INDEX

ABBREVIATIONS
constituents of smokeless
tobacco, 70
ABRASION (DENTAL)
defined, 128
relation to smokeless tobacco, 130
ABUSE LIABILITY OF
NICOTINE
defined, 145, 157
evidence for abuse potential,
166-167
experimental studies, 157-166
implications of studies, 162
pharmacodynamic effects, 158
research needs, 184
self-administration, 159-162
ACANTHOSIS
clinical report, 115-118
defined, 113
ADENOCARCINOMA
relation to snuff use, 48
ADOLESCENT USE
attitudes, 24
data criteria, 17
ethnic groups, 20
males vs. females, 20
National Program Inspection
study, 24
peer and family influences, 24
rural vs. urban areas, 20
ADULT USE
patterns, 16-17
ADVISORY COMMITTEE TO
THE SURGEON GENERAL,
REPORT
carcinogens revealed, vii

conclusions, Vii-viii, xxii

gingival recession, viii

historical perspective of report,
XVvil-xix

nicotine addiction and effects, viii

noncancerous conditions, xxi

oral leukoplakia, viii

organization of report, xvii

overview, Xx-xxii

precancerous oral health
conditions, xxi

review methods, xix-xx

ALCOHOL CONSUMPTION
relation to smokeless tobacco, 35
ANIMAL MODELS
bioassays with chewing tobacco,
79, 82-83
bioassays with constituents of
smokeless tobacco, 86-88
bioassays with snuff, 83-86
metabolism of NMOR, 74-75
metabolism of NNK, 71-73
metabolism of NNN, 73-74
mutagenicity assays, 88-89
pharmacodynamic effects of
nicotine, 158
physiologic effects of nicotine, 178
salivary glands, 126-127
short-term tests, 88-89
ASIAN DATA
case-control studies, 42-43, 119
chewing of quids, 42-43, 50
esophageal neoplasms, 50
rates of oral cancer, 42-43
smokeless tobacco products, 42-43
smoking and oral cancer risk,
43-44

BIOASSAYS FOR CARCINOGENIC
ACTIVITY OF CHEWING
TOBACCO OR CHEWING
TOBACCO EXTRACTS, 80

BIOASSAYS FOR CARCINOGENIC
ACTIVITY OF SNUFF OR SNUFF
EXTRACTS, 81

BIOASSAYS WITH
CHEWING TOBACCO
(See also ANIMAL MODELS)
application to the cheek pouch,

79, 82-83
application to the oral mucosa,
79, 82-83
oral administration, 79
skin application, 83
subcutaneous application, 83

BIOASSAYS WITH
CONSTITUENTS OF
SMOKELESS TOBACCO
(See also ANIMAL MODELS)
inducement of tumors, 86-88

187
BIOASSAYS WITH SNUFF
(See also ANIMAL MODELS)
application to the lip, oral
mucosa, or cheek pouch, 84-86
oral administration, 83-84
relation to herpes simplex virus,
86-87
subcutaneous administration, 86
Bladder Neoplasms, See URINARY
TRACT NEOPLASMS
Blockade Therapy, See NICOTINE
ADDICTION TREATMENT

BUCCAL CARCINOMA
case studies, 34-36

CALCULUS (DENTAL)
defined, 129
use of smokeless tobacco, 130
CARCINOGENICITY OF TOBACCO.-
SPECIFIC NITROSAMINES, 82

CARCINOGENS
daily exposure from snuff and
chewing tobacco usage, 64
in smokeless tobacco, 58-60, 64-65
N-nitrosamines, 58-60, 64
polonium?!0 (210Po), 58, 65
polynuclear aromatic hydro-
carbons (PAH), 58, 65
saliva analysis, 64
CARCINOMA JN SITU
defined, 114
diagnoses differ, 123
squamous cell carcinoma study,
120
Cardiovascular System, See
PHYSIOLOGIC EFFECTS OF
NICOTINE
Central Nervous System, See
PHYSIOLOGIC EFFECTS OF
NICOTINE
CHARACTERISTICS OF SMOKE-
LESS TOBACCO PRODUCTS, 6
CHEEK NEOPLASMS
(See also ORAL CANCER)
animal models, 79, 82, 84
case study, 120
CHEMICAL COMPOSITION
processed tobacco, 58
nicotine, 58
CHEMICAL CONSTITUENTS
OF SMOKELESS TOBACCO
carcinogens, 58-59, 60, 64-65
chemical composition, 58

