Smokeless Tobacco - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

SMOKELESS TOBACCO A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES J ...

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SMOKELESS TOBACCO A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES

J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS

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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright 2004 by ICON Group International, Inc. Copyright 2004 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1

Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Smokeless Tobacco: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References / James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary, and index. ISBN: 0-597-84216-7 1. Smokeless Tobacco-Popular works. I. Title.

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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors, or authors. ICON Group International, Inc., the editors, and the authors are not responsible for the content of any Web pages or publications referenced in this publication.

Copyright Notice If a physician wishes to copy limited passages from this book for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications have copyrights. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs, or other materials, please contact us to request permission (E-mail: [email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International, Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this book.

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Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this book which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which produce publications on smokeless tobacco. Books in this series draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this book. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany Freeman for her excellent editorial support.

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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for health books by ICON Health Publications. Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for ICON Health Publications.

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About ICON Health Publications To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes&Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health

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Table of Contents FORWARD .......................................................................................................................................... 1 CHAPTER 1. STUDIES ON SMOKELESS TOBACCO .............................................................................. 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Smokeless Tobacco....................................................................... 13 E-Journals: PubMed Central ....................................................................................................... 26 The National Library of Medicine: PubMed ................................................................................ 27 CHAPTER 2. NUTRITION AND SMOKELESS TOBACCO .................................................................... 71 Overview...................................................................................................................................... 71 Finding Nutrition Studies on Smokeless Tobacco ....................................................................... 71 Federal Resources on Nutrition ................................................................................................... 74 Additional Web Resources ........................................................................................................... 75 CHAPTER 3. ALTERNATIVE MEDICINE AND SMOKELESS TOBACCO .............................................. 77 Overview...................................................................................................................................... 77 National Center for Complementary and Alternative Medicine.................................................. 77 Additional Web Resources ........................................................................................................... 84 General References ....................................................................................................................... 85 CHAPTER 4. DISSERTATIONS ON SMOKELESS TOBACCO ................................................................ 87 Overview...................................................................................................................................... 87 Dissertations on Smokeless Tobacco ............................................................................................ 87 Keeping Current .......................................................................................................................... 88 CHAPTER 5. PATENTS ON SMOKELESS TOBACCO ........................................................................... 89 Overview...................................................................................................................................... 89 Patents on Smokeless Tobacco...................................................................................................... 89 Patent Applications on Smokeless Tobacco................................................................................ 104 Keeping Current ........................................................................................................................ 108 CHAPTER 6. BOOKS ON SMOKELESS TOBACCO............................................................................. 109 Overview.................................................................................................................................... 109 Book Summaries: Federal Agencies............................................................................................ 109 Book Summaries: Online Booksellers......................................................................................... 110 The National Library of Medicine Book Index ........................................................................... 112 Chapters on Smokeless Tobacco ................................................................................................. 112 Directories.................................................................................................................................. 116 CHAPTER 7. MULTIMEDIA ON SMOKELESS TOBACCO .................................................................. 119 Overview.................................................................................................................................... 119 Video Recordings ....................................................................................................................... 119 CHAPTER 8. PERIODICALS AND NEWS ON SMOKELESS TOBACCO ............................................... 123 Overview.................................................................................................................................... 123 News Services and Press Releases.............................................................................................. 123 Newsletters on Smokeless Tobacco............................................................................................. 125 Newsletter Articles .................................................................................................................... 126 Academic Periodicals covering Smokeless Tobacco.................................................................... 126 CHAPTER 9. RESEARCHING MEDICATIONS .................................................................................. 129 Overview.................................................................................................................................... 129 U.S. Pharmacopeia..................................................................................................................... 129 Commercial Databases ............................................................................................................... 130 APPENDIX A. PHYSICIAN RESOURCES .......................................................................................... 133 Overview.................................................................................................................................... 133 NIH Guidelines.......................................................................................................................... 133 NIH Databases........................................................................................................................... 135 Other Commercial Databases..................................................................................................... 137

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APPENDIX B. PATIENT RESOURCES ............................................................................................... 139 Overview.................................................................................................................................... 139 Patient Guideline Sources.......................................................................................................... 139 Finding Associations.................................................................................................................. 152 APPENDIX C. FINDING MEDICAL LIBRARIES ................................................................................ 155 Overview.................................................................................................................................... 155 Preparation................................................................................................................................. 155 Finding a Local Medical Library................................................................................................ 155 Medical Libraries in the U.S. and Canada ................................................................................. 155 ONLINE GLOSSARIES................................................................................................................ 161 Online Dictionary Directories ................................................................................................... 161 SMOKELESS TOBACCO DICTIONARY................................................................................. 163 INDEX .............................................................................................................................................. 205

