Ask Dr. Hallberg: more on smokeless tobacco

Minnesota's smoke-free policies have given many smokers an incentive to quit, but a new report suggests that some smokers may be turning to chewing tobacco, snuff, or snus packets to get nicotine during times when smoking is prohibited.

The report is the first time the Centers for Disease Control and Prevention has published data on smokeless tobacco use in all 50 states. The findings show that Minnesota has one of the highest rates of smokers who also use smokeless tobacco.

MPR News medical analyst Dr. Jon Hallberg joined All Things Considered's Tom Crann on Monday to discuss the dangers of smokeless tobacco. Hallberg is a physician in family medicine at the University of Minnesota and medical director of the Mill City Clinic in Minneapolis.

Tom Crann: If people are turning to smokeless tobacco, chewing tobacco and other things, instead of cigarettes, how do those health risks compare?

Dr. Jon Hallberg: You're suddenly talking about not worrying about lung cancer, but you're worrying about cancer where the tobacco sits. So all of these tobacco forms that you don't light up and smoke, you put in your mouth. And if it sits in your mouth, you start to worry about dental disease, gum disease, teeth becoming loose, developing oral cancer, esophageal cancer because the juice has dripped down the throat, and pancreatic cancer, interestingly.

Crann: What affect does chewing tobacco have on the body, compared to cigarettes? Is there still that shot of nicotine one would get from a cigarette?

Hallberg: There sure is. And so you might get the nicotine absorbed maybe a little bit less quickly when you are putting it in your mouth as opposed to inhaling it, but actually the nicotine lasts in the bloodstream longer if you're chewing it. So nicotine is nicotine is nicotine. It's an addictive substance. The tobacco companies know that. They're taking advantage of it, and that sort of helps determine how they prepare the tobacco products.

Crann: We know about cigarette manufacturers adding ingredients, additives, to make cigarettes more effective as a nicotine delivery system. Do the manufacturers of chewing tobacco or smokeless tobacco do anything to adulterate their products to make them more addictive?

Hallberg: Oh, yes. Traditionally, chewing tobacco was basically a tobacco leaf that's rolled up and wrapped into sort of a rope-like thing. And farmers used to take a big chaw of that and sort of just chew on that. That's actually not a very good way of getting the tobacco.

So the tobacco companies will take that, chop it up into very, very small pieces, and the smaller the pieces, the greater the surface area. So the long cut is a little bit less addictive than the fine cut. Then they'll put things in like ... silicone dust, basically glass particles, to scuff up the gums so that it allows for greater and faster absorption of the nicotine.

Crann: You deal with this issue in your work as one the consulting physicians for the Minnesota Twins. Obviously, it's very popular with ballplayers. How do young ballplayers get started, get hooked on this?

Hallberg: There's something about baseball, and I think it's similar to people who fish and go deer hunting and are sitting in ice houses. There's a certain pace to the game. There's a certain mystique and tradition associated with it, and a lot of this goes hand in hand.

This is why Minnesota has such a high rate of tobacco use, is because of the hunting and fishing and cabins and sitting on boats. And it's just very relaxing. It seems nice because you're not lighting up, but really, it's disgusting.

In fact, when I first started with the Minnesota Twins back in 1997, Major League Baseball had a massive campaign to get guys to quit chewing, partly just because of the image. It's absolutely disgusting.

But tobacco is, to a certain level, just like caffeine. Though it's a stimulant, it kind of calms the mind. You're jazzed a little bit, but it allows you to focus and maybe suppresses your appetite a little bit. It's good on many levels for a ballplayer, unfortunately.

Crann: Today, "stop smoking" efforts are really common and publicly supported, in terms of public opinion as well. Are there "stop dipping" efforts here for chewing tobacco?

Hallberg: Oh, sure. I mean all the quit plans -- if you are smoking tobacco, you can call the same number and people will help you quit. We use the same products. We use Chantix. We'll use Nicorite.

I find that the gum, frankly, works really well because people are used to parking, as it's called, the wad of tobacco in the cheek and gum. You can do the same thing with the nicotine-containing gums. Anything and everything, all the same efforts -- picking a quit date, all of that -- it's basically the same.

Crann: If someone comes in to (see) you as a patient and they say, "Well, I'll give up cigarettes, but I'm going to chew tobacco because I think it's healthier," what would your response be?

Hallberg: Wrong, bad idea. It's a different kind of problem, but it really is the same issue.

(Interview transcribed and edited by MPR reporter Madeleine Baran)