188

CHEVRON KERATINIZATION
case report, 116-117
defined, 114
CHEWING TOBACCO (See also
SMOKELESS TOBACCO,
BIOASSAYS)
case-control studies, 36, 40
characteristics, 5
looseleaf, 5, 7
plug, 5, 7
twist, 5, 7
Commonalities Between Tobacco
and Other Addictive Substances,
See NICOTINE ADDICTION
CONCEPTUAL MODEL
of smokeless tobacco lesions, 121

CONCEPTUAL NATURAL HISTORY
OF ORAL MUCOSAL CHANGES
ASSOCIATED WITH THE USE OF
SMOKELESS TOBACCO, 122

CORONARY AND PERIPHERAL
VASCULAR DISEASE
acute coronary events, 177-178
and nicotine, 177-178
atherosclerosis, 177
effect. on platelets, 177
endothelial injury, 177
research needed, 185
ventricular fibrillation, 178

Cotinine, See PHARMACO-
KINETICS OF NICOTINE

CURRENT POPULATION
SURVEY (CPS)
survey data, 12, 14

DATA: ABUSE LIABILITY STUDIES
AT ADDICTION RESEARCH
CENTER, 160

DENTAL CARIES
defined, 128
relation to smokeless tobacco,

129-130

DOSE RESPONSE EFFECTS
(See also ANIMAL MODELS)
and oral leukoplakia, 131
nicotine, 147, 152-153, 158,

182-183

DRUG DEPENDENCE

commonalities between tobacco
and other substances, 146-147,
152-157

defined, 145

physiologic or physical
dependence, 145-146
DYSPLASIA
defined, 114
diagnoses differ, 121, 123
relation to oral lesions, 115-116

Endocrine System, See
PHYSIOLOGIC EFFECTS
OF NICOTINE
EPIDEMIOLOGIC STUDIES
AND SMOKELESS TOBACCO
data from Asia, 42-44
data from North America and
Europe, 33-42
oral cancer, 33-44
other cancers, 47-55
EROSION (DENTAL)
defined, 128
ERYTHROPLAKIA
defined, 113
ESOPHAGEAL NEOPLASMS
case-control study, 39, 48-50
cohort study, 49-50
ESTIMATED EXPOSURE OF U.S.
RESIDENTS TO NITROSAMINES,
64
ESTIMATED RELATIVE RISKS
ASSOCIATED WITH SNUFF USE
FOR CANCERS OF THE ORAL
CAVITY, PHARYNX, AND
LARYNX, CASE-CONTROL
DATA FROM VOGLER ET AL.,
FEMALES ONLY, 38
ESTIMATED RELATIVE RISK FOR
CANCER OF THE HEAD AND
NECK FROM SMOKELESS
TOBACCO USE BY ANATOMIC
SITE, THIRD NATIONAL CAN-
CER SURVEY, MALES ONLY, 39
ESTIMATED RELATIVE RISK OF
ORO-PHAR YNGEAL CANCER
ACCORDING TO DURATION OF
SNUFF USE AND ANATOMIC
SITE, WINN ET AL., 41
ESTIMATES OF RELATIVE RISKS
OF BLADDER CANCER IN
PERSONS WHO HAVE EVER
USED CHEWING TOBACCO
AND SNUFF, 53
ETHNIC USE OF SMOKELESS
TOBACCO
of youth, 21-22
Experimental Studies Exposing
Laboratory Animals,
See ANIMAL MODELS