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FORWARD In March 2001, the National Institutes of Health issued the following warning: "The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading."1 Furthermore, because of the rapid increase in Internet-based information, many hours can be wasted searching, selecting, and printing. Since only the smallest fraction of information dealing with smokeless tobacco is indexed in search engines, such as www.google.com or others, a non-systematic approach to Internet research can be not only time consuming, but also incomplete. This book was created for medical professionals, students, and members of the general public who want to know as much as possible about smokeless tobacco, using the most advanced research tools available and spending the least amount of time doing so. In addition to offering a structured and comprehensive bibliography, the pages that follow will tell you where and how to find reliable information covering virtually all topics related to smokeless tobacco, from the essentials to the most advanced areas of research. Public, academic, government, and peer-reviewed research studies are emphasized. Various abstracts are reproduced to give you some of the latest official information available to date on smokeless tobacco. Abundant guidance is given on how to obtain free-of-charge primary research results via the Internet. While this book focuses on the field of medicine, when some sources provide access to non-medical information relating to smokeless tobacco, these are noted in the text. E-book and electronic versions of this book are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). If you are using the hard copy version of this book, you can access a cited Web site by typing the provided Web address directly into your Internet browser. You may find it useful to refer to synonyms or related terms when accessing these Internet databases. NOTE: At the time of publication, the Web addresses were functional. However, some links may fail due to URL address changes, which is a common occurrence on the Internet. For readers unfamiliar with the Internet, detailed instructions are offered on how to access electronic resources. For readers unfamiliar with medical terminology, a comprehensive glossary is provided. For readers without access to Internet resources, a directory of medical libraries, that have or can locate references cited here, is given. We hope these resources will prove useful to the widest possible audience seeking information on smokeless tobacco. The Editors

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From the NIH, National Cancer Institute (NCI): http://www.cancer.gov/cancerinfo/ten-things-to-know.

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CHAPTER 1. STUDIES ON SMOKELESS TOBACCO Overview In this chapter, we will show you how to locate peer-reviewed references and studies on smokeless tobacco.

The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and smokeless tobacco, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type “smokeless tobacco” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is what you can expect from this type of search: •

Chewing Tobacco Use and Dental Caries Among U.S. Men Source: JADA. Journal of the American Dental Association. 130(11): 1602-1610. November 1999. Summary: Chewing tobacco contains high levels of sugars and may be cariogenic, but few studies have investigated such an association. This article reports on a study undertaken to examine the relationship between chewing tobacco use and dental caries among U.S. adult men. Participants in the Third National Health and Nutrition Examination Survey (NHANES III) conducted from 1988 to 1994 were interviewed about tobacco use and examined by dentists. The authors included in their analysis dentate (with teeth) men 18 years of age or older. The authors calculated the mean number of decayed or filled permanent teeth (DFT), and decayed or filled coronal tooth

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surfaces (DFS), as well as the mean number and percentage of decayed or filled root surfaces (RDFS), and decayed root surfaces (RDS) by tobacco use status. Men who currently used only chewing tobacco had a higher adjusted mean number of DFT than did those who currently used only snuff, only cigarettes, or more than one form of tobacco, or who never used tobacco. Mean DFS also was higher among chewing tobacco users than among those who used only snuff, only cigarettes, or more than one form of tobacco. Chewing tobacco users had a higher mean RDFS and RDS than did the users of other forms of tobacco or nonusers. Current users of chewing tobacco were more than four times as likely as those who never used tobacco to have one or more RDFS or RDS, with a dose response relationship between number of packages used per week and odds of having root surface caries. The authors conclude that, in addition to its established role as a carcinogen, chewing tobacco may be a risk factor in the development of root surface caries and, to a lesser extent, coronal caries. This may be due to high sugar content, increased gingival (gum) recession, and enhanced collagenase activity. The authors emphasize that interventions by dentists and other members of the oral health care team to prevent tobacco use and help users quit can reduce the risk of developing oral and systemic disease. 4 tables. 34 references. •

Dental-Based, Athletic Trainer-Mediated Spit Tobacco Cessation Program for Professional Baseball Players Source: CDA Journal. California Dental Association Journal. 26(5): 365-376. May 1998. Contact: Available from California Dental Association (CDA). 1201 K Street, Sacramento, CA 95814. (916) 443-0505. Summary: During 1997 spring training, the National Spit Tobacco Education Program provided a spit (smokeless) tobacco intervention program to 16 professional baseball clubs. The program consisted of an awareness raising presentation and an opportunity to discuss quitting spit tobacco use with an expert cessation counselor. For two clubs, however, a more extensive intervention was pilot-tested for feasibility and acceptability among their major and minor league teams during their regularly scheduled health examinations at the beginning of spring training. The intervention included an oral exam by a dentist; brief cessation counseling by a specially trained dental hygienist; and ongoing support and follow up by the certified athletic trainer to promote cessation. Findings from this pilot study indicate that this intervention, which is dependent upon the involvement of dental professionals, was feasible to implement during spring training and appeared to be well-received by the athletes. Dental professionals are in an excellent position to advise and help spit tobacco users to quit and can have an important role in helping youth overcome this rapidly growing addiction. 3 tables. (AA).

