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Smokeless Tobacco TODS 2014
Smokeless Tobacco TODS 2014
Nicotine is a naturally occurring toxic chemical found in tobacco plants.
FDA
Tobacco Producers
China 39.6%
17% in 1971 to 47% in 1997
India 8.3%
Brazil 7.0%
United States 4.6%
Canadian Tobacco Growers – Norfolk, ON
About 1000 family farms persist in growing tobacco in Canada after a $300 million buyout of farms using tobacco penalty funds.
Tobacco: Major Delivery Forms Cigars, Cigarettes, Pipes, Smokeless
1 mg
6-12 mg
4 mg
4 mg
2 mg
Smokeless Tobacco – What is it?
TWO MAJOR FORMS
Chewing tobacco
Twist, loose leaf, plug
Snuff
Moist, dry and sachet –known as “dip”
SNUS
steam-pasteurized, not fermented and no added sugar
Twist Loose leaf
Moist Snuff
Dry snuff sachets
SNUS
A “log” of Moist Snuff A log is 5 tins
$3-4 a tin in the US
$26 a tin in Manitoba
And then came dissolvable orbs…
Vape or E-cigarettes
In the US, the number of calls to poison control centers associated with e-cigarette liquid rose from • one per month in September 2010 • 215 per month in February 2014.
Smokeless in Canada
Chew Use in Canada
Only 1% of the Canadian public use smokeless tobacco.
With higher use in the western provinces (3% in Alberta).
Rural use is higher than in major cities.
In the general public, males use chew substantially more than females.
Tobacco
Cigarette consumption down to 17-18%, but tobacco users up! Smokeless, e cigarettes, Hooka, Pipe, Cigars
Brands and Consumption
Predominant brands of moist snuff are Skoal and Copenhagen, with some use of RedMan (loose), and SNUS .
Average consumption is about 1.5 tins/week.
52 x 1.5 x $26 = $2028 Canadian
52 x 1.5 x $4 = $312 US or smuggled
Athletes and Doping
Laboratoire de contrôle du dopage Pointe-Claire Québec H9R 1G6 Canada E-mail: [email protected]
All Olympic Sports & others
Adverse Analytical Finding
2.1. Presence of a Prohibited Substance or its Metabolites or Markers in an Athlete’s Sample
2.2. Use or Attempted Use by an Athlete of a Prohibited Substance or a Prohibited Method
2.3. Refusing or failing without compelling justification to submit to Sample collection after
notification as authorized in applicable anti-doping rules, or otherwise evading Sample collection
2.5. Tampering or Attempted Tampering with any part of Doping Control
2.6. Possession of Prohibited Substances and Prohibited Methods
2.7. Trafficking or Attempted Trafficking in any Prohibited Substance or Prohibited Method
800 plus substances and methods are banned.
WADA Doping Violation
www.cces.ca
Beyond doping: athlete health Anti-doping programs act like the
drug police.
Anti-doping programs do not “level
the playing field”
Anti-doping is not designed to
enhance the health and well being of
an athlete or sport participant.
Anti-doping issues are minor in comparison to improper substance use, and general habits related to sleep and exercise
The real issues of substance use in sport and health are...
Illicit drugs
Alcohol – episodic excessive, DUI, DUI death or injury, hazing
Tobacco
Supplements – waste of money, and misdirected resources (financial, time, cognitive)
Caffeine – high dose only
Hydration
Caloric control & balance
Performance fuelling
Sleep (focus and motivation)
Approaches that look at the whole picture:
Taking It- Informed Decision Making Model
Avoiding dysfunctional!
Redirecting the athlete to “consistent quality training with good rest and nutrition”
Healthy athlete
Marijuana
8.2% 12.8%
2.6% 1.5%
75%
I tried it once More than once a year Monthly Weekly Never
16.8 % more than once a year
Marijuana – OFF SEASON
15.2%
15.2%
18.8% 8.6%
42.1%
I tried it once More than once a year Monthly Weekly Never
43 % more than once a year
Marijuana
Booze
HOCKEY BINGE DRINKING
28%
59.7%
4.8% 7.5%
Monthly Weekly Daily Never
CANADA GAMES Binge DRINKING
32.6%
25.9%
2.8%
38.8%
Monthly Weekly Daily Never
Alarming level of binge drinking – 5 or more drinks a night
Smokeless Tobacco in Athletes
25.) Smokeless tobacco or chew. Responses
Monthly 28 6.67%
Weekly 18 4.29%
Daily 15 3.57%
Never 359 85.48%
Totals 420 100%
Smokeless Tobacco Canada Games Athletes- Manitoba
14.5% smokeless tobacco users across 25 sports.
14-20 years old.
All male.
Across the board in athletes
Surveys have reported that across sports there is a range between 12-20% use rate. This rate is averaged across sports – many of which do not have users (synchronized swimming).