FORMATION OF TOBACCO-
SPECIFIC NITROSAMINES, 60

FREQUENCY OF SMOKELESS
TOBACCO USE IN PAST YEAR,
14

Gastric Neoplasms,
See STOMACH NEOPLASMS
GENERAL PRINCIPLES IN
EVALUATING CARCINOGENIC
RISK OF CHEMICALS OR COM-
PLEX MIXTURES (INTERNA-
TIONAL AGENCY FOR
RESEARCH ON CANCER, xxi
GINGIVAL AND PERIODONTAL
HEALTH
bone loss, 125
effects of smokeless tobacco, 101,
103-104, 123
inflammation, 126
studies in Sweden, 126
studies in the United States, 125
GINGIVAL CARCINOMA
case studies, 34, 36, 44, 120
GINGIVAL RECESSION
Advisory Committee report, viii
defined, 123
related to oral leukoplakia/
mucosal pathology, 112
studies in the United States, 125
GINGIVITIS
defined, 123
relation to smokeless tobacco,
125, 129
studies in the United States, 125
GLYCYRRHIZIC ACID
metabolic consequences, 179

HEAD AND NECK NEOPLASMS
case-control study, 38-39, 38.39
HEROIN ADDICTION
THERAPY
model used, 156
HERPES SIMPLEX VIRUS
relation to oral cancer, 86-87, 93
HISTORICAL PERSPECTIVE
chewing tobacco, xvii
consequences of use, XVill-xix
decline of use, 5
early uses, xviii-xix, 5
snuff, xvii-xix
HYPERKERATOSIS
cuhort study, 117-118
defined, 113
relation to snuff use, 125

189
HYPERORTHOKERATOSIS
cohort study, 118
defined, 113
HYPERPARAKERATOSIS
cohort study, 118-119
defined, 113
HYPOKALEMIA
nonnicotine metabolic
consequences, 179

INHALED SNUFF
relation to nasal carcinoma, 93

Kidney Neoplasms, See URINARY
TRACT NEOPLASMS

LARYNGEAL NEOPLASMS
(See also THIRD NATIONAL
CANCER STUDY)
case-control study, 37, 38, 50-51

Leukoplakia, Oral, See ORAL
LEUKOPLAKIA

LIP NEOPLASMS (See also
ORAL CANCER)
animal models, 84-85
case-control study, 36
labial mucosa, 116-117

Looseleaf, See CHEWING
TOBACCO

MANUFACTURING TRENDS:
QUANTITIES OF SMOKELESS
TOBACCO MANUFACTURED IN
THE UNITED STATES FROM
1961 TO 1985 EXPRESSED IN
MILLION POUNDS, 8

MEAN FREQUENCY OF SMOKE-
LESS TOBACCO USE DURING
LAST 7 DAYS BY ETHNICITY
BY MALE RESPONDENTS, 23

METABOLIC PATHWAYS OF
NMOR, 74

METABOLIC PATHWAYS OF
NNK, 71

METABOLIC PATHWAYS OF
NNN, 73

METABOLISM OF
CONSTITUENTS OF
SMOKELESS TOBACCO
conversion of products, xx-xxi
of NMOR, 74-75
of NNK, 71-73
of NNN, 73-74

MOUTH NEOPLASMS
(See also ORAL CANCER)
case-control study, 36-37, 36, 37,

39, 120

190

MUCOSAL PATHOLOGY
snuff-induced lesions, 114-116
studies in Scandanavia, 111-112
studies in the United States, 107,

108-109, 110-112

MUTAGENICITY ASSAYS AND
OTHER SHORT-TERM TESTS
(See also ANIMAL MODELS)
chewing tobacco, 88
snuff, 88
tobacco-specific N-nitrosamines,

88-89

NASAL NEOPLASMS
posterior nasal space tumors, 48
relation to snuff use, 48

Nass, See ASIAN DATA

NATIONAL BLADDER
CANCER STUDY
relation to smokeless tobacco

use, 52-53

NATIONAL BLOOD CANCER
STUDY
survey data, 16

NATIONAL HEALTH INTER-
VIEW SURVEY (NHIS)
survey data, 10, 14-15

NATIONAL INSTITUTE ON
DRUG ABUSE (NIDA)
survey data, 13-15

NATIONAL PREVALENCE OF
CURRENT USE OF SNUFF BY
GENDER, AGE, AND RACE FOR
1980 THROUGH 1985, 11

NATIONAL PREVALENCE OF
SMOKELESS TOBACCO USE BY
ADULT STATUS AND SEX,

NIDA SAMPLE, 1985, 13
NATIONAL PREVALENCE OF
SMOKELESS TOBACCO USE:
DATA SOURCES, 9
NATIONAL SURVEY DATA
conclusions, 24-25
Current Population Survey, 12, 14
discussion of data, 14-15
National Health Interview
Survey, 10, 14-15

