Rick Bender was 12 when he stuck the first pinch of snuff between his cheek and gum.
He was 26 when doctors diagnosed him with oral cancer and removed half of his jaw, a third of his tongue, and part of his neck.
"I always thought smokeless tobacco was the safer alternative to cigarettes," says Bender, now 38. "'Smokeless' sounds so harmless. You know, no smoke, no fire."
An estimated 7.6 million Americans use snuff or chewing tobacco today. Over half a million of those are thought to be under age 18. Many teens, like Bender in his youth, have no idea that smokeless tobacco can cause one of the most deadly types of cancer known: oral cancer.
Those who use snuff -- also known as spit tobacco --are up to 11 times more likely to develop cancer of the mouth, cheek, gums, tongue, lips, or throat than nonusers. According to the American Cancer Society, oral cancers are diagnosed in about 35,000 people every year, and over 7,600 die from it annually. Only 53 percent of all oral cancer patients are alive five years after diagnosis.
Smokeless tobacco has also been associated with other types of cancers, as well as heart disease. It can speed tooth decay, cause your gums to recede, stain your teeth, and give you bad breath. In addition, high nicotine levels (higher than cigarettes) make this kind of tobacco extremely addictive.
Yet while public health campaigns have often led to smoking bans in schools and public places, an unintended consequence may have been that more students have switched from cigarettes to chewing tobacco. A 2006 CDC survey found that 3 percent of middle school students had used smokeless tobacco and about 8 percent of high school students had used smokeless tobacco in the past 30 days.
A survey of teenage smokeless tobacco users in West Virginia -- one of the top smokeless-tobacco-consuming states -- found that only 74 percent knew the product was harmful. Of 808 public high school boys surveyed, 7 percent of fifth graders said they used snuff, 22 percent of eighth graders, and 32 percent of 11th graders.
Craig Stotts, RN, PhD, an investigator at Arkansas' Program Against Teen Chewing (PATCH), says the number of adolescents using smokeless tobacco has doubled in the past three decades. The typical users are young white males, many of whom play baseball and don't do very well in school.
"Peer pressure, especially among baseball players, is severe," says Stotts. "We've tried recruiting [teens for our project] at high school baseball teams and have had no luck," often because the coaches are users too, he adds.
To make matters worse, Stotts says, U.S. tobacco companies often give away free hats and tins of snuff at the sporting events most popular among rural teens: baseball games, tractor pulls, and rodeos.
Rick Bender was a baseball player as a teen. He knows the kind of peer pressure kids face when it comes to smokeless tobacco, and the kind of resistance they'll put up if told to quit.
"I don't care what age you are, nobody likes to be told what to do," says Bender, who now spends most of the year talking to high school students about his experience with smokeless tobacco. "I just give them the information and let them know it's their decision -- a life and death decision."
Kids snap to attention when Bender walks into an auditorium. "I'm different, and they sit there and listen to what I have to say," he says.
More than 200 kids across the country have surreptitiously slipped Bender their tins of snuff following his lectures. "They'll palm it in their right hand and then hand it off when they shake my hand," Bender says. He keeps those cans in his garage as trophies.
When Bender first developed oral cancer in 1989, doctors gave him just two years to live. Fortunately, the extremely invasive surgery he underwent succeeded in removing all of the cancer. The media has dubbed Bender "The Man Without a Face." He says that he doesn't mind the moniker, but quips that "The Man With Half a Face" would be more accurate.
"This thing was supposed to kill me and it didn't," Bender says. "And maybe talking to these kids is the reason God left me here."
National Institute of Dental and Craniofacial Research. Oral Cancer Statistics. http://www.nidcr.nih.gov/OralHealth/Topics/OralCancer/AfricanAmericanMen/OralCancerStatistics.htm
American Cancer Society. Detailed Guide: Oral Cavity and Ovopharyngeal Cancer.
American Cancer Society. Child and Teen Tobacco Use.
National Cancer Institute. What you need to know about oral cancer.http://www.cancer.gov/cancertopics/wyntk/oral/page1
National Cancer Institute. Smokeless Tobacco and Cancer. Tobacco Related Statistics, SAMHSA http://www.cdc.gov/tobacco/research_data/survey/samhsa.htm
Cancer Facts. National Cancer Institute http://cis.nci.nih.gov/fact/3_63.htm
"Oral Cancer," The American Dental Hygienists' Association.