The first time I used smokeless tobacco I puked in my mothers car. She was driving me, my sister and one of my sisters friends home from a high school football game. I vomited what felt like my entire guts onto the back-seat floorboard while my sisters friend hugged the opposite door in an effort not to get splattered.
I was about 12 years old.
I thought about smokeless tobacco Thursday while undergoing a combined positron emission tomography and computed tomography scan at Mercy Regional Medical Center in Durango. Oncologists use PET/CT scans to look for tumors kind of like physicians use X-rays to look for broken bones.
My oncologist arranged a PET/CT scan to see if my cancer had returned. The scan took about 30 minutes. While I was lying inside the machines whirring, coffin-sized tube, I mainly wondered if the scanner would detect any new tumors. I thought about smokeless tobacco briefly because several groups have focused on smokeless tobacco use in Montezuma County recently.
The Target Tobacco Coalition, the Montezuma County Health Departments tobacco education and prevention program and the School Community Youth Coalitions youth leadership council want the Cortez City Council to crack down on businesses that sell smokeless tobacco to minors.
The groups want city councilors to pass an ordinance that would require retailers selling smokeless tobacco products to buy an annual license from the city. Businesses already face fines if they sell smokeless tobacco to youths; however, under the proposed city regulation, businesses caught repeatedly selling smokeless tobacco to youths would lose the right to sell those products to anyone.
Councilors discussed the proposal during a Feb. 22 meeting but are not expected to vote on any new regulation until later this spring.
Julia Hesse, coordinator of the tobacco education and prevention program, has said a 2008 survey indicated 45 percent of area high school students reported using forms of tobacco other than cigarettes.
I can easily believe 45 percent of Montezuma County high school students would chew tobacco or dip snuff. I grew up in a small town in a county packed with farms and ranches. Rodeo was as popular as football, boots were as common as sneakers, and Future Farmers of America jackets were as cool as letter jackets. Thinking back on my high school days, I can remember more boys who did use smokeless tobacco than boys who didnt.
Thats probably why puking my guts out didnt stop me from using smokeless tobacco again back when I was 12 years old. I couldnt keep those tiny, wintergreen-and-tobacco flavored snuff grains in one tight, little, neat pellet between my lip and gum, so I tried chewing tobacco next. After a year or two of chewing tobacco, I started dipping snuff regularly.
When I was about 15, a new girlfriend said she wouldnt kiss a boy whod had any nasty tobacco in his mouth. I never quit a bad habit so quickly in my life. The snuff cans and spittoon thudded into a trash can. As much as I enjoyed smokeless tobacco when I used it, I never had any craving for the taste of tobacco on my tongue again.
I was lucky.
More than 30,000 new cases of cancer of the oral cavity and of the pharynx the membrane-lined cavity behind the nose and mouth are diagnosed annually, according to the Centers for Disease Control and Prevention. The American Cancer Society estimates fewer cases, 25,800, for 2010.
The CDC attributes about 75 percent of deaths from cancer in the oral cavity and pharynx to smoked and smokeless tobacco. According to the American Cancer Society, people who chew tobacco and dip snuff can develop cancers of the cheek, gums and lips, and are susceptible to gum disease, destruction of bone sockets around teeth, and tooth loss.
The Oral Cancer Foundation lists some other interesting statistics: Dipping eight to 10 times per day can introduce as much nicotine into the body as smoking 30 to 40 cigarettes. Smokeless tobacco users absorb two to three times as much addictive nicotine as smokers. Almost 600,000 U.S. females older than 12 use smokeless tobacco. Additionally, chewing tobacco contains 28 carcinogens.
I never suffered from oral cancer. The cancer I had was intestinal, and as I lay on that PET/CT scanner at Mercy Regional Medical Center, I was concerned with my oncologist finding a new tumor in my colon, not my mouth.