National Institute on Drug
Abuse Household Survey, 13-15

Office on Smoking and Health
Surveys, 7, 10, 12, 14

Simmons Market Research
Bureau, 10, 12, 14-15
NEUROADAPTATION (See also
PHYSICAL DEPENDENCE
POTENTIAL OF NICOTINE,
PHYSIOLOGIC EFFECTS OF
NICOTINE)
defined, 145
demonstrated, 153
nicotine, 162

NICOTINE (See also PHARMA-
COKINETICS OF NICOTINE,
NICOTINE ADDICTION,
NICOTINE EXPOSURE,
ABUSE LIABILITY, PHAR-
MACODYNAMICS OF NICO-
TINE, PATHOLOGIC
EFFECTS OF NICOTINE, AND
SMOKELESS TOBACCO)
absorption, 141-142, 185
cotinine levels, 143
dependence, 154
distribution, 142
elimination, 142-143
habituating agent, 58
levels, 143
physical dependence, 162-166
self-administration, 159-161
therapeutic effects, 154-155
turnover, 143

NICOTINE ADDICTION (See also
NICOTINE EXPOSURE,
PHYSICAL DEPENDENCE
POTENTIAL OF NICOTINE)
commonalities with other

addictive substances, 146-147,
152-157, 184
dose manipulations, 153
encourages other drug use, 184
pattern of use, 152
relation to smokeless tobacco, 58,
144-147, 152, 185
self-administration, 152-153
social tolerance, 156
therapeutic effects, 154-155
tolerance of use developed, 153
treatment for, 155-156

NICOTINE ADDICTION
TREATMENT
blockade therapy, 156
nicotine gum, 156
pretreatment, 156
substitution, 156
supportive therapy, 156

NICOTINE CHEWING GUM
as substitution, 156
reinforcing properties, 166-167
research needs, 184
self-administration, 167

NICOTINE EXPOSURE
(See also NICOTINE,
NICOTINE ADDICTION)
delivery to the central nervous
system, 147
other physiological effects,
Vill, XXil, XXVi
pharmacokinetics, xxiv, 141-144
peer pressure, 147, 152
reinforcer for animals, 147
relation to addiction, xxiv-xxv,
144-157
NICOTINE SELF-ADMINISTRATION
PATTERNS, 161
NMOR (See also
ABBREVIATIONS)
metabolism in rats, 74-78
N-NITROSAMINES
(See also CARCINOGENS)
exposure in nontobacco
products, 64, 64
in snuff, 60
in tobacco leaves, 59
metabolized by tissue, 70-75
nonvolatile, 60, 62
tobacco-specific, 60, 63
volatile, 60, 61
N-NITROSAMINES IN SMOKELESS
TOBACCO, 59
NNK (See also
ABBREVIATIONS)
metabolism in rats, 71-73
NNN (See also
ABBREVIATIONS)
metabolism in rats, 73-74
relation to buccal mucosa, 73
relation to lingual mucosa, 73
NONCANCEROUS CONDITIONS
(See also PRECANCEROUS
CONDITIONS)
relation to smokeless tobacco,
100-105
NONVOLATILE NITROSAMINES
IN SMOKELESS TOBACCO
(PPB), 62

OFFICE ON SMOKING AND
HEALTH (OSH)
survey data, 7, 10, 12, 14
ORAL CANCER (See also ORAL
LEUKOPLAKIA, ORAL SOFT
TISSUES, LIP NEOPLASMS,
MOUTH NEOPLASMS,
CHEEK NEOPLASMS, AND
TONGUE NEOPLASMS)
case studies, 34-41

