addiction by One Oral Snuff Manufacturer,” Tobacco Control 4(1):73-79,
1995.
14
Freedman, AM, “How a Tobacco Giant Doctors Snuff Brands to Boost Their Kick,” The Wall Street Journal, October 26, 1994.
15
Brown, JE, et al., “Candy Flavorings in Tobacco,” New England Journal of Medicine, DOI: 10.1056/NEJMc1403015, May 7, 2014, http://www.nejm.org/doi/full/10.1056/NEJMc1403015. 16
Alpert, HR, et al., “Free nicotine content and strategic marketing of moist snuff tobacco products in the United States: 2000-2006,” Tobacco Control 17:332-338, 2008.
17
Delnevo, C, et al., “Examining market trends in the United States smokeless tobacco use: 2005 – 2011,” Tobacco Control, October 31, 2012, doi:10/1136/tobaccocontrol-2012-050739.
18
Rocky Mountain News, June 22, 1996.
19
Massachusetts Department of Public Health, Smokeless Tobacco Advertising Expenditures Before and After the
Smokeless Tobacco Master Settlement Agreement: A Report of the Massachusetts Department of Public Health, May 2002, http://archives.lib.state.ma.us/bitstream/handle/2452/49479/ocm50878863.pdf.
20
U.S. House Committee on Energy and Commerce, Can Tobacco Cure Smoking? A Review of Tobacco Harm
Reduction, Hearing, June 3, 2003, Serial No. 108-31, at 132, http://www.gpo.gov/fdsys/pkg/CHRG108hhrg87489/pdf/CHRG-108hhrg87489.pdf. Dipasquale, CB, “Smokeless Tobacco Company Pulls Magazine Ads,”
Ad Age, June 7, 2002, http://adage.com/article/news/smokeless-tobacco-company-pulls-magazine-ads/34765/.
21
Substance Abuse and Mental Health Administration (SAMHSA), Analysis of data from the 2012 National Survey on
Drug Use and Health.
22
SAMHSA, Analysis of data from the 2013 National Survey on Drug Use and Health.
23
SAMHSA, Analysis of data from the 2013 National Survey on Drug Use and Health.
24
Lofstock, J, “Smokeless Sales are Surging,” Convenience Store Decisions, December 7, 2012.
25
Lofstock, J, “Smokeless Sales are Surging,” Convenience Store Decisions, December 7, 2012.
26
SAMHSA, Analysis of data from the 2013 National Survey on Drug Use and Health.
27
Nelson, L, “If you think Snus is a safe alternative to smoking, think again,” Kansas City Star, October 31, 2007.
28
Craver, R, “Dissolvable tobacco products to be tested,” Winston-Salem Journal, February 24, 2011.
29
Craver, R, “R.J. Reynolds scales back marketing of dissolvable tobacco products,” Winston-Salem Journal, July
31, 2013.
30
FDA, Summary: TPSAC Report on Dissolvable Tobacco Products, March 1, 2012,
http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/TobaccoProductsScientificAdvisory
Committee/UCM295842.pdf. See also, TFK, The Danger from Dissolvable Tobacco and Other Smokeless Tobacco Products, http://www.tobaccofreekids.org/research/factsheets/pdf/0363.pdf.
31
Kansas Department of Health and Environment, World No Tobacco Day; Kansas Test Market for New Tobacco
Product, Press Release, May 26, 2011, http://www.kdheks.gov/news/web_archives/2011/05262011.htm.
32
Craver, R, “Dissolvable tobacco products to be tested,” Winston-Salem Journal, February 24, 2011.
33
U.S. Department of Health and Human Services (HHS), The Health Consequences of Using Smokeless Tobacco:
A Report of the Advisory Committee to the Surgeon General, Bethesda, MD 20892, NIH Publication No. 86-2874,
April 1986, http://profiles.nlm.nih.gov/NN/B/B/F/C/.
34
National Cancer Institute (NCI), “Smokeless Tobacco and Cancer,” Accessed September 9, 2014. http://www.cancer.gov/cancertopics/factsheet/Tobacco/smokeless#r1. See also: NIH, NCI, Smoking and Tobacco
Control Monograph 2: Smokeless Tobacco or Health: An International Perspective, September 1992, http://cancercontrol.cancer.gov/tcrb/monographs/2/m2_complete.pdf.
35
National Toxicology Program, Public Health Service, HHS, Report on Carcinogens, Thirteenth Edition, October
2014, http://ntp.niehs.nih.gov/ntp/roc/content/profiles/tobaccorelatedexposures.pdf.
