The North-east has the highest incidence of consumption of smokeless tobacco (chadha) in the world, and this is not a coincidence that the region also has the highest number of throat and mouth cancer patients.
Observing this at a seminar organised by the North East Cancer Hospital and Research Institute in association with the North East Community Health Association on Saturday, Dr Munindra Narayan Baruah, director of the North East Cancer Hospital and Research Institute, said that late detection of cancer had been a major stumbling block in successful treatment of cancer patients in the North-east. The seminar was organized on the occasion of World Cancer Day.

Quoting from the Union of International Cancer Congress (UICC), Dr Baruah said that the North-east had the maximum number of smokeless tobacco consumers and that consumption of tobacco had a direct bearing on throat and mouth cancers – which had the highest incidence in the region.

Underlining the importance of enhanced awareness and early detection, Dr Baruah said that a majority of the patients coming to his hospital were Stage-IV patients and it was not possible to cure them. The important thing, Dr Baruah said, was not which hospital a patient is treated in but how early he is getting treatment.

Former Vice Chancellor of Gauhati University Dr Nirmal Kumar Choudhury – the chief guest on the occasion – stressed the need for timely detection and treatment of cancer in the North-east, a region having a high incidence of the dreaded disease but with limited facilities to counter the scourge.

Dr Choudhury said that a cancer patient often tends to regard himself as good as dead which warrants the doctors attending on him to look after his mental needs as well – something termed as ‘personalized medicine.’

Lauding the cancer institute for ensuring modern cancer care to the region, Dr Choudhury said that an urgent need was to disseminate information on cancer among the masses so that they could avail timely treatment and defeat the disease.

Father George, director of the North East Community Health Association who was the guest of honour on the occasion also emphasized on enhancing people’s awareness levels on cancer, especially in a region like the North-east.

With Army regulations restricting the areas of use for smoking, smokeless tobacco has become a popular alternative. Many users believe smokeless tobacco is more convenient because it doesn’t emit smoke, leave a smell on their clothes or harm others around them. But what tobacco users may not realize is those Army restrictions apply to all forms of tobacco, including snuff, dip and chewing tobacco. That means that soldiers and civilians using smokeless tobacco or cigarettes in a federal facility can be held in violation of Army Regulation.

Maj. Arlene LeDoux, chief public health nurse, at Bayne-Jones Army Community Hospital’s Department of Preventive Medicine, said that lack of knowledge of the smoking restrictions can affect others.
“Can you imagine how horrible it would be for a kid to pick up a discarded spit bottle or can of smokeless tobacco and put it in their mouth?” LeDoux asked. “It’s just not safe to leave something like that lying around.”
LeDoux said soldiers’ increased use of smokeless tobacco can be caused by many factors — the most widely held belief is that it’s a safer alternative to cigarettes; however, it is just as dangerous as smoking, she said.
“Many soldiers try to give up smoking cigarettes and then end up going to smokeless tobacco,” LeDoux said. “They don’t realize they’re just setting themselves up for another problem. People try to find other alternatives for their addiction, but quitting is the right answer.”
Patricia Taylor, health promotion nurse, Preventive Medicine, said soldiers may also become dependent on tobacco when they deploy.
“Companies that produce cigarettes and smokeless tobacco send free products to soldiers with the intention of getting them addicted to their product,” she said. “When soldiers come back to the States, that product is no longer free, so they pay to feed that addiction.”
According to www.tricare.mil, some 19 percent of 18-24-year-old men in the armed forces use smokeless tobacco, more than double the national rate.
To help combat those numbers, Preventive Medicine’s Tobacco Cessation Program was implemented to help soldiers quit their addiction to tobacco.
When a soldier enters the program, the first step they go through is a self-evaluation to measure their readiness to quit.
“After they fill out several questionnaires, we have a one-on-one session where we look at how they evaluated themselves and see if they are ready to continue to the next stage,” said Taylor.
If it’s determined that the soldier is ready to start the quitting process, they have the option of seeing a health provider to help them through recovery and withdrawal with nicotine patches or prescription medicine. From there, individuals have the option to quit by joining a structured group, go it alone, or use the Department of Defense’s Quit Tobacco — Make Everyone Proud campaign at www.ucanquit2.org.
Taylor said people must be mentally ready to quit for counseling to be effective.
“Sometimes soldiers will come to us and say ‘my doctor said I have to do this.’ We tell them they have to be confident and their health has to become a priority. If it’s not important to them, they will eventually start back in the habit.”
Even with all the help Preventive Medicine provides, recovering from nicotine addiction takes time.
“We will get people who come in and it will be their sixth or seventh time trying to quit,” Taylor said. “As many times as they want to come back, we will work with them until they are successful.”