Seventeen months after undergoing surgery for cancer, I cannot run, go backpacking or hiking, swim, ride my mountain bike, play recreational sports, or lift more than the lightest weight settings on my home gym. My digestive system doesnt work like its supposed to, and I experience random nausea and dry heaves as if my body were having chemotherapy flashbacks. Ive also endured chronic pain almost every woken moment of my life for the past 17 months.
Even with all that, I feel pretty fortunate when I consider what many people with oral cancer suffer.
Imagine what it would feel like to have a malignant tumor growing in your mouth. The American Cancer Society lists surgery as the main treatment for oral cancer. Some oral cancer patients have their tongue removed. Some have their jawbone removed. Some have the palate the roof of their mouth removed. Some have a tracheostomy a hole cut through their neck and into their windpipe so they can breathe because the tumor blocks their throat. Some have a gastrostomy tube a feeding tube inserted through their abdomen and into their stomach so they can eat.
Anti-tobacco organizations in Montezuma County have valid reasons to ask the Cortez City Council to tighten restrictions on smokeless tobacco sales, and regulations that keep youths from forming what could be a deadly habit are worth passing. However, I think the real focus should be on cultural acceptance of smokeless tobacco and on education. Tightening local regulations might help, but youths probably will continue to find ways to get smokeless tobacco just as they find ways to get alcohol.
Smokeless tobacco is part of rural culture. If I had lit up a cigarette in front of my mother when I was 12 years old, she probably would have yanked it out of my lips, washed my mouth out with soap and grounded me for a month. I could chew or dip tobacco in front of my parents at a very young age, however, and that was considered OK. I remember students at my high school chewing and dipping tobacco in the parking lot before classes started. That was an accepted part of the local culture. I certainly didnt see any kids smoking cigarettes in the parking lot before school.
Youths either dont learn about the risks of smokeless tobacco or dont learn enough. I remember hearing people call cigarettes cancer sticks when I was very young, but those same people didnt talk about the risks of smokeless tobacco. When I was 12 years old, and when I was in high school, smokeless tobacco was not, in my mind, something that could kill me. Cancer and death were things that happened to old people. I dont even recall hearing the term oral cancer when I used smokeless tobacco.
I think Montezuma County youths are the same way now. I dont think theyve really learned they might be developing a tobacco addiction that could catch up to them and kill them, even if it takes 20 or 30 years. I threw my last snuff can in the trash when I was 15. Thirty years later, I was diagnosed with cancer anyway. I never imagined it would happen to me. If a person who quits using tobacco after three years can get cancer for no apparent reason, a person who continues to use tobacco for 10, 20 or 30 years shouldnt believe theyre immune.
Montezuma County youths arent going to stop using smokeless tobacco until they see the big picture. Local anti-tobacco groups need to put that picture in front of students faces. In places that youths frequent, hang photos of oral cancer tumors or of cancer survivors with facial reconstruction. Have a smokeless tobacco user who survived oral cancer speak to youths.
Parents who think using smokeless tobacco is just part of growing up in Montezuma County should focus on culture. They should take the time to learn what could happen to their children and ask themselves if chewing tobacco and dipping snuff is OK.
Parents, educators and city councilors, along with youths who use smokeless tobacco, should spend 30 minutes on the Internet reading about oral cancer and seeing images of what chewing tobacco and snuff can do to people.
Try an Internet search such as oral cancer or oral cancer photo. Or try some of the following websites: Oral Cancer Foundation, www.oralcancerfoundation.org; Centers for Disease Control and Prevention, www.cdc.gov; American Cancer Society, www.cancer.org; www.quittobacco.com; and www.killthecan.org.
Maybe, with a dose of reality, the number of local high school students using forms of tobacco other than cigarettes will drop below 45 percent. Maybe somebody from Montezuma County wont need to have his, or her, tongue cut out.
Russell Smyth is managing editor of the Cortez Journal. He can be reached at 565-8527 or firstname.lastname@example.org.