Hey, c’mon now . . .

1. Hey, c’mon now . . . Just Spit it OUT !

2. Facts About Spit Tobacco • Use is rising among young males • Smokeless (spit) tobacco is marketed to young people through sports and athletic events • Spit tobacco causes disease, including mouth cancer and nicotine addiction • Users can successfully quit

3. What is SPIT TOBACCO? • Loose leaf chewing tobacco • Plug chewing tobacco • Dry snuff • Moist snuff • Fine cut tobacco

4. Who Uses Spit Tobacco?

5. Who Uses Spit Tobacco? • About 16% of high school males in Missouri use spit tobacco (about 2% of high school females) • 4.6% of middle school students in MO

6. Why Spit Tobacco Use is Increasing • Increased smoking restriction in schools and public places, including worksite • Positive macho image of spit tobacco use in advertising campaigns • Introduction of milder and sweeter brands • The suggestion that spit tobacco improves overall athletic performance

7. How They Hook You • Positive image • Graduation method • Advertising Spitters Make Better Hitters

8. How They Hook You Yeah, a real major league role model

9. How They Hook You Counter Measure in Sports Joe Garagiola National Spokesperson National Spit Tobacco Education Program Garth Brooks PSA at Nat’l Western Stock Show

10. How They Hook You The following is what a representative of US Tobacco (the leading manufacturer of smokeless tobacco products) said about one of its spit tobacco brands: “Cherry Skoal is for somebody who likes the taste of candy, if you know what I’m saying.”

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

12. Spit Tobacco Graduation Theory

13. Methods of Marketing Spit Tobacco to Youth • Techniques that appeal to the “individual,” “risk taker,” “macho man,” and “rugged” • Offer “free” gifts • Educate youth on how to use the product • Offer gear and coupons • Advertise spit tobacco as a safe alternative to smoking

14. Methods of Marketing Spit Tobacco to Youth • “Macho” man image • Outdoors--fishing, hunting • Rodeos • Car Racing • Use it when you can’t smoke

15. Methods of Marketing Spit Tobacco to Youth Location Location Location

17. Chemicalsin Spit TobaccoDo You Really Want to Put These in Your Mouth? • Cadmium (car batteries) • Polonium 210 (nuclear waste) • Lead (decreased IQ in children nervous system damage) • Formaldehyde (embalming fluid) • Arsenic (rat poison) • Cyanide (used in the gas chamber) • Nitrosamines (potent cancer-causing agents)

18. Chemicals in Spit Tobaccocon’t. • Nickel • Nicotine • Pesticides • Acetaldehyde • Benzopyrene (cancer-causing) • Hydrazine • Uranium 235 and 238 • Over 30 metals

19. Chemicals in Spit Tobaccocon’t. • Some smokeless tobacco products contain fiberglass and sand • That’s right, fiberglass and sand to cut the gums and mouth and ensure that users absorb more nicotine and other harmful chemicals into their bloodstream – as quickly as possible

20. The Real Story

21. Health Consequences of Nicotine Exposure • Increased heart rate • Stroke • High blood pressure • Delayed wound healing • Peptic ulcer disease • Low birth weight babies and other reproductive disorders

22. Oral Health Effects of Spit Tobacco Usage • Stained teeth • Rough patches in the mouth (leukoplakia) • Bad breath (halitosis) • Receding gum line • Oral cancer

23. Are You Hooked on Chew? • You have switched to a stronger brand • You can’t go more than a few hours without it • You have strong cravings when you try to quit • You reach for a dip first thing in the morning

24. Not A Safe Alternative • Spit tobacco is just as addictive as smoking • Spit tobacco use is deadly • Spit tobacco causes bad breath, gum disease, tooth decay • Spit tobacco has many of the same poisons

25. Not A Safe Alternative

26. Not A Safe Alternative

27. Not A Safe Alternative

28. Not A Safe Alternative • At age 12, Sean Marcey started using spit tobacco • At age 18, he was diagnosed with tongue cancer • At age 19, he was DEAD • A victim of oral cancer • A victim of tobacco.

29. The Cessation Process7 Steps to Recovery National Spit Tobacco Education Program

30. The Cessation Process7 Steps to Recovery Nicotine addiction can be hard to beat, but establishing a quitting process can help.

31. The Cessation Process7 Steps to Recovery Step 1: Decide to Quit and Make a List of Reasons Why

32. The Cessation Process7 Steps to Recovery Step 2: Set a Date

33. The Cessation Process7 Steps to Recovery Step 3 See a Health Care Provider

34. The Cessation Process7 Steps to Recovery Step 4 Taper Off and Change Your Routine

35. The Cessation Process7 Steps to Recovery Step 5 Build A Support Team

36. The Cessation Process7 Steps to Recovery Step 6 Your Quit Day

37. The Cessation Process7 Steps to Recovery Step 7 Staying Off Spit Tobacco

38. The Cessation Process7 Steps to Recovery During the toughest moments of withdrawal and temptation, try methods that are “DEAR”

39. The Cessation Process7 Steps to Recovery • DEAR • Delay: • If you can wait another 30 minutes before taking a dip, • orif you can put dipping out of your mind by doing something else and thinking positive thoughts, • - -the urge may pass- -

40. The Cessation Process7 Steps to Recovery • DEAR • When feeling irritable from nicotine withdrawal and presented with a confrontation, • Escape: consider walking away from the source and doing something else for a minute or two

41. The Cessation Process7 Steps to Recovery • DEAR • Avoid: • Stay away from situations where the temptation to use is high until you are confident you can remain tobacco-free. If you can't avoid these high risk situations, then plan ahead what you will doinstead of dippingso that you will be able to resist the temptation to use.

42. The Cessation Process7 Steps to Recovery • DEAR Give yourself a reward (other than dipping!) every day you stay tobacco free. Reward:

43. Additional Information Sources National Center for Tobacco-Free Kids1400 Eye StreetSuite 1200Washington DC 20005 Tel: 202-296-5469 Fax: 202-296-5427 www.tobaccofreekids.org American Legacy Foundation1001 G Street, NW, Suite 800Washington, DC 20001 202-454-5555 phone202-454-5599 fax www.americanlegacy.org

44. Additional Information Sources Oral Health America410 North Michigan Avenue Suite 352Chicago, Illinois 60611-4211Tel.: (312) 836-9900Fax: (312) 836-9986www.oralhealthamerica.orgwww.nstep.org • Oral Cancer Foundation • 3419 Via Lido #205 • Newport Beach CA 92663 • Tel: 949-646-8000 • Fax: 949-376-1499 • www.oralcancerfoundation.org/

45. Additional Information Sources 800 / ACS - 2345 www.cancer.org 888 / 842-6355 www.cdc.gov/tobacco 800 - 4 - CANCER www.cis.nci.nih.gov

46. Missouri Dept of Health & Senior Services P O Box 570 Jefferson City MO 65102-0570 • Bureau of Health Promotion (tobacco control) 573-522-2820 buchal@dhss.state.mo.us • Bureau of Cancer Control 573-522-2841 cowans@dhss.state.mo.us • Oral Health Policy Unit 573-751-6247 perkid@dhss.state.mo.us