Bite-sized dissolvable “orbs” that look like breath mints and melt in your mouth are the tobacco industry’s latest attempt to fight falling U.S. cigarette sales. Charlotte is one of two test markets for Winston-Salem-based Reynolds American’s newest products: dissolvable, smokeless tobacco lozenges that come as orbs, sticks or strips. The products all contain less nicotine than cigarettes, between .5 and 3 milligrams instead of 12 to 15 milligrams. And, Reynolds spokesman David Howard said, they meet a “societal expectation.”

“There’s no secondhand smoke, no spitting and no cigarette butt litter,” Howard said.
But health officials still worry about the risks of smokeless options.
Smokeless tobacco users may not get lung cancer, health experts say, but they risk mouth cancer, gum disease and tooth loss. Prenatal dangers for pregnant women also still exist.
“There are no safe tobacco products,” said Dr. Matt Carpenter, a clinical psychologist and associate professor at the Medical University of South Carolina who’s researching the effect of smokeless products on smoking habits.
Huntersville, N.C., resident Joey Hodge, who’s smoked for almost five years, sees the appeal of smokeless products that won’t be as tough on his lungs or make him smell like smoke. But the 20-year-old isn’t sold on Reynolds’s newest offering.
“They were definitely not the greatest thing I’ve ever tasted,” Hodge said. Plus, he added, the products “really didn’t do much” to satisfy his nicotine craving.
Hodge’s reaction isn’t the sort tobacco makers are hoping for. As cigarette sales slide because of the health risks and social stigma, tobacco companies are counting on smokers like Hodge to fuel the new smokeless market. The dissolvable products sell for about $2 for a 12-pack – comparable, Reynolds says, to its other smokeless products.
“They can enjoy tobacco pleasure without bothering others and without having to leave the workplace, or the restaurant or the bar,” Howard said.
Analysts say new laws banning cigarettes in public places, like the ban on smoking in restaurants and bars that took effect in North Carolina last January, are among the factors driving a steep decline in cigarette sales.
“In recent years you’ve seen smoking banned in most states in most bars and restaurants. That kind of takes away the fun,” said Phil Gorham, industry analyst for investment firm Morningstar.
In its second quarter earnings report last month, Reynolds reported the number of cigarettes sold in the U.S. fell 4.4 percent. Gorham said companies like Reynolds can combat falling sales by increasing prices in the short term, but they’ll eventually need to diversify revenues.
While American sales of cigarettes drop 3 percent to 4 percent every year, the market for smokeless products grew 3 percent in 2009 and 7 percent in 2010, said Mary Gotaas, tobacco industry analyst for researcher IBISWorld. This year, smokeless sales are expected to jump 8 percent, Gotaas said.
While Reynolds is testing its new dissolvables, Richmond, Va.-based rival Philip Morris has its own product in the works: a dissolvable tobacco stick.
The growth of smokeless products worries some public health advocates who think the new products appeal to children. During the first round of testing, the orbs’ packaging resembled Tic-Tacs, creating concern that children might confuse them with candy, said Dr. John Spangler, professor of family health and community medicine at Wake Forest Baptist Medical Center.
For this round of testing, there’s larger packaging and new warnings. Packages now say “This product contains nicotine and is for adult tobacco consumers only” and “There is no safe tobacco product,” in addition to one of four required FDA warnings.
The Tobacco Products Scientific Advisory Committee of the FDA is holding hearings exploring the implications of smokeless products. Right now, all tobacco products must be age-restricted and kept behind the counter, just like cigarettes.
Warning labels on smokeless tobacco products must cover at least 30 percent of the packaging and every product must carry one of four messages: “Smokeless tobacco is addictive,” “This product can cause mouth cancer,” “This product can cause gum disease and tooth loss,” or “This product is not a safe alternative to cigarettes.”
Howard said there’s no expectation that smokeless dissolvables will be regulated less strictly than other tobacco products. But Sen. Sherrod Brown, D-Ohio, one of 12 senators who called for the hearings, called dissolvables the latest way for tobacco companies to stay “one step ahead of the sheriff.”
One issue on the committee’s agenda: the potential use of smokeless tobacco products as quitting aids. Gotaas said that appeal is one of the factors driving smokeless sales.
Dean Torrance of Charlotte, a smoker for 20 years, has tried, and failed, to quit. She said smokeless products may be just what she needs. “I would like to be able to do smokeless to get me to stop,” Torrance said.
But doctors say there are safer ways to quit smoking. Both Spangler and Carpenter recommend their patients use tested and proven medications, such as nicotine replacement pills and patches, instead of other tobacco products with unknown consequences that could keep them addicted.
Said Carpenter: “The very best thing that anybody can do for their health, if they’re a smoker, is to quit all tobacco products completely.”