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Use of Smokeless Tobacco by Young Adult Females Source: Journal of Substance Abuse. 10(1): 19-25. 1998. Contact: Available from Ablex Publishing Corporation. 100 Prospect Street, P.O. Box 811, Stamford, CT 06904-0811. (203) 323-9606. Summary: In contrast to the well documented use of smokeless tobacco (ST) by men, far less is known about ST use by women. In part, this is due to the small overall prevalence of ST use among women. This article offers a descriptive report of the use of ST by young adult women in the upper midwest. Twenty women, identified as ST users, completed a tobacco questionnaire and brief interview. The majority (80 percent) were introduced to ST by friends and 60 percent had tried cigarettes before using ST. Almost

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all used ST daily, averaging 3.6 dips per day. The number of dips per day was significantly correlated with salivary cotinine. Subjects listed relaxation and pleasure most frequently as reasons for using ST. Twenty five percent reported using ST to quit smoking and a similar percentage reported using ST to curb their appetite. The women consumed less tobacco than male ST users and, although aware of health risks, were unconcerned about their present use of ST. The authors note that with the introduction of new flavored snuff products, ST may become more appealing to the tastes of diverse groups of people, including women. The potential acceptance of ST among women should be the focus of further research. 19 references. •

Effects of Tobacco Excise Taxes on the Use of Smokeless Tobacco Products in the USA Source: Health Economics. 6(4): 525-531. July-August 1997. Contact: Available from John Wiley and Sons, Ltd. Journals Subscription Department, 1 Oldlands Way, Bogner Regis, West Sussex PO22 9SA, UK. E-mail: [email protected]. Summary: In this report, data from the September 1985 Current Population Survey are used to estimate the effects of tobacco excise taxes and state laws restricting smoking in public places on the likelihood of current use of cigarettes or smokeless tobacco (ST) products (moist snuff or chewing tobacco) among males in the U.S. The results indicate that higher ST excise tax rates are associated with a reduced probability of ST use, whereas higher cigarette excise tax rates are associated with an increased probability of ST use, holding other factors constant. State laws restricting smoking have no apparent affect on ST use. The authors caution that these estimates are obtained from data that pre date the passage of the Comprehensive Smokeless Tobacco Act of 1986 and the proliferation of restrictive smoking laws. Estimates obtained from more recent data might yield different conclusions. Nonetheless, the results reported here will provide a useful reference point for future research. 1 appendix. 2 tables. 16 references.

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Smokeless Tobacco (Shamma) and Oral Cancer in Saudi Arabia Source: Community Dentistry and Oral Epidemiology. 27(6): 398-405. December 1999. Contact: Available from Munksgaard, International Publishers Ltd. Commerce Place, 350 Main Street, Malden, MA 02148-5018. (781) 388-8273. Fax (781) 388-8274. Summary: Oral use of smokeless tobacco (ST) has been associated with the development of oral cancer. Shamma is a preparation of smokeless tobacco. This article reports on a study undertaken to explore the possible relationship between shamma and oral cancer, among the provinces of the Kingdom of Saudi Arabia (KSA). A total of 26,510 Saudi cancer patients were referred over a 20 year period (1976 to 1995). The frequency of oral cancer was investigated, specifically for those primary sites located near the habitual placement of this smokeless tobacco product. Notably, 35.4 percent of these oral cancers were referred from one province (Jizan). The percentage of oral cancer cases from this province is significantly higher than the percentage of total malignant cases referred to the hospital and research center from this province, and the Saudi population of this province when compared to the whole of the KSA. These data suggest that there is a relationship between the factors smokeless tobacco product (shamma), frequency of oral cancer, and Jizan province; oral cancer appears to be more common in this province where shamma is also common. 8 tables. 27 references.

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Epidemiology of Cancer and Other Systemic Effects Associated with the Use of Smokeless Tobacco Source: Advances in Dental Research. 11(3): 313-321. September 1997. Contact: Available from International Association for Dental Research. 1619 Duke Street, Alexandria, VA 22314-3406. (703) 548-0066. Fax (703) 548-1883. Summary: Persons who use chewing tobacco and snuff (spit tobacco or smokeless tobacco) experience an increased risk of oral cancer. This article describes recent research on cardiovascular disease, oral and other cancers, and other potential long term or chronic systemic effects of smokeless tobacco (ST). The relatively few human population studies to date conflict with respect to whether ST use elevates cardiovascular risk factors or leads to cardiovascular disease or death from cardiovascular causes. Hemoglobin adducts to carcinogens present in ST products are measurable in the blood of ST users, indicating the ST related carcinogens circulate throughout the body. This prompts a concern that ST may increase risks of other cancers as well. The evidence to date from epidemiologic studies indicates no relationship between ST and bladder cancer, but there is suggestive evidence linking ST use to prostate cancer risk. Only single studies have been conducted of some cancers, and inconsistencies among studies of the same cancer site have been reported. Molecular epidemiologic studies may help identify markers of malignant transformation in ST users; this identification may help in early intervention to prevent or reduce the consequences of oral cancer. The author concludes with a call for further studies to determine more clearly the cardiovascular and non-oral cancer risks potentially associated with ST use. 56 references. (AA-M).

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Oