1. The Truth About Teenagers and Smokeless Tobacco A School Safety Project Presented by Bill Querry October 16, 2012

2. Why All The Fuss? You don't smoke it or swallow it. You slosh it around in your mouth and spit out the brown juices. Sure it’s disgusting; but after all, it's chewing tobacco. That means you chew it and spit it, not smoke it, so it can't be as bad as inhaling tobacco smoke into the lungs, right? Wrong: the fact is, smokeless tobacco is dangerous; even deadly.

3. Chew on This! Did you know that smokeless tobacco contains 28 carcinogens including arsenic and is a known cause of human cancer? That smokeless tobacco leads to serious nicotine addiction and dependence? That teens who use smokeless tobacco are more likely to become cigarette smokers? That use of smokeless tobacco is on the rise at Sacopee Valley High School (SVHS)?

4. What Is Smokeless Tobacco? A product consisting of tobacco or a tobacco blend that is chewed, inhaled, or sucked on rather than smoked. Available in two forms: –Chewing tobacco. This type of smokeless tobacco comes in loose leaf, plugs, or twists. As the name suggests, it's chewed. –Snuff. This product is available dry or moist, in loose leaf or in pouches that look like tea bags. A pinch of snuff may be placed between the cheek and the gum or inhaled into the nostrils.

5. What Is Smokeless Tobacco? It’s Chemicals – chemicals that are harmful to health: Nicotine (addictive drug) Polonium 210 (nuclear waste) Cadmium (used in car batteries) N-Nitrosamines (cancer-causing) Lead (poison) Formaldehyde (embalming fluid) (Also: Acetaldehyde, crotonaldeyde, hydrazine, arsenic, nickel, and benzopyrene (Source: National Cancer Institute)

6. It is estimated that 14 million American’s use smokeless tobacco products. Of that, 3 million are under the age of 21. Almost 23% of young users start by 6th grade and 73% by 9th grade. The majority of users are male with 6% being female. Most young users become addicted before their 18th birthday - the age they are legally able to buy the product. (Source: American Cancer Society).

7. What About Maine? As many as 20% of Maine’s high school boys and 4% of high school girls use smokeless tobacco, according to the Partnership for a Tobacco Free Maine. Peer pressure and culture are just a few reasons for starting the habit. It is also easy to carry and conceal. But – it is impossible to hide its effect on the body.

8. Nicotine Affects the Body It is just as addictive as heroine and cocaine. As the body becomes physically and psychologically dependent on it; users need more. It acts as a depressant: –Interferes with the flow of information between nerve cells. –As the nervous system adapts to nicotine, users increase the amount of tobacco and there is more nicotine in the blood. –After a while, users develop a tolerance to the drug. Leads to increased use over time. Must maintain level of use or suffer from withdrawal symptoms Source: National Institute of Health

9. Smokeless Tobacco Is More Addictive Than Cigarettes One can of smokeless tobacco contains as much nicotine as 60 cigarettes. The nicotine results in a "buzz" that is more addictive than cigarettes. 75% of cancers in the mouth, lips, tongue, throat, nose and larynx are due to smokeless tobacco use. Long-term users have a 50% greater risk of developing oral cancers than non-users.

10. Smokeless Is Not Harmless Stained Teeth & Bad Breath: Prolonged use of chewing tobacco can stain teeth and tongue, as well as give hard-to-cover foul breath…all very unattractive. Dulled Sense of Taste and Smell: The harsh chemicals of chewing tobacco do more than impair oral health; they also disrupt one’s sense of taste and smell. Increased Tooth Decay: The sugar and other agents in smokeless tobacco damage tooth enamel and contribute to cavities. Slowed Healing After Extraction or Other Surgery: The irritating agents in chewing tobacco reduces or impairs the body’s ability to heal. Source: Centers for Disease Control and Prevention (CDC).

11. Smokeless is Not Harmless Gum Recession: Having a small “pinch” of chewing tobacco next to the gums causes constant irritation. The effect is permanent damage to gums and surrounding bone. Damaged gum tissue pulls away from teeth, causing sensitivity and additional exposure to tooth decay. If bone surrounding the tooth erodes too much it can result in permanent tooth loss. Spitting/drooling: Because of the smokeless tobacco, your mouth makes extra saliva, and you need to spit out the tobacco juice from time to time. If you don't have a place to spit smokeless tobacco, you run the risk of getting smokeless tobacco and tobacco juice on your face and on your clothes. And that’s not a good- looking sight! Source: Centers for Disease Control and Prevention (CDC) For more visual proof, search “Effects of Smokeless Tobacco” in Google images – but brace yourself – it is not a pretty site.