Smokeless tobacco use is on the rise – according to national statistics, but also according to anecdotes from Ridgewood High School (RHS) Principal Jack Lorenz. At a presentation Tuesday night given by a prevention specialist with The Center for Alcohol and Drug Resources, a program of Children’s Aid and Family Services, a handful of Ridgewood parents listened and learned about the dangers of smokeless tobacco and why it is growing in use, especially among youth.

Jamie England, the specialist with the Hackensack-based Center for Alcohol and Drug Resources, said that 1,200 people die every day from smoking-related deaths, “and the companies need to replace them. There’s no point in marketing to people over age 25, since the chances of them beginning to smoke that late are much less – so they can start by marketing chew tobacco to kids as young as 12.”

At RHS, Lorenz said he was aware of an increase in smokeless tobacco usage, particularly in the past eight months.

“We’re finding disgusting things in washrooms,” Lorenz said. “This year was probably the worst. … It’s of great concern to me.”

Smokeless tobacco comes in many forms, including looseleaf, “plug” tobacco – such as a new Camel brand called Snus – and snuff, England said. Many are made with harmful chemicals such as cadmium, lead, formaldehyde, arsenic and cyanide, as well as fiberglass and sand, which cut the gum so the tobacco can directly enter the bloodstream.

England provided theories about why so many harmful chemicals are put into tobacco: to improve flavor, to help it stick together, and, in the case of cigarettes, to increase burning productivity – but stressed that there was “no definitive answer.”

Statistics from the Substance Abuse and Mental Health Services Administration show that New Jersey’s rates of chewing tobacco were 6.9 percent in 2002, 5.5 percent in 2007, and 9 percent in 2009.

While lower than the national averages, the overall trend is toward an increase in usage, England said. In particular, the increase is notable in young men ages 12 to 21.

The trend can partly be accounted for by increased tightening of restrictions on smoking in public places, as well as a more aggressive marketing strategy which appeals to youth, she suggested. For example, chewing tobaccos are often mild or flavored with cherry or mint, and sometimes placed at eye level in convenience stores to “normalize” their presence.

There is also a perception in films or advertising that chewing tobacco is popular with athletes, especially in sports like baseball, NASCAR racing, and football.

“They use positive imagery in advertising … like, ‘This is my hero, so it’s OK he does this,’” she said.

England emphasized that, contrary to tobacco companies’ allusion that smokeless tobacco is less dangerous than smoking, it can cause different kinds of cancer: not only mouth and gum cancer, but, due to the ingestion of the chemically-tainted saliva, also gastric and esophageal cancers and damage to the liver, pancreas and kidneys.

“It’s smokeless, not harmless,” she said.

The presentation was sponsored by a grant obtained by the Ridgewood Municipal Alliance Committee, chaired by Sheila Brogan, who is also a trustee at the Board of Education.

Brogan said the committee might follow up later this year by encouraging high school administrators to address students more directly about the trend, through health classes and sports coaches. Brogan and Lorenz also suggested the district may look into participating in the “Great American Spit Out” in February.

The US tobacco group, said its third-quarter profits increased 28 per cent to $1.1bn as its flagship cigarette, Marlboro, gained market share and sales of smokeless tobacco rose. Revenue climbed 1.6 per cent to $6.4bn, with cigarettes accounting for $5.7bn of sales, smokeless tobacco $389m, cigars $147m, wine $107m and financial services $30m, the company said on Wednesday. In spite of the contraction of overall demand for cigarettes, Marlboro’s share of the US retail market rose to 42.6 per cent during the third quarter from 41.9 per cent in the same period of the previous year.

Through internal cost management, Altria increased its operating income for cigarettes by 15 per cent over the prior year. Sales of smokeless tobacco products, including Skol and Copenhagen, rose 10 per cent. Operating income in the category was up 65 per cent.

“We are seeing increased interest among adult tobacco consumers” in smokeless tobacco, said Michael Szymanczyk, Altria chief executive. “We are optimistic about long-term prospects for these kinds of products.”

Mr Szymanczyk said the company’s new merchandising programme for smokeless tobacco products, involving the installation of in-store product displays, could help boost sales.

“The smokeless tobacco category historically has not received the necessary merchandising space in retail stores,” he said.

“By offering fixtures, retailers can improve merchandising, reduce out of stock and help achieve objectives.”

David Beran, chief financial officer, attributed the company’s increased profitability to higher prices for its cigarettes, cost savings and reduced promotional spending.

Overall, the company estimates the cigarette market is declining at a rate of 4 per cent annually, while the smokeless tobacco category is on a 7 per cent growth track.

Altria, which markets Marlboro and other Philip Morris branded cigarettes, raised prices on its US brands by 8 cents per pack in May. The company said the average price per pack of Marlboros in the US was $5.63, while the average pack of cigarettes cost $4.19. The average state excise tax levied on each pack of cigarettes was $1.36.

Material from: ft.com

Sept. 13, 2010 — Smokeless tobacco products — whether chewed or used as dry or moist snuff — may increase the risk of heart attack, fatal stroke and certain cancers, says a new policy statement published online in Circulation: Journal of the American Heart Association.

“No tobacco product is safe to consume,” Mariann Piano, PhD, lead writer of the policy statement and a professor in the department of behavioral health science at the University of Illinois at Chicago, says in a news release.

The notion that smokeless tobacco may help reduce the rate of cigarette smoking is based in part on Swedish research, which showed a significant decline in smoking by Swedish men between 1976 and 2002 that corresponded with an increase in the use of smokeless tobacco.

But in similar research in the U.S., the opposite was found to be true, the article says. There was no reduction in smoking rates among people who used smokeless tobacco products.
Piano says that smokers trying to kick the habit might want to try nicotine-replacement therapy, by chewing nicotine gum or using a nicotine patch that can be attached to the skin, rather than using smokeless tobacco products.

Piano tells WebMD that most people who use nicotine-replacement therapy do so for short periods of time, and it doesn’t appear to be as addictive as smokeless tobacco “because of slower absorption, lower doses of nicotine, greater cost, lack of flavoring, sociocultural influences” or a combination of such factors.

She says most health professionals feel that people switch from smoking to nicotine-replacement therapy are better off, even if they have difficulty throwing away nicotine gum and patches, “because they are not exposed to tobacco carcinogens and oxidants.”

Recent research has found that smokeless tobacco products may slightly increase the risk of a fatal heart attack and fatal stroke in long-term users, she writes. Smokeless tobacco products have also been linked to an increased risk in oral cancer.

Clinical research has found no increased risk of heart attack or stroke in people who use nicotine gum or patches, Piano says.

She notes that as smoke-free air laws have become increasingly common, smokeless tobacco products have been marketed as a pleasurable substitute. But she adds that “smokeless tobacco products are harmful and addictive,” which “does not translate to a better alternative.”

The Yurok Tribe, Resighini Rancheria, Wiyot Tribe, and Blue Lake Rancheria have passed a policy that prohibits commercial tobacco companies from giving away free tobacco samples on their tribal lands. The use of non-commercial tobacco for traditional and ceremonial purposes is excluded from this policy.

United Indian Health Services’ NATIVE Tobacco Project would like to thank the Yurok Tribe and the Resighini Rancheria for taking a stand against commercial tobacco companies and stopping them from giving away free tobacco samples to lure new smokers.