36
NCI and CDC, Smokeless Tobacco and Public Health: A Global Perspective, Bethesda, MD: HHS, CDC, NIH, NCI, NIH Publication No. 14-7983, December 2014, http://cancercontrol.cancer.gov/brp/tcrb/global-perspective/index.html. See also: International Agency for Research on Cancer. A Review of Human Carcinogens: Personal Habits and
Indoor Combustions. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, Volume 100E (2012). http://monographs.iarc.fr/ENG/Monographs/vol100E/mono100E-8.pdf
37
Hatsukami, D & Severson, H, “Oral Spit Tobacco: Addiction, Prevention and Treatment,” Nicotine & Tobacco
Research 1:21-44, 1999.
38
Tomar, SL, “Chewing Tobacco Use and Dental Caries Among U.S. Men,” Journal of the American Dental
Association, 1999, 130: 160.
Smokeless Tobacco & Kids / 8
39
National Cancer Institute, “Smokeless Tobacco and Cancer,” Accessed September 9, 2014.
http://www.cancer.gov/cancertopics/factsheet/Tobacco/smokeless#r1; Hatsukami, D & Severson, H, “Oral Spit Tobacco: Addiction, Prevention and Treatment,” Nicotine & Tobacco Research 1:21-44, 1999.
40
Brunnemann, KD, et al., “Aging of Oral Moist Snuff and the Yields of Tobacco -Specific N-Nistrosamines,”
American Health Foundation, Massachusetts Tobacco Control Program, June 22, 2001.
41
Stepanov, I, et al., “Analysis of 23 Polycyclic Aromatic Hydrocarbons in Smokeless Tobacco by Gas
Chromatography-Mass Spectrometry,” Chemical Research in Toxicology [epub ahead of print], October 27, 2009.
42
Tomar, SL, “Snuff Use and Smoking In U.S. Men: Implications for Harm Reduction,” AJPH 23(3), 2002.
43
Tomar, S, “Is use of smokeless tobacco a risk factor for cigarette smoking? The U.S. experience,” Nicotine &
Tobacco Research 5(4):561-569, August 2003.
44
Alpert, HR, et al., “Free nicotine content and strategic marketing of moist snuff tobacco products in the United
States: 2000-2006,” Tobacco Control 17:332-338, 2008.
SMOKELESS TOBACCO IN THE UNITED STATES
Health Harms of Smokeless Tobacco
Public health authorities including the Surgeon General and the National Cancer Institute have found that
smokeless tobacco use is hazardous to health and can lead to nicotine addiction. Smokeless tobacco
contains at least 28 cancer-causing chemicals and causes oral, pancreatic and esophageal cancer. Use
of smokeless tobacco is also associated with other health problems including lesions in the mouth and
tooth decay.
Health Care Authorities on Smokeless Tobacco Products in the USA
1
U.S. Surgeon General
• “After a careful examination of the relevant epidemiologic, experimental, and clinical data, the
committee concludes that the oral use of smokeless tobacco represents a significant health
risk. It is not a safe substitute for smoking cigarettes. It can cause cancer and a number of
non-cancerous oral conditions and can lead to nicotine addiction and dependence.”
• “The scientific evidence is strong that the use of snuff can cause cancer in humans. The
evidence for causality is strongest for cancer of the oral cavity, wherein cancer may occur several
times more frequently in snuff dippers compared to non-tobacco users.”
2
U.S. National Cancer Institute
• “The bioassay data strongly support the epidemiological observation that ST is carcinogenic
to humans. Twenty-eight carcinogens have been identified in chewing tobacco and snuff. The high
concentrations of N-nitrosamines in ST, and especially the high levels of TSNA, are of great concern.”
• “The evidence that NNK and NNN play a role in human oral cancer induced by snuff is strong.
Both compounds are present in significant amounts in snuff and in the saliva of snuff dippers. They
are metabolically activated in snuff dippers to intermediates that bind to hemoglobin. They cause oral
tumors in rats and are metabolically activated by rat and human oral tissue. Although there are many
questions about the mechanisms by which snuff causes oral tumors in rats and humans, there is no
doubt that the presence of NNK and NNN in snuff is an unacceptable risk to people who choose to
use these products.”
3
• “Smokeless tobacco causes oral cancer, esophageal cancer, and pancreatic cancer.”
4
U.S. National Toxicology Program
• “The oral use of smokeless tobacco is known to be a human carcinogen based on sufficient
evidence of carcinogenicity from studies in humans which indicate a causal relationship between
exposure to smokeless tobacco and human cancer.”
• “Smokeless tobacco has been determined to cause cancers of the oral cavity. Cancers of the
oral cavity have been associated with the use of chewing tobacco as well as snuff which are the two
main forms of smokeless tobacco used in the United States.”
