Smoking Cessation Guidelines Should Include Smokeless Tobacco

Increasing numbers of Americans are using smokeless tobacco, becausethey think it is a safe alternative to cigarettes. Upcoming federalguidelines on smoking prevention and cessation should includeinformation about the health risks associated with smokeless tobacco,Maureen Hannley, PhD, of the American Academy of Otolaryngology--Headand Neck Surgery, said at a meeting sponsored by the Agency forHealth Care Policy and Research (AHCPR) on smoking preventionand cessation guidelines.

Smokeless tobacco, also known as "spit" or chewing tobacco,is often used by young children and teens, who see professionalathletes chewing it during sporting events. "Society seeschewing tobacco as an accoutrement to sports success," saidDr. Hannley, the Academy's Associate Vice President for Researchand Development. Education about the risks of smokeless tobacco,therefore, must be aimed at young children, and these lessonsshould begin in the early school years, she said. They must bemade aware that both cigarette smoking and smokeless tobacco areharmful.

Guidelines Expected by 1996

The smoking cessation guidelines--which are expected to be completedin early 1996--are the first of three on preventive health- careissues scheduled by the AHCPR. The panel will evaluate interventiontherapies used for nicotine dependence treatment and the evidenceof their effectiveness. The panel is chaired by Michael C. Fiore,MD, associate professor, University of Wisconsin School of Medicine,and director of its Center for Tobacco Research and Intervention.It also includes experts in pulmonary medicine, psychology, pediatricand adolescent medicine, cardiology, dentistry, and pharmacology;there are no oncologists on the panel.

According to Dr. Hannley, the guidelines also should address thehazards of passive smoking. It has been estimated that at least9 million US children live with one adult smoker, and these childrenare at increased risk for respiratory illnesses and other diseases,she said. The Academy plans to target passive smoking in educationalmaterials and public service announcements over the next severalyears, she said.

A representative of the American Lung Association said the guidelinesneed to help physicians realize that even modest improvementsin quit rates have enormous public health implications.