The commercial tobacco industry has identified American Indian communities as an untapped and unprotected opportunity to maximize profits beyond the limits of state and county regulated jurisdictions. The commercial tobacco companies have sought to manipulate the sacred use of tobacco by improperly suggesting that commercial cigarette and smokeless tobacco products are retail substitutes for tobacco approved by elders for ceremonial use.

By prohibiting tobacco sampling, the Yurok Tribe and Resighini Rancheria are showing their commitment to the health and wellness of all people.

Further flexing its newly-gained muscles to regulate tobacco, the Food and Drug Administration (FDA) has announced new federal regulations further restricting the marketing of cigarettes and smokeless tobacco products to persons under 18.

The new regulations, authorized under the Family Smoking Prevention and Tobacco Control Act, go into effect on June 22, 2010, and will:

* Prohibit the sale of cigarettes or smokeless tobacco to people younger than 18.

* Prohibit the sale of cigarette packages with fewer than 20 cigarettes.

* Prohibit the sale of cigarettes and smokeless tobacco in vending machines, self-service displays, or other impersonal modes of sales, except in very limited situations.

* Prohibit free samples of cigarettes and limits distribution of smokeless tobacco products.

* Prohibit tobacco brand name sponsorship of any athletic, musical, or other social or cultural event, or any team or entry in those events.

* Prohibit gifts or other items in exchange for buying cigarettes or smokeless tobacco products.

* Require that audio ads for cigarettes and smokeless tobacco products use only words with no music or sound effects.

* Prohibit the sale or distribution of items, such as hats and tee shirts, with tobacco brands or logos.

“This ruling is a critical piece of a coordinated effort to save lives, lower costs, and reduce suffering from heart disease, cancer and other tobacco-related illness,” said Health and Human Services Secretary Kathleen Sebelius in a press release. “Today, we’re addressing a larger public health effort to prevent our children from becoming the next generation of Americans to die early from tobacco-related disease. This is a great step toward a healthier America.”

By Robert Longley, Usgovinfo

A new law targeting cigarette smugglers has cleared both houses of the General Assembly and now goes to the governor for his signature.
The House of Delegates on Wednesday joined the Senate in unanimously passing Senate Bill 476, sponsored by Sen. John C. Watkins, R-Midlothian.

The bill would establish additional penalties for “any person who sells, purchases, transports, receives, or possesses unstamped cigarettes” in Virginia.

Cigarettes are stamped in most states to ensure that the tax on them has been paid. If a pack of cigarettes is sold in Virginia without a stamp, that means no tax has been paid to the commonwealth.

In Virginia, the tax on a pack of cigarettes is 30 cents. In South Carolina, the tax per pack is 7 cents, and that state doesn’t stamp its cigarettes. Smugglers often purchase cigarettes in states with low tobacco taxes and sell them illegally in states with higher tobacco taxes, pocketing the difference as profit.

If Gov. Bob McDonnell signs SB 476 into law, first-time offenders would be charged $2.50 a pack, up to $500. For a second violation within 36 months, the fine would be $5 per pack, up to $1,000. And for a third violation, the penalty would be $10 per pack, up to $50,000.

If authorities determine that the violator had a willful intent to defraud the commonwealth, the penalty would be $25 a pack, up to $250,000.

On another tobacco-related issue, the House last week also gave final approval to SB 478, which would change the tax on moist snuff tobacco.

Currently, snuff is taxed at 10 percent of the manufacturer’s sales price. Under SB 478, which was proposed by Watkins, the tax would be 18 cents an ounce.

The House voted 92-6 for the bill. It passed the Senate last month, 38-2. If McDonnell signs the bill, it would take effect on Jan. 1, 2011.

Bill Phelps, a spokesperson for the U.S. Smokeless Tobacco Co., said the bill would help both tobacco companies and the commonwealth. Phelps said it makes sense to change the tax on snuff to an excise tax, as Virginia taxes gasoline or beer. That way, the tax is based on the amount of the product sold, not the quality.

“We think that taxing moist tobacco by weight … is a fair way to tax the product,” Phelps said.

He said taxing snuff by the ounce will provide a more stable source of revenue for the commonwealth, because the price of snuff has gone down every year for the past six years.

By Rich Griset, Wpcva