12. Cancer and Smokeless Tobacco Oral Cancer: Chewing tobacco contains 28-cancer causing agents including arsenic and formaldehyde and leaves gums, cheeks, lips and throat in constant exposure to unhealthy juices. In addition, smokeless tobacco use is strongly associated with leukoplakia—a precancerous lesion of the soft tissue in the mouth that consists of a white patch or plaque that cannot be scraped off. This can result in cancer of the oral cavity, pharynx, larynx, and esophagus.

13. Taking On the Tobacco Industry The tobacco industry markets smokeless tobacco to young adults and teenagers. As educators we must keep the conversation going with our students about the dangers of this drug. Take a moment to review this video and share it with your students: http://www.tobaccofreemaine.or g/train_take_action/countermar keting-parent_03.php

14. Smokeless Tobacco Is Big Business Tobacco companies spend millions marketing their smokeless products in convenience stores, magazines, or online to lure kids into thinking smoking is cool, or is a way to express their independence. Exposure to tobacco more than doubles the odds that children under 18 will become tobacco users. As much as a third of all youth who experiment with smoking do so because of effective tobacco industry marketing.

15. Unique Tobacco Products Some products sold in sweet flavors posing as healthy alternatives to cigarettes, also appeal to younger smokers. Though these products masquerade as safe, they are more harmful than cigarettes. Kreteks, clove cigarettes; Bidis, candy- flavored cigarettes, and Hookahs, or water pipes, are becoming increasingly popular with teenage girls. Source: http://www.tobaccofreemaine.org/chan nels/parents/unique_tobacco_products.php

16. Consider This Tobacco marketing tactics and specialized tobacco products are eroding efforts toward tobacco prevention. As educators, it is important that we know about the unique issues that affect our student’s choices when it comes to tobacco use. Consider: The average age of first-time users of smokeless tobacco is 10 years old. Females turn to smokeless tobacco as a means to lose or control weight.

17. How You Can Help Make yourself available to your students and if they use smokeless tobacco products – offer to help them break the habit. If they decide to quit, encourage them, and help enlist support. Suggest substitutes such as sugarless gum; hard candy; beef jerky; sunflower seeds; shredded coconut; raisins; or dried fruit. Suggest getting involved in healthier activities: lifting weights, shooting baskets, going for a swim, etc. Source: http://www.drugfree.org/

18. Learn the medical facts and speak honestly to your students. Discuss with your students ways to refuse without feeling peer pressure. Support and encourage students who want to quit. Discuss how the glamorization of tobacco products is a false image. Support organizations that oppose glorification of smokeless tobacco. Support warning labels on smokeless tobacco products. Encourage students to focus on positive role models, including athletes, who endorse a no-use policy of smokeless tobacco. Stress how much money can be saved by not using tobacco products. Create and implement tighter restrictions and penalties. Support our school’s no-use, no-tolerance policy. Learn, Discuss, Support,

19. Real Talk About Smoking The following video link features teenage smokers describing what it feels like to be a smoker: http://www.tobaccofreemaine.org/channels/educators/real_talk_ about_smoking.php It is intended for a high school audience and includes a discussion guide to assist teachers with facilitating an open dialog with students. Along with in-classroom discussion it helps address concerns and pressures that many of our students are facing. Source: Partnership for a Tobacco Free Maine

20. Support the School Policy Initiative A Policy Initiative through the Partnership for a Tobacco Free Maine School helps Maine schools create and maintain 100% tobacco-free campuses. This is an important step in raising awareness and helps provide tobacco-free model environments for school districts and communities. Schools become “Star Schools” when they meet PTM criteria for being tobacco free. Help SVHS become a Star School.