World Health Organization (WHO)
• “There is conclusive evidence that certain smokeless tobacco products increase risk of oral
5
cancer, specifically … smokeless tobacco in the United States.”
Despite all the evidence of the harms of smokeless tobacco, smokeless tobacco companies, particularly
the U.S. Smokeless Tobacco Company (UST), now a subsidiary of Altria, the parent company of Philip
6
Morris USA, has in the recent past denied that smokeless tobacco causes cancer or any other disease.
1400 I Street NW · Suite 1200 · Washington, DC 20005
Phone (202) 296-5469 · Fax (202) 296-5427 · www.tobaccofreekids.org
Smokeless Tobacco in the U.S. / 2
Smokeless Tobacco Use in the U.S.
Although cigarette smoking in the U.S. has been on the decline, the latest survey from the Centers for
Disease Control and Prevention showed that the use of smokeless tobacco among youth has held steady
since 1999. In 2013, 14.7 percent of high-school boys and 8.8 percent of all high-school students
7
reported current use of smokeless tobacco products. Each year, more than 400,000 kids ages 12-17
8
use smokeless tobacco for the first time.
In 16 states, smokeless tobacco use among high school boys is higher than the national rate, with the
highest boys’ rates in Alabama (23.1%), Arkansas (24.2%), Kentucky (22.3%), Montana (21.6%), North
9
Dakota (22.0%), Oklahoma (21.2%), Tennessee (20.9%), West Virginia (27.4%) and Wyoming (21.9%).
Among adult men ages 18 and older, 7.1 percent currently use smokeless tobacco. Use among young
10
adult males (ages 18 – 25) is even higher at 10.5 percent. State-specific data from the 2009 Behavior
Risk Surveillance System (BRFSS) show wide variation in adult smokeless tobacco use across the
11
states, with the highest prevalence among adult men in West Virginia (17.1%) and Wyoming (16.9%).
(Although the BRFSS has been conducted more recently, data on adult smokeless tobacco use has not
been reported since 2009).
Dual Use – Smokeless Tobacco Use and Cigarette Smoking
12
Research shows that youth who use smokeless tobacco are also more likely to smoke cigarettes. For
example, according to a 2010 study based on data from national U.S. surveys, the prevalence of cigarette
smoking is substantially higher among middle and high school males who use smokeless tobacco than
th
among those who do not. For 12 grade males, the prevalence of smoking one-half pack of cigarettes or
13
more per day was nearly five times greater among smokeless tobacco users than non-users. The
national Monitoring the Future Survey of secondary school students reports that 20 to 50 percent of daily
14
smokeless tobacco users are also daily smokers.
Dual use of smokeless tobacco and cigarettes is concerning, because users can face greater health risks
than they would from using either product alone. Moreover, the risk of lung cancer and other smokingrelated disease depends largely on how long a person smokes—not just the number of cigarettes
15
smoked. Thus, youth smokers, including those who transitioned from smokeless products, put
themselves at greater risk for tobacco-related diseases in the future.
Marketing Smokeless Tobacco
Smokeless tobacco companies in the U.S., particularly the U.S. Smokeless Tobacco Company (UST),
now a subsidiary of Altria (the parent company of Philip Morris USA) have a long history of creating new
16
products that appeal to kids and marketing them aggressively to children. In recent years, there has
been an onslaught of new smokeless tobacco products on the market, which, coupled with aggressive
marketing strategies, could attract new youth users.
Not surprisingly, tobacco marketing plays an important role in attracting users – particularly youth. The
2012 Surgeon General’s report, Preventing Tobacco Use among Youth and Young Adults, found that the
“integration of product design with marketing helped to reverse the mid-twentieth century decline in
smokeless tobacco use and spurred a rapid increase in smokeless tobacco use by adolescents and
17
young adult males.”
From 1998 to 2011 (the most recent year for which data are available), the total advertising and marketing
expenditures of the top-five smokeless tobacco companies in the U.S. more than tripled. In 2011, these
smokeless tobacco companies spent $451.7 million to advertise and market their products—an increase of
18
more than 80 percent from 2005 expenditures ($250.8 million). Some of these funds pay for smokeless
19
tobacco ads in magazines with high youth readership, such as Sports Illustrated and Rolling Stone. In
fact, in the few years after signing the Smokeless Tobacco Master Settlement Agreement (STMSA),
despite its restrictions placed on youth advertising, UST increased its expenditures in magazines with a
20
significant number of youth readers by 161 percent, from $3.6 million to $9.4 million.
