You don't smoke it. You don't swallow it. All you do is slosh it around your mouth and spit out the brown juices every few seconds. OK, so it actually is pretty disgusting. But so what? After all, it's called smokeless or chewing tobacco. That means you chew and spit it, not smoke it, so it can't be as bad as inhaling tobacco smoke into your lungs, right?

Wrong . . . unfortunately, smokeless doesn't mean harmless. The fact is, chewing tobacco is dangerous, too.

What Is Smokeless Tobacco?

Smokeless tobacco, also called spit tobacco, chewing tobacco, chew, chaw, dip, plug, and probably a few other things, comes in two forms: snuff and chewing tobacco.

Snuff is a fine-grain tobacco that often comes in teabag-like pouches that users "pinch" or "dip" between their lower lip and gum. Chewing tobacco comes in shredded, twisted, or "bricked" tobacco leaves that users put between their cheek and gum.

Whether it's snuff or chewing tobacco, you're supposed to let it sit in your mouth and suck on the tobacco juices, spitting often to get rid of the saliva that builds up. This sucking and chewing allows nicotine, which is a drug you can become addicted to, to be absorbed into the bloodstream through the tissues in your mouth. You don't even need to swallow.

Where Does It Come From?

Smokeless tobacco has been around for a long time. Native people of North and South America chewed tobacco, and snorting and chewing snuff was popular in Europe and Scandinavia (the word "snuff" comes from the Scandinavian word "snus").

In the United States, chewing tobacco has long been associated with baseball. Players chewed it to keep their mouths moist, spit it into their gloves to soften them up, and used it to make a "spitball," a special pitch that involved the pitcher dabbing the ball with saliva to cause it to spin off the fingers easily and break sharply. (Spitballs were banned from the sport in 1920.)

By the 1950s, chewing tobacco had fallen out of favor in most of America, so by that time not too many baseball players were spitting big brown gobs all over the infield. Instead of chewing their tobacco, most people were smoking it.

But in the 1970s people became more aware of the dangers of smoking. Thinking it was a safe alternative to lighting up, baseball players started chewing on their tobacco again. Some players even developed the habit of mixing their chewing tobacco with bubble gum and chewing the whole thing. Gross, huh?

These days, you don't find the majority of professional ballplayers with wads of chaw in their cheeks. But lots of guys and girls, athletes or not, still find time for chewing and spitting.

Who Chews?

As many as 20% of high school boys and 2% of high school girls use smokeless tobacco, according to the Centers for Disease Control and Prevention (CDC). Of the 12 to 14 million American users, one third are under age 21, and more than half of those developed the habit before they were 13.

Peer pressure is just one of the reasons for starting the habit. Serious users often graduate from brands that deliver less nicotine to stronger ones. With each use, you need a little more of the drug to get the same feeling.

So What's the Danger?

Just like smoking cigarettes, chewing smokeless tobacco can eventually rip apart your body and kill you. It's that simple, really. There's no such thing as a "safe" tobacco product.

Take Bill Tuttle, for example. An outfielder for the Detroit Tigers, the Kansas City Athletics (before they moved to Oakland), and the Minnesota Twins, Tuttle chewed tobacco for most of his career. In fact, a lot of Tuttle's baseball cards over the years pictured him with a cheek bulging with chewing tobacco. Thirty-eight years after the end of his baseball career, Tuttle had a more ominous bulge in his cheek — a huge tumor that was so big that it came through his cheek and extended through his skin. Doctors removed the tumor, along with much of Tuttle's face. Chewing tobacco as a young man had cost him his jawbone, his right cheekbone, a lot of his teeth and gumline, and his taste buds. Cancer caused by his chewing habit finally claimed him in 1998, but Tuttle spent the rest of his life trying to steer young people, as well as grown athletes, away from smokeless tobacco.

Other baseball players have met a similar fate. Even one of the greatest of all time, Babe Ruth, was fond of dipping and chewing tobacco. He died at age 52 of an oropharyngeal tumor, which is a cancerous tumor in the back part of the throat.

But, of course, it isn't just baseball players who regret their choice to start chewing tobacco. According to the CDC, each year about 30,000 Americans learn they have mouth and throat cancers, and nearly 8,000 die of these diseases. Sadly, only about half of people with diagnosed mouth or throat cancer survive more than 5 years.

What Can Chewing Tobacco Do to Me?

The more immediate effects can disrupt your social life: bad breath and yellowish-brown stains on your teeth. You'll also get mouth sores (about 70% of spit tobacco users have them).

But it gets a lot more serious than that. Consequences of chewing and spitting tobacco include:

• cracking and bleeding lips and gums
• receding gums, which can eventually make your teeth fall out
• increased heart rate, high blood pressure, and irregular heartbeats, all leading to a greater risk of heart attacks and brain damage (from a stroke)
• cancer

Oral cancer means cancer of the mouth and can happen in the lips, the tongue, the floor of the mouth, the roof of the mouth, the cheeks, or gums. It's been medically proven that long-time use of chewing tobacco can lead to cancer.

But cancer from chewing tobacco doesn't just occur in the mouth. Some of the cancer-causing agents in the tobacco can get into the lining of your stomach, your esophagus, and into your bladder.

Quitting the Dipping

If you're a dipper, put some long thought into breaking the habit and quitting now. When you decide to quit, don't do it alone. Tell friends or family and enlist their support.

Strategies for breaking the habit include:

• using a nicotine gum or a patch (ask your doctor about these options first)
• planning ahead and using substitutes such as tobacco-free, mint-leaf snuff; sugarless gum; hard candy; beef jerky; sunflower seeds; shredded coconut; raisins; or dried fruit
• getting involved in healthier activities: lifting weights, shooting baskets, going for a swim, etc.

It's tough to quit, but realize that backsliding is common, so don't give up. Your chances of success increase with each try!

Reviewed by: Steven Dowshen, MD
Date reviewed: July 2011