21. More Important Healthy Maine Partnership Resources Learn more about developing tobacco free policies in our school at: http://www.tobaccofreemaine.org/channels/educators/de veloping_school_policies.php Also download the following policy guide: Creating and Maintaining a Tobacco-Free School Policy: http://www.tobaccofreemaine.org/channels/educators/do cuments/25-094-11_SchoolPolicy.pdf

22. Display Posters and Other Materials

23. Post This In Your Class: It Might Save a Life http://www.tobaccofreemaine.org/quit_tob acco/Maine_Tobacco_HelpLine.php

24. Additional Statistics & Facts on Smokeless Tobacco Smokeless tobacco is a known carcinogen (U.S. Dept. of Health & Human Services, Report on Carcinogens, December 2002) Approximately 31,000 new cases of oral cancer were diagnosed in the U.S. in 2008; nearly 2/3 were male. Estimated deaths from oral cancer in 2006 were 4,830 men and 2,400 women. (American Cancer Society Cancer Facts & Figures 2009) Long term users are 50% more at risk for cancer of cheek and gums. (American Cancer Society) Nicotine will cause the heart to beat faster and blood pressure to rise. (American Cancer Society) Smokeless tobacco users increase their risk of cancers of the oral cavity, throat, larynx and esophagus when compared to people who do not use tobacco products. (American Cancer Society) Over 600,000 females over age 12 in the U.S. use smokeless tobacco (National Institute of Drug Abuse - an agency of the National Institutes of Health, March 2009) About 75% of daily users of smokeless tobacco will get leukoplakia. (American Cancer Society)

25. Remember: Smokeless Tobacco Can Be Fatal One of Oklahoma’s most outstanding athletes, Sean Marsee had won 28 track medals in the 400 meter relay while running the anchor leg. His classmates honored him with a walnut plaque. After a ten month battle with rapidly spreading cancer that started on his tongue, Sean Marsee died at age 19. A smokeless tobacco user since age 12, Sean refused to believe the warnings that tobacco was hazardous, smoke or no smoke.

26. Share Sean’s Story With Your Students Sean’s story is not an easy one to learn about or watch – but it is extremely important: http://www.youtube.com/watch?v=ayfZmbWudLU http://www.ok.gov/okswat/documents/swat_sean_marse e.pdf http://whyquit.com/whyquit/SeanMarsee.html

27. Another Cautionary Tale Oral cancer is difficult to treat. Disfiguring surgery is often needed. Only half with the disease survive more than 5 years (of 30,000 new cases each year; 9,000 die. Gruen Von Behrens was 13 when he became addicted to smokeless tobacco. Here is his story: http://abcnews.go.com/Politics/chewing- tobacco-baseball-field-oral-cancer-survivor- dangers/story?id=10377063

28. Resources CDC/Smoking and Tobacco Use http://www.cdc.gov/tobacco Tobacco Control Network (TCN) http://www.ttac.org/TCN/materials/06.07.06.html CDC Healthy Youth http://www.cdc.gov/HealthyYouth/tobacco/publications.htm http://www.cdc.gov/HealthyYouth/tobacco/tobacco- free.htm Use and Prevention Strategies http://qhr.sagepub.com/cgi/content/abstract/12/9/1264

29. Additional Resources CDC Fact Sheet http://www.cdc.gov/tobacco/data_statistics/fact_sheets/s mokeless/smokeless_facts/index.htm Teenager Conversations About Smokeless Tobacco http://whyquit.com/whyquit/LinksYouth.html Partnership for a Tobacco Free Maine http://www.tobaccofreemaine.org/train_take_action/contac t_PTM.php

30. Additional Resources Smokeless Tobacco Fact Sheet Provided by the Department of Health and Human Service and the Centers for Disease Control and PreventionSmokeless Tobacco Fact Sheet http://www.cdc.gov/tobacco/data_statistics/fact_sheets/smokeless/smokeless_facts/i ndex.htm Team Of Destiny Had A Dirty Habit The 2004 Boston Red Sox were a bunch of chewers...Team Of Destiny Had A Dirty Habit http://www.boston.com/sports/baseball/redsox/articles/2006/04/11/team_of_destiny_h ad_a_dirty_habit/ Smokeless Tobacco and Cancer: Questions and Answers Questions and answers provided by the National Cancer Institute.Smokeless Tobacco and Cancer: Questions and Answers http://www.cancer.gov/cancertopics/factsheet/Tobacco/smokeless Smokeless Tobacco: Tips on How to Stop Provided by the FamilyDoctor.org which is operated by the American Academy of Family Physicians (AAFP), a national medical organizations representing more than 93,700 family physicians, family practice residents and medical students.Smokeless Tobacco: Tips on How to Stop http://familydoctor.org/familydoctor/en/diseases-conditions/tobacco- addiction/treatment/smokeless-tobacco-tips-on-how-to-stop.html

31. Additional Materials I have accumulated a lot of materials regarding smokeless tobacco including models and posters. I am available to discuss this important subject with your students at any time.