Smokeless Tobacco in the U.S. / 3
Cigarette Companies Enter the Smokeless Market
The downward trend in smoking rates and the continued popularity of smokeless tobacco products has
pushed cigarette companies into the smokeless tobacco market, relying on their popular cigarette brand
names to attract new users. The two largest U.S. cigarette manufacturers, both of whom were found to
be racketeers and guilty of marketing to kids by a U.S. District Court Judge, both acquired two of the
largest smokeless tobacco manufacturers and are producing their own smokeless tobacco products
under their famous cigarette brand names. Reynolds American – labeled as a “serial violator” of the
Master Settlement Agreement by the U.S. Department of Justice – entered into the smokeless tobacco
market with its purchase of Conwood in 2006, while Philip Morris USA’s parent company, Altria,
purchased UST in 2009. Not to be left out, the smaller cigarette companies – Lorillard and the Liggett
Group – also test-marketed their own smokeless products in 2008.
There is reason for concern given the track record of UST and its prior marketing behavior aimed at kids
and adolescents as well as the recent entry of Reynolds American and now Philip Morris USA into the
21
smokeless tobacco category. In her landmark ruling in the Department of Justice (DOJ) lawsuit against
Philip Morris USA and R.J. Reynolds (and the other defendant companies), Judge Kessler found, “The
evidence is clear and convincing – and beyond any reasonable doubt – that Defendants have marketed
22
to young people twenty-one and under while consistently, publicly, and falsely, denying they do so.”
Just one example is a recent California Supreme Court ruling that found R.J. Reynolds (which is owned
by Reynolds American) had, on six separate occasions, violated California state law banning the free
23
distribution of cigarettes at events attended by minors.
Novel Products
In the last several years, cigarette companies have introduced a number of new smokeless tobacco
products. Most notable are the snus products, which are small, teabag-like pouches containing tobacco
and other flavorings that users place between their upper gum and lip. R.J. Reynolds’s Camel Snus and
Philip Morris USA’s Marlboro Snus are now sold nationally in a variety of flavors, and Liggett Group’s
Grand Prix Snus and Lorillard’s Triumph Snus were test-marketed in 2008. Because these products do
not require spitting, their use can be easily concealed. One high school student admitted using Camel
Snus during class, saying, “It’s easy, it’s super-discreet…and none of the teachers will ever know what
24
I’m doing.”
In addition to Star Scientific’s Ariva tobacco lozenges and Stonewall Hard Snuff, both forms of dissolvable
tobacco pellets, R.J. Reynolds began test-marketing its own new line of dissolvable tobacco products,
again under the Camel brand name, in three cities in January 2009. R.J. Reynolds pulled the products
from the market, redesigned the packaging and products, and put them back out for test-market in two
25
different cities in March 2011. In 2013, Reynolds announced that it would be scaling back efforts on its
26
dissolvable products, but they continue to be sold in limited test markets. Camel Orbs are pellets of
ground tobacco resembling tic tacs, Camel Strips are flat sheets of ground tobacco that work like
dissolvable breath strips, and Camel Sticks are toothpick-like sticks of ground tobacco. The Indiana
Poison Center issued a warning that the products’ resemblance to non-tobacco products put children at
risk for accidental poisoning. As required by the Family Smoking Prevention and Tobacco Control Act of
2009, the Tobacco Products Scientific Advisory Committee of the U.S. Federal Drug Administration
reviewed the products and released a report stating, “concluded that the available evidence, while limited,
leads to a qualitative judgment that availability of DTPs [dissolvable tobacco products] could increase the
27
number of users of tobacco products.”
Philip Morris USA has also introduced its own the dissolvable tobacco products, a toothpick-like product
with flavored tobacco coating under both the brand name of the most popular cigarettes, Marlboro, and
one of the most popular smokeless tobacco products, Skoal. These Marlboro and Skoal Sticks come in
four flavors and have been test-marketed in select markets in Kansas starting in March 2011. The
Kansas Department of Health and Environment (KDHE) issued a warning about the products, stating, “As
the state’s health agency, KDHE is particularly concerned about the potential appeal of these new
tobacco sticks to youth. The packages are so small that they could easily be concealed in a shirt or pants
pocket and youth could use tobacco sticks in front of parents or teachers while appearing to have a
Smokeless Tobacco in the U.S. / 4
simple toothpick in their mouth. We are also concerned about the risk of young children accidentally
28
ingesting these products.”
While very new, these developments could possibly result in changes in the smokeless tobacco market
specifically and more generally in the market for all tobacco products, but the nature of those changes is
not certain. Potential outcomes could include:
- Increased youth access to smokeless tobacco products as the new low-weight tobacco products
continue to be inadequately taxed at the state and federal level.
