 "Photo: Justin Maurer")
Rick Bender is sometimes called the man with no face. A former semi-pro baseball player, he lost a third of his tongue, his entire jaw and the skin that connects the right side of his neck with his body. Cancer destroyed his jaw and damaged his mouth, teeth, tongue, neck and arm muscles. It's impossible for him to lick his own lips.
At age 12, Bender, a former player for the California Angels, started using snuff - powdered tobacco that's sniffed up the nostril instead of smoked. He used smokeless tobacco for 10 years until he fell victim to undifferentiated squamous cell carcinoma, or oral cancer. The first sign was a small white sore on his tongue.
Four operations later, doctors removed the cancerous cells from his mouth and throat, and a chunk of his tongue and some lymph nodes. The surgery left him with nerve damage limiting his right arm - his throwing arm.
"I can still throw a baseball," Bender says, "but I have a hard time getting it across the infield with any velocity. It also messed up my swing of the bat."
He says he dipped because of peer pressure, persuasive tobacco ads and above all, the game of baseball. He now tours the country, dissuading high school students from caving in to the temptations of tobacco.
"I want to give them something else to chew on," he says about the students. "I want to give them that information, so they can make a better choice than I did."
Scott Tomar, professor and chair of the department of community dentistry and behavioral science at the University of Florida, says there are a large number of smokeless tobacco products in the United States, but the most popular kind is known as moist snuff, or dip.
Dip is finely ground tobacco, either dry, moist or in sachets and packaged in tins. Most tobacco users place it in their mouth, their cheek or between their gum and cheek, suck on it and spit out its juices. Tomar says like cigarettes, smokeless tobacco contains high levels of nicotine, among hundreds of other components, such as flavoring, moisturizers, more than 500 different chemicals and 28 cancer-causing agents.
In 2006, Reynolds American - a large U.S. tobacco and cigarette corporation - purchased Conwood Company, the second-largest smokeless tobacco corporation in the United States. In September, the Altria Group, formerly known as Philip Morris Companies and producer of popular cigarettes like Marlboro and Parliament, bought the country's largest smokeless tobacco company, U.S. Tobacco, for $10 billion.
According to the Centers for Disease Control, the two leading smokeless tobacco brands are Skoal and Copenhagen, both produced by U.S. Tobacco.
Tomar says there are three reasons why major cigarette companies have branched into the smokeless tobacco market - a decline in American cigarette sales, the success of the smokeless tobacco industry and, of course, to "keep smokers smoking."
"It is quite clear that the prevalence of smoking falls in response to Clean Indoor Air laws, and smokeless tobacco products are marketed as a situational substitute for cigarettes for times when smokers can't smoke," Tomar says. "Smokeless tobacco temporarily reduces nicotine craving until the next cigarette, and may reduce smokers' motivation to quit."
He says traditional cigarette companies will also introduce new types of smokeless tobacco to the market. Marlboro Snuff and Snus, produced by Philip Morris, and Camel Snus, made by Reynolds American, are still in test marketing.
Bender says the new products, with names that young people will easily recognize, have been tested in big cities with comprehensive Clean Indoor Air Acts, like Indianapolis and Atlanta. Their ads target the young urban professional.
"If you've seen their point of sale flyer, it says, 'Where and when to use snus: at a concert right in front of the security guard; on an airplane from Miami to L.A.; at a high-class restaurant or bar,' " he says. "It is obviously targeted at the Clean Indoor Air Act."
Stephen Goodwin, associate professor in the department of health science and exercise at the university, says he teaches about smokeless tobacco in his classes. He says there are huge periodontal problems with smokeless tobacco, meaning it affects the oral cavity - the mouth, throat and tongue. It can also affect the pancreas.
Smokeless tobacco users tend to constantly put the tobacco in the same spot in their mouth, which erodes the gums and teeth in this area away, he says. Other effects are tooth loss, bleeding and receding gums, elevations in blood pressure and heart rate, small white lesions in the mouth, low birth rate and pre-term delivery for women.