Exclusively male use in sport settings.
Specific sports have higher use rates.
CHEW
55% use in provincial baseball players
52% use in Manitoba Junior Hockey League, stable over 5 years
30-55% use in AAA minor hockey
a growing use in provincial, junior and CIS football players between 24 and 40%
a high use in boxing (up to 100% of Canada games members)
34% use in rugby
Sport Specific Use
Age, Exposure, Setting, Parental
Over 75% of the team try
Use is most often adopted between 12 and 16 years of age.
The two primary setting for adoption are
An older brother or family member chewed and this is associated with an earlier onset of use
A team sport setting such as when travelling
Parents are generally unaware of the use till about 2 years after commencement
Smokeless tobacco - dependency
A dip or plug will release between 4 and 8 cigarettes worth of nicotine.
Nicotine is a stimulant, and creates strong dependency.
Cessation or quitting is very difficult, and studies reveal it to be more difficult to stop than cigarettes.
Nicotine replacement (gum, lozengers, etc) have been shown to have limited benefit as they contain very low nicotine levels relative to chew itself.
Champix which exhibits good success with cigarette cessation, has limited benefit for smokeless tobacco users. Relapse due to sport culture exposure.
Smokeless in Hockey Major Junior Hockey
I use chew because
I am
bore
d whi..
.
My
buddies
do ...
It h
elps
me
on...
It s
eem
s lik
e ...
I lik
e th
e ru
s...
44%
11%
33%
11%
0%
1. I am bored while we travel
2. My buddies do it
3. It helps me on ice
4. It seems like the thing to do in
hockey
5. I like the rush
Started Smokeless when?
Smokeless tobacco or chew.
1 ti
n a m
onth
1 ti
n a w
eek
2-3
tins
a wee
...
3-6
tins
a wee
...
1 ti
n a d
ay
11%
22%
33%
0%
33%
1. 1 tin a month
2. 1 tin a week
3. 2-3 tins a week
4. 3-6 tins a week
5. 1 tin a day
Parents screamed at me …
Where I started chew…
2010/2011 MJHL
13.) Smokeless tobacco or chew. Responses
Monthly 29 14.65%
Weekly 14 7.07%
Daily 57 28.79%
Never 98 49.49%
Totals 198 100%
50.5% smokeless tobacco users!
2009 Ice Hockey World Championships
72 samples were collected
Nicotine and/or metabolites were detected in every urine sample.
Concentration measurements indicated an exposure within the last 3 days for
eight specimens out of ten (80%)
role models galore.
The potential use of smokeless tobacco as a doping agent in ice hockey requires further investigation
"In certain sports we know that the use of nicotine is widespread." According to Rabin (WADA Scientific Director), scientific evidence suggests that using certain amounts of nicotine is akin to using a stimulant.
WADA and World HOCKEY
Enroll your child in hockey and they will have a 50% chance of becoming addicted to smokeless tobacco.
Fair Play Legal Performance Health Medical Safety Financial
Taking It – Informed Decision Making
7 elements
Fair Play – ethical conduct –rules of sport or code
Legal – rules of law
Performance – gain or loss, applicable to you?
Health – benefits to health at dose
Medical – side effects at dose
Safety – will you hurt someone else by using
Financial – costs of use both direct and indirect
Smokeless Tobacco
Smokeless Tobacco – Downsides
Cancer
Oral (max 2% of users)
Leukoplakia
40-60% - white or red patches
Heart disease
Gum and tooth disease
Dental caries, gingival recession, staining of teeth, loss of taste, bad breath.
Financial
$4 a tin US
$26 a tin Canada
Social
Smokeless Tobacco- oral cancer signs
• A sore that bleeds easily and does not heal• A lump or thickening anywhere in the mouth or neck• Soreness or swelling that does not go away• A red or white patch that does not go away• Trouble chewing, swallowing, or moving the tongue or jaw
Smokeless Tobacco – Addiction Level
I no longer get sick or dizzy when I dip or chew, like I did when I first started.
I dip more often and in different settings.
I've switched to stronger products, with more nicotine.
I swallow juice from my tobacco on a regular basis.
I sometimes sleep with dip or chew in my mouth.
I take my first dip or chew first thing in the morning.
I find it hard to go more than a few hours without dip or chew.
I have strong cravings when I go without dip or chew.
Smokeless Tobacco – Withdrawal
Urges to dip, cravings -- especially in the places you used to dip the most
Feeling irritable, tense, restless, impatient
Constipation/irregularity
Hunger and weight gain
Desire for sweets
Do’s
Check for signs- harm reduction
Discuss the risks
Alcohol & smokeless tobacco – oral cancer risk elevated
Take part in prevention starting at 12 years old
Inform parents of the issues
Smoking cessation approaches don’t work for smokeless
Take action in sports (hockey, baseball, football, etc)
De-normalize the behavior