- Increased efforts by smokeless manufacturers to encourage adult smokers who are concerned
about their health or who are interested in quitting to switch to smokeless tobacco rather than quit
completely.
- Increase in nicotine addiction due to dual use of smokeless and combusted tobacco products in
light of increasing limitations on public indoor and workplace smoking.
- Increased youth experimentation with smokeless tobacco (due to the ability to use it
discretely/secretly) and it could be a deterrent to youth tobacco use cessation efforts.
- Decreased cessation rates as smokers use smokeless tobacco products in places they cannot
smoke rather than being abstinent from tobacco and nicotine exposure.
Campaign for Tobacco-Free Kids, September 9, 2014 / Ann Boonn
Types of Smokeless Tobacco
• Oral (moist) snuff is a finely cut, processed tobacco, which the user places between the cheek and
gum that releases nicotine which, in turn, is absorbed by the membranes of the mouth.
• Snus (or pouches) is a tea-bag like packet of moist snuff tobacco and flavorings, placed between the
upper gum and lip. The product design does not require the user to spit, unlike traditional moist snuff.
• Dissolvable tobacco products are made of ground tobacco and flavorings, shaped into pellets, strips,
or other forms, that the user ingests orally. These products do not require spitting.
• Looseleaf chewing tobacco is stripped and processed cigar-type tobacco leaves, loosely packed to
form small strips. It is often sold in a foil-lined pouch and usually treated with sugar or licorice.
• Plug chewing tobacco consists of small, oblong blocks of semi-soft chewing tobacco that often contain
sweeteners and other flavoring agents.
• Nasal snuff is a fine tobacco powder that is sniffed into the nostrils. Flavorings may be added during
fermentation, and perfumes may be added after grinding.
For more information on smokeless tobacco, see the Campaign’s website at
http://www.tobaccofreekids.org/facts_issues/fact_sheets/toll/products/smokeless/.
1
U.S. Department of Health and Human Services (HHS), The Health Consequences of Using Smokeless Tobacco: A
Report of the Advisory Committee to the Surgeon General, Bethesda, MD 20892, NIH Publication No. 86-2874, April
1986, http://profiles.nlm.nih.gov/NN/B/B/F/C/.
2
National Institutes of Health (NIH), National Cancer Institute (NCI), Smoking and Tobacco Control Monograph 2:
Smokeless Tobacco or Health: An International Perspective, September 1992, http://cancercontrol.cancer.gov/tcrb/monographs/2/m2_complete.pdf.
3
National Cancer Institute, “Smokeless Tobacco and Cancer,” Accessed September 9, 2014.
http://www.cancer.gov/cancertopics/factsheet/Tobacco/smokeless#r1. See also: International Agency for Research
on Cancer. A Review of Human Carcinogens: Personal Habits and Indoor Combustions. IARC Monographs on the
Evaluation of Carcinogenic Risks to Humans, Volume 100E (2012).
http://monographs.iarc.fr/ENG/Monographs/vol100E/mono100E-8.pdf
4
HHS, Public Health Service, National Toxicology Program, Report on Carcinogens, Eleventh Edition, January 31, 2005, http://ntp.niehs.nih.gov/index.cfm?objectid=32BA9724-F1F6-975E-7FCE50709CB4C932.
5
World Health Organization Scientific Advisory Committee on Tobacco Product Regulation, Scientific Advisory
Committee on Tobacco Product Regulation Recommendation on Smokeless Tobacco Products, 2003.
6
Letter to Secretary Donald S. Clark, U.S. Federal Trade Commission, dated February 5, 2002, from Daniel C.
Schwartz, Partner, Bryan Cave LLP. UST website (accessed May 8, 2006), 2005 Annual Report & 2006 Proxy UST, http://ccbn.mobular.net/ccbn/7/1301/1391/print/print.pdf.
Smokeless Tobacco in the U.S. / 5
7
U.S. Centers for Disease Control and Prevention (CDC), “Youth Risk Behavior Surveillance—United States, 2013,”
Morbidity and Mortality Weekly Report (MMWR) 63(4), June 13, 2014, http://www.cdc.gov/mmwr/pdf/ss/ss6304.pdf.
8
Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality.
The NSDUH Report: Trends in Smokeless Tobacco Use and Initiation: 2002 to 2012, July 24, 2014.
http://www.samhsa.gov/data/2K14/NSDUH189/sr189-smokeless-tobacco-2014.htm
9
Other states with boys’ smokeless use rates higher than the national rate include Georgia (15.7%), Louisiana (18.5%), Mississippi (18.5%), Missouri (18.0%), Ohio (15.1%), South Dakota (16.9%), and Vermont (15.0%). CDC,
“Youth Risk Behavior Surveillance—United States, 2013,” MMWR 63(4), June 13, 2014,
http://www.cdc.gov/mmwr/pdf/ss/ss6304.pdf.
10
2012 National Survey on Drug Use and Health. See also, HHS, The Health Consequences of
Smoking—50 Years of Progress: A Report of the Surgeon General, 2014.
11
CDC, “State-Specific Prevalence of Cigarette Smoking and Smokeless Tobacco Use Among Adults—United States,
2009,” MMWR 59(43):1400-1406, November 5, 2010, http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5943a2.htm.
12
Tomar, S, et al., “Patterns of dual use of cigarettes and smokeless tobacco among US males – findings from
national surveys,” Tobacco Control 19:104-109, 2010; Severson, H, et al., “Use of smokeless tobacco is a risk factor
for cigarette smoking,” Nicotine & Tobacco Research, 9(12):1331-1337, December 2007; Forrester, K, et al.,
“Predictors of smoking onset over two years,” Nicotine & Tobacco Research, 9(12):1259-1267, December 2007;
Tomar, S, “Is use of smokeless tobacco a risk factor for cigarette smoking? The U.S. experience,” Nicotine &
Tobacco Research 5(4):561-569, August 2003; Haddock, CK, et al., “Evidence That Smokeless Tobacco Use Is a
Gateway for Smoking Initiation in Young Adult Males,” Preventive Medicine 32:262-267, 2001.
13
Tomar, S, et al., “Patterns of dual use of cigarettes and smokeless tobacco among US males – findings from
national surveys,” Tobacco Control 19:104-109, 2010.
14
Johnston, LD, et al., Monitoring the Future national survey results on drug use, 1975-2013: Volume 1,
Secondary school students. Ann Arbor: Institute for Social Research, The University of Michigan, 2014.
15
HHS, The health consequences of smoking: a report of the Surgeon General, 2004 (page 95).
See, e.g., TFK Factsheet, Smokeless Tobacco and Kids, http://www.tobaccofreekids.org/research/factsheets/pdf/0003.pdf.
17
HHS. Preventing Tobacco Use Among Youth and Young Adults: A Report of the Surgeon General, 2012, at 539.
18
Federal Trade Commission (FTC), Smokeless Tobacco Report for 2011, 2013, http://www.ftc.gov/reports/federaltrade-commission-smokeless-tobacco-report-2011. Data for top 5 manufacturers only: Altria Group, Inc.; North
Atlantic Trading Company, Inc.; Reynolds American, Inc.; Swedish Match North America, Inc.; and Swisher
International Group, Inc..
19
Morrison, MA, et al., “Under the Radar: Smokeless Tobacco Advertising in Magazines With Substantial Youth Readership,” American Journal of Public Health (AJPH) 98:543-548, 2008. See also, Sports Illustrated, July 30, 2001, and December 11, 2009; Rolling Stone, June 10, 2010, and December 5, 2013.
20
Massachusetts Department of Public Health, Smokeless Tobacco Advertising Expenditures Before and After the Smokeless
Tobacco Master Settlement Agreement: A Report of the Massachusetts Department of Public Health, May 2002,
http://archives.lib.state.ma.us/bitstream/handle/2452/49479/ocm50878863.pdf.
21
For more examples, see TFK Factsheet, Smokeless Tobacco and Kids, http://www.tobaccofreekids.org/research/factsheets/pdf/0003.pdf.
22
Tobacco Control Legal Consortium, The Verdict Is In: Findings From United States v. Philip Morris, Marketing to
Youth, 2006.
23
California Attorney General, Attorney General Lockyer Announces $5 Million Settlement with R.J. Reynolds to Resolve
Lawsuit Over Firm’s Distribution of Free Cigarettes, May 8, 2006, http://oag.ca.gov/news/press_release?id=1301. 24
Nelson, L, “If you think Snus is a safe alternative to smoking, think again,” Kansas City Star, October 31, 2007.
25
TFK, The Danger from Dissolvable Tobacco and Other Smokeless Tobacco Products, http://www.tobaccofreekids.org/research/factsheets/pdf/0363.pdf.
26
Craver, R, “R.J. Reynolds scales back marketing of dissolvable tobacco products,” Winston-Salem Journal, July
31, 2013.
27
U.S. Food and Drug Administration’s Tobacco Products Scientific Advisory Committee (TPSAC), Summary:
TPSAC Report on Dissolvable Tobacco Products, March 1, 2012, http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/TobaccoProductsScientificAdvisory
Committee/UCM295842.pdf. See also, Deyton, L (Director of the FDA Center for Tobacco Products), “Letter to
Industry on Dissolvable Smokeless Tobacco Products (R.J. Reynolds Tobacco Company)” and “Letter to Industry on
Dissolvable Smokeless Tobacco Products (Star Scientific, Inc),” February 1, 2010.