191
ORAL CANCER—Cont.
epidemiologic studies, 33-55
in rats, 72, 79, 84-86, 88-89
ORAL LEUKOPLAKIA
causation, vii
defined, 113
prospective study, 118
relation to smokeless tobacco, viii,
xxiii-xxiv, 107, 110-112, 121
studies in Scandanavia, 111-112
studies in the United States, 107,
108-109, 110-112
ORAL SOFT TISSUES
clinical reports of lesions, 114-117
cohort studies, 117-119
definitions, 113-114
oral lesions, 119-120
transformation, 113-123

PANCREATIC NEOPLASMS
chewing tobacco use, 54-55
PARANASAL SINUS
NEOPLASMS
relation to snuff use, 48
PATHOLOGIC EFFECTS OF
NICOTINE AND SMOKELESS
TOBACCO
coronary and peripheral vascular
disease, 177-178
hypertension, 178
nonnicotine metabolic
consequences, 179
peptic ulcer disease, 178
pregnancy risks, 178-179
PERIODONTAL TISSUE
DEGENERATION (See also
MUCOSAL PATHOLOGY,
GINGIVAL AND
PERIODONTAL HEALTH)
and teenagers, 110
PERMISSIBLE LIMITS FOR
INDIVIDUAL N-NITROSAMINES
IN CONSUMER PRODUCTS, 65
PHARMACODYNAMICS OF
NICOTINE
Liking Scale, 158
Morphine Benzadrine Group
Scale, 158
research needs, 184
self-administration
implications, 162
PHARMACOKINETICS OF
NICOTINE
absorption, 141-142
cotinine blood levels, 143

192

PHARMACOKINETICS OF
NICOTINE—Cont.
distribution, 142
elimination, 142-143
levels in smokeless tobacco, 141
nicotine blood levels, 143
time course of turnover, 143
PHARYNGEAL NEOPLASMS
case-control study, 37, 38, 39-40
cohort study, 41-42
PHYSICAL DEPENDENCE
POTENTIAL OF NICOTINE
(See also NEUROADAPTATION)
defined, 145, 162
determination, 153-154
evidence for physical dependence,
157-166
evidence of withdrawal
symptoms, 164-166
implications of physical
dependence, 166
reinforcement with nicotine
gum, 167
studies conducted, 157, 162-163
tobacco withdrawal, 163-164
PHYSIOLOGIC EFFECTS OF
NICOTINE (See also NEURO-
ADAPTATION, PHYSICAL
DEPENDENCE POTENTIAL
OF NICOTINE)
cardiovascular system, 175-176
central nervous system, 147, 176,
183
differentiation possible, 162
endocrine system, 176
pleasant effects produced, 162,
176
PLAQUE
defined, 128
use of smokeless tobacco, 130
Plug, See CHEWING TOBACCO
Polonium2!0 (210Po),
See CARCINOGENS
Polynuclear Aromatic
Hydrocarbons (PAH),
See CARCINOGENS
POSTERIOR NASAL SPACE
TUMORS
relation to liquid snuff, 48
PRECANCEROUS CONDITIONS
(See also NONCANCEROUS
CONDITIONS)
Advisory Committee Report, xxi
defined, 113
relation to leukoplakia, 119
relation to smokeless tobacco, xxi
PRECANCEROUS LESION
defined, 113
oral lesions, 119

PREVALENCE OF SMOKELESS
TOBACCO USE BY CENSUS
REGION, 1985, 16

PREVALENCE OF USE OF SMOKE-
LESS TOBACCO AMONG YOUTH
BY GENDER AND GRADE:
LOCAL SURVEYS USING STAN-
DARDIZED QUESTIONS, 21-22

PREVALENCE OF USE OF SMOKE-
LESS TOBACCO AMONG YOUTH
BY GENDER AND GRADE:
REGIONAL AND STATE LEVEL
SURVEYS REPORTED SINCE
1980, 18-19