"You can see the entire root of the tooth in some users who have been using it for a long time," Goodwin says. "You can also develop what is called leukoplakia very quickly. Leukoplakia is basically considered a pre-cancerous lesion that develops in just about all users, usually pretty quickly. Two to six percent develops into an oral cancer."
People with oral cancer, he says, have a very low survival rate. Bender is a living testament to this.
"The bottom line is, regardless of your age, the day you start using tobacco products, it's the same as putting your body at risk for cancer," Bender says.
Smokeless tobacco contains 28 carcinogens. According to the CDC's Web site, some of the cancer-causing agents are formaldehyde; a colorless and flammable gas found in fertilizer, paper, plywood, antiseptics, medicines, and cosmetics; cadmium; which is used in car batteries; arsenic; which is commonly associated with lung, skin and other internal cancers; and polonium-210; a radioactive material a "only if it is taken into the body by breathing or eating or entering through a wound."
Smokeless tobacco products can be as addicting as cigarettes, leaving tobacco corporations with little to do to maintain customers.
"There is more nicotine in smokeless tobacco than in cigarettes," Goodwin says, regarding a type of smokeless tobacco called chew. "In terms of the delivery of it, it's a little bit slower - cigarettes have a little faster delivery system. The user gets the nicotine more quickly when they smoke cigarettes than when they chew, but it lasts longer when they chew. The person using smokeless tobacco eventually does get more nicotine over a longer period of time."
When using smokeless tobacco, the nicotine is absorbed slowly through the mucus membranes, causing the nicotine to stay in the bloodstream longer, prolonging the buzz.
. Tomar says as a result, dip users experience the same difficulties in quitting that cigarette smokers do and nicotine replacement products haven't been very successful substitutes.
In fact, Bender still considers himself addicted.
"It's like riding a bicycle," he says. "Once you know how to ride a bicycle, you always know how to ride a bicycle. Once you're addicted to any of these mind-altering drugs, you're always addicted."
Tomar says the majority of American dip users are adolescent boys and young men in rural areas. Women in certain parts of the country, such as Alaska, are regular snuff users as well.
A drug study conducted by the Substance Abuse and Mental Health Services Administration revealed that 20.8 percent of 18- to 25-years old Americans used smokeless tobacco products at least once in their lifetime. Less than half of this number - 8.5 percent - used smokeless tobacco within that year, and 5.1 percent used it within the last 30 days of the survey.
In Delaware, Goodwin says the percentage of smokeless tobacco users is 5.2 percent - a relatively low number compared to the rest of the country. However, he says it's becoming more popular at the university.
"I don't have any data on the number of users here on campus - I've never seen that," he says. "But it certainly is very prevalent."
Tomar says statistically, only 4 percent of male students on college campuses have used snuff or dip in the past month.
"Yet, as a professor, running through campus all of the time, I can see the empty cans all over the place," he says.
Senior Mike Kirby is one of the supposed 4 percent. He never liked cigarettes so instead, he began dipping his senior year of high school during football season. His friends, mostly athletes, wanted to protect their lungs but get the same buzz as cigarettes. Kirby, who says dip keeps him motivated and alert while studying, has struggled on and off with quitting. Occasionally, he would dip four or five times a day, and was addicted. He says he knows he needs to end his habit, but he often finds himself unable to follow through.
"Anytime I make an excuse to do one, it is easy to come up with an excuse to do another," Kirby says.
While the sale of dip, snuff and snus is illegal in Europe - with the exception of Sweden - they are legal in the United States. Their presence is constant among high school and college students, including students at the university.
Bender says many users aren't aware of the signs that they are damaging their health - and when trouble does strike, it hits hard and with no remorse. Oral cancer is an intense and belligerent disease, but Bender fought back and beat it.
"I kept saying, 'I can do this, I can do this,' " he says. "And I'm one of the rare few under the age of 30 that have. Most people under the age of 30 with this type of cancer die from it."
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