28
Kansas Department of Health and Environment, World No Tobacco Day; Kansas Test Market for New Tobacco
Product, Press Release, May 26, 2011, http://www.kdheks.gov/news/web_archives/2011/05262011.htm.
16
TobaccoFreeBaseball.org
It’s Time To Take Tobacco
Out of Baseball
Smokeless tobacco use by Major League Baseball (MLB) players endangers the health of impressionable youth who follow their lead, as well as the players themselves. It sets a terrible example for the
millions of young people who watch baseball and see players and managers using tobacco. It is time to
take tobacco out of baseball once and for all – both to set the right example for America’s kids and for
the health of baseball players.
PROBLEM
Recent headlines have driven home the seriousness of the problem. Last June, Hall of Famer
Tony Gwynn died at age 54 after a long battle with salivary gland cancer, which he attributed
to his longtime use of chewing tobacco. Two months later, pitching great Curt Schilling,
only 47, announced his treatment for oral cancer that he said was “without a doubt,
unquestionably” caused by 30 years of chewing tobacco. How much more tragic news
should we have to endure? Face facts:
•
Smokeless tobacco is harmful to health
Public health authorities, including the U.S. Surgeon General and the National Cancer
Institute, have found that smokeless tobacco use is hazardous to health and can lead to
nicotine addiction. Smokeless tobacco contains at least 28 cancer-causing chemicals and
causes oral, pancreatic and esophageal cancer – as well as other health problems.
•
Too many kids are using smokeless tobacco
Even as cigarette use continues a steady decline among youth, smokeless tobacco use
has remained troublingly steady. According to the Centers for Disease Control and
Prevention (CDC), in 2013, 14.7 percent of high school boys (and 8.8 percent of all high
school students) reported current use of smokeless tobacco products. Each year, about
535,000 kids age 12-17 use smokeless tobacco for the first time.
1
I T ’ S T I M E T O TA K E T O B AC C O O U T O F B A S E B A L L • Tobacco use in baseball reinforces
tobacco marketing
Smokeless tobacco companies spent $435 million on
marketing in 2012 (the most recent year available),
three times the amount spent in 1998. Smokeless
tobacco use in baseball reinforces the industry’s
message that teen boys can’t be real men unless
they chew.
• Professional baseball players are role
models for youth
A CDC expert stated, “Athletes serve as role models
for youth, and smokeless tobacco manufacturers
have used advertising, images, and testimonials
featuring athletes and sports to make smokeless
tobacco products appear attractive to youth.”
SOLUTION
It’s time for city and state leaders to step up to the plate
and protect our kids by passing laws to make the game
of baseball completely tobacco-free.
It’s time for city and state
leaders to step up to the plate
and protect our kids by passing
laws to make baseball stadiums
completely tobacco-free.
For years, leading health organizations have called for
an end to smokeless tobacco in baseball. We mounted a major campaign in 2010-2011 that
made some strides – including securing a prohibition on players carrying tobacco tins in
their uniforms and using smokeless tobacco during TV interviews. But these restrictions did
not eliminate smokeless tobacco use at ballparks – the step that can best prevent young
people from ever starting down the road to addiction, disease and premature death. It’s
time — finally — to take tobacco out of baseball completely. The obvious solution is for MLB
and the players association to agree to rid baseball of tobacco for good. However, the league
cannot unilaterally prohibit smokeless tobacco and no agreement has been reached to date.
Since baseball has been unable to address this threat to kids across the country, it’s now
up to cities and states with major league teams to step up and protect our kids. They can
take a critical step by prohibiting use of all tobacco products, including smokeless tobacco,
at baseball venues. San Francisco passed such a law earlier this year. Now, Los Angeles and
Boston are pursuing that route as well.
RATIONALE
Such legislation will send a simple and powerful message to kids: baseball and tobacco don’t
mix. Our national pastime should be about promoting a healthy and active lifestyle, not a
deadly and addictive product.
This action will not affect what players can do in their personal lives, although they should
be encouraged to quit using tobacco for their own health. Baseball stadiums, however,
are workplaces and public places. It’s entirely appropriate to restrict the use of a harmful
substance in such a setting. While players are on the job — on the field or in front of a
camera — they have a responsibility to set the right example for kids.
2
TobaccoFreeBaseball.org
Don’t just take our word for it
Baseball experts, editorial boards, sportswriters and others all agree that
it’s time to take tobacco out of baseball.