PREVALENCE OF SNUFF AND
CHEWING TOBACCO USE BY
ADULT MALES IN 10
GEOGRAPHIC AREAS, 17

PREVALENCE OF SNUFF USE
AMONG COLLEGE STUDENTS
18 YEARS OF AGE OR OLDER
BY GENDER AND YEAR, 12

PREVALENCE OF THE USE OF
SNUFF AND CHEWING TOBACCO
AMONG MALES BY AGE, 1970
NHIS AND 1985 CPS SURVEYS, 11

Quids, See ASIAN DATA

RECENCY OF SMOKELESS
TOBACCO USE BY SEX AND
AGE GROUP, 13

RELATIVE RISK OF ORAL CANCER
FROM BETEL QUID WITH AND
WITHOUT TOBACCO (WITH 95-
PERCENT CONFIDENCE
LIMIT), 43

RELATIVE RISKS OF
ESOPHAGEAL CANCER IN
PERSONS EXPOSED TO CHEW-
ING TOBACCO AND SNUFF:
SUMMARY OF FOUR CASE-
CONTROL STUDIES, 49

Renal Neoplasms, See URINARY
TRACT NEOPLASMS

RESEARCH NEEDS
carcinogenesis, 93-94
nicotine exposure, 184-185
oral health effects 131-132
prevalence/trends of use, 25
standardizing methods, 25

SALIVA ANALYSIS
of snuff dippers, 64
SALIVARY GLANDS
effects of smokeless tobacco,
101-103, 126-128
SCHEME LINKING NICOTINE TO
FORMATION OF THE
PROMUTAGENIC DNA ADDUCT
O8METHYLGUANINE, 72
SELECTED STUDY SUMMARIES
FOR THE NONCANCEROUS
ORAL HEALTH EFFECTS FROM
THE USE OF SMOKELESS
TOBACCO, 100-105
SIALADENITIS
defined, 123
relation to smokeless tobacco, 127
relation to snuff dippers, 127
SIMMONS MARKET
RESEARCH BUREAU
survey data, 10, 12, 14-15
SMOKELESS TOBACCO (See also
CHEWING TOBACCO, SNUFF)
carcinogenesis associated with,
33-93
chemical constituents, 58-69
cohort studies, 41-42
commonalities with other
addictive substances, 146-147,
152-157
conclusions, 24-25, 92-93,
130-131, 182-183
effect on oral leukoplakia/
mucosal pathology, 107-112
epidemiologic studies and case
reports of oral cancer, 33-44
epidemiologic studies of other
cancers, 47-55
evidence for abuse and
dependence, 166-167
experimental studies exposing
laboratory animals, 78-79
experimental studies of abuse
and dependence, 157-166
metabolism of constituents, 70-75
nicotine addiction, 144-146
nicotine exposure, xxiv, 141-185
noncancerous and precancerous
oral health effects, xxiii-xxiv,
99-130
pharmacokinetics of nicotine,
141-144
physiologic and pathologic
effects, 175-179
prevalence and trends of use,
xxii, 4-24

193
SMOKELESS TOBACCO—Cont.
product characteristics, 5
research needs, 25, 93-94,
131-132, 184-185

transformation of oral soft
tissue, 113-120

trends in production and sales,
5,7

trends in self-reported use, 7, 10,
12-17, 20, 24

SMOKELESS TOBACCO AND HEAD
AND NECK CANCER BY ANA-
TOMIC SITE, CASE-CONTROL
DATA FROM VINCENT AND
MARCHETTA, MALES ONLY, 38

SMOKELESS TOBACCO AND
MOUTH CANCER, CASE-
CONTROL DATA FROM
MOORE ET AL., 36

SMOKELESS TOBACCO AND
MOUTH CANCER, CASE-
CONTROL DATA FROM
PEACOCK ET AL., 37

SNUFF (See also SMOKELESS
TOBACCO, BIOASSAYS,
ANIMAL MODELS)
case-control studies, 37, 40
characteristics, 5
dry, 7
historical uses, xviii-xix
levels of carcinogens, 60, 64-66
moist, 7 ;
relation to cancer, 41, 53-55
saliva analysis, 64

SNUFF-DIPPER’S CARCINOMA
defined, 113
exposure to nitrosamines, 64
oral lesions, 120
reports, 35
Scandinavian study, 111

SQUAMOUS CELL CARCINOMA
case studies, 34-36
clinical study, 117
defined, 114
oral lesions, 119-120
snuff and ear neoplasms, 47

STAINING (DENTAL)
defined, 129

STATE AND LOCAL SURVEY
DATA
adolescent use, 17, 20, 24-25
adult use, 16-17

STOMACH NEOPLASMS
relation to smokeless tobacco,

51-52

194

Substitution Therapy, See
NICOTINE ADDICTION
TREATMENT

SUMMARY OF DATA: LIABILITY
OF NICOTINE AS TOBACCO
SMOKE OR INTRAVENOUS
INJECTIONS, 159

SUMMARY OF REPORTS IN
WHICH NICOTINE WAS AVAIL-
ABLE UNDER INTRAVENOUS
DRUG SELF-ADMINISTRATION
PROCEDURES, 148-151

SUMMARY OF SELECTED CASE
REPORTS, 106

Supportive Therapy, See
NICOTINE ADDICTION
TREATMENT

Surgeon General’s Advisory
Committee on the Health
Consequences of Using Smokeless
Tobacco, See ADVISORY
COMMITTEE TO THE SUR-
GEON GENERAL, REPORT

TEETH

dental caries, 129-130

effect of smokeless tobacco,

128-130

other hard tissue effects, 130
THERAPEUTIC EFFECTS OF

NICOTINE

as an anoretic, 154

mood regulator, 154

performance of cognitive tasks,

154

self-medication, 155

work enhancement, 154
THIRD NATIONAL CANCER

STUDY (TNCS)

bladder cancer, 54

laryngeal neoplasms, 50-51

other cancer sites, 55

stomach neoplasms, 52
TOBACCO SNIFFING

rare practice, xvii
TOBACCO-SPECIFIC

N-NITROSAMINES IN SMOKE-

LESS TOBACCO (PPB), 63
TOBACCO-SPECIFIC

N-NITROSAMINES IN SNUFF,

U.S. BRANDS, 1985, 66
TOBACCO WITHDRAWAL

(See also PHYSICAL DEPEN-

DENCE OF NICOTINE)

evidence of symptoms, 164-166
TOBACCO WITHDRAWAL—
Cont.
study findings, 165
symptoms, 163-164
University of Minnesota
studies, 164-166
TONGUE NEOPLASMS (See aiso
ORAL CANCER, MOUTH
NEOPLASMS)
case-control study, 36, 120
TRENDS IN PRODUCTION
AND SALES
categories of products, 7
temporal trends, 7
United States Department of
Agriculture (USDA) reports, 5
TRENDS IN SELF-REPORTED
USE: SURVEY DATA
national survey data, 7, 10, 12-15
state and local survey data,
15-17, 20, 24
Twist, See CHEWING TOBACCO

URINARY TRACT NEOPLASMS
case-control studies, 52-54
relationship to smokeless

tobacco, 52-54

USE OF SMOKELESS TOBACCO IN
THE UNITED STATES BY
INDIVIDUALS OVER 21 YEARS
OF AGE, 10

VARIATIONS IN TERMS USED AND
DEFINITIONS PROVIDED FOR
GINGIVITIS AND GINGIVAL RE-
CESSION BY STUDIES CITED, 124

VARIATIONS IN TERMS USED AND
DEFINITIONS PROVIDED FOR
LEUKOPLAKIA/MUCOSAL
PATHOLOGY ASSOCIATED
WITH SMOKELESS TOBACCO
USED BY STUDIES CITED,
108-109

VERRUCOUS CARCINOMA
defined, 114
dysplastic lesions, 131

VOLATILE NITROSAMINES IN
SMOKELESS TOBACCO (PPB),

61

WORLD HEALTH
ORGANIZATION (WHO)
Committee on Drug Dependence,

145
defines oral leukoplakia, 107
differing diagnoses, 123

195

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color, national origin, handicap. or age. be excluded from participation in, be denied
the benefits of, or be subjected to discrimination under any program or activity tor.
on the basis of sex, with respect to any education pro activity: recewing
Federal financial assistance. In adaiion. Executive ty4 OMENS Ghee.
nation on the basis of age by contractors and sun
Federal contracts. and Executive Orcer * 246:
tractor May discriminate aga 7s
because of race oO (55 "

Service must be obese nm Som beatles ar