The Fresno Bee, June 18, 2014
“[Y]ou can bet that many kids wanted to emulate their heroes. … So this should be another teachable moment
— for teenage boys in particular — on the dangers of smokeless tobacco. … [P]layers ought to think about the
example they’re setting as well as their own health as they try to break the addiction.”
Keith Olbermann, noted baseball commentator, June 22, 2014
“Banning the habit would be a good idea, not just as a way of remembering Tony Gwynn but protecting
players’ health and as an example for the fans of the game.”
The Boston Globe, Aug. 23, 2014
“It’s time for the Major League Baseball players’ union to honor [Tony] Gwynn, [Curt] Schilling, and other
victims of chewing tobacco by banning it from baseball.”
Jim Caple, ESPN columnist and senior writer, June 17, 2014
“[Tony] Gwynn was a wonderful man. The best way to honor him is to eliminate the very thing that killed him.
Let’s get rid of chewing tobacco so that no other player suffers and dies as Tony did.”
The Chicago Sun-Times, July 19, 2014
“The tobacco tin may be carefully stowed away, but when Major League Baseball players head out to the field
there’s no mistaking a cheek bulging with chaw. In honor of Tony Gwynn, it’s time to end the charade. MLB
players can honor Gwynn … by agreeing to ban all smokeless tobacco products on the field.”
Joe Garagiola, Sr., ex-MLB player, TV host and longtime advocate against chewing
tobacco in baseball, June 17, 2014
“Let’s do something … Tony Gwynn’s death is sad enough. I hope it triggers [a ban].” In a separate interview,
he said, “I just wish that [the players association] would take a more serious look at it and don’t wait for good
people to die, good guys like Tony Gwynn. That’s a big loss for baseball.”
Deron Snyder, sportswriter, The Washington Times, June 18, 2014
“Now that he’s dead from oral cancer at 54, I wish baseball had banned the practice [of dipping tobacco]
during his 20-year Hall of Fame career. ... Here’s hoping the players’ union supports a ban in the next labor
agreement, to assist the loved ones of current and future ballplayers.”
Connor O’Gara, sportswriter, The Kearney Hub in Nebraska, June 17, 2014
“Major League Baseball has slept far too long on the growing epidemic of chewing tobacco in its game. The
argument that ‘it’s just part of the culture,’ is the problem and the excuse. Gwynn’s death needs to show the
players union that a ban on chewing tobacco has to happen and it has to happen now.”
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Bill introduced to ban smokeless
tobacco in Yankee Stadium and
Citi Field
42 Comments
By Craig CalcaterraFeb 5, 2016, 9:25 AM EST
Baseball’s push to rid the sport of smokeless tobacco has slowly increased in intensity
over the years. It has banned minor leaguers from using the stuff and has passed rules
— not stringently enforced it appears to the casual observer — prohibiting major
leaguers from using it during games or when cameras are present. According to the
New York Timesthey have also instituted a program intended to help big leaguers who
want to quit, which is laudable.
But perhaps a bigger incentive to keep big leaguers from using the stuff are state or
local ordinances which outlaw smokeless tobacco use in ballparks. We’ve talked about
San Francisco and in California as a whole passing laws to this effect. Now, in that
Times story, we learn that New York is set to do the same:
Now, a member of the New York City Council, Corey Johnson, is set to
introduce a bill Friday that will include language that would ban
smokeless tobacco from Yankee Stadium and Citi Field, along with other
public arenas in the five boroughs.
“If New York passes this bill, and I think it will, it moves us dramatically
closer to the day when smokeless tobacco is prohibited in all major
league cities,” said Matthew Myers, the president of Campaign for
Tobacco-Free Kids.
The Yankees and Mets have indicated that they support the bill. As they should given
the total lack of any upside whatsoever to their ballplayers using smokeless tobacco. If
nothing else, on a practical level, it relieves the league and the union from having to
negotiate and enforce rules about this stuff in collective bargaining and, instead, allows
them all to simply say “hey, don’t break the law at the ballpark.”
In a larger sense, I appreciate that there are some sticky considerations when it comes
to regulating the otherwise legal behavior of consenting adults, but I don’t lose much
sleep over tobacco regulation in public places. People talk about slippery slopes and the
like, but tobacco is different and far more dangerous than large sodas.
With cigarettes this is obvious given the secondhand smoke concerns. With smokeless
tobacco it’s less clear, but it’s no accident that young ballplayers — Babe Ruth league
and high school players — use the stuff in greater numbers than their peers. It’s purely
emulative behavior. Having a chaw or a dip in has long been part of the “look like a
ballplayer” thing, and any effort to eradicate that or, in effect, have major league
ballplayers endorsing that is a good move.
Libertarians can register their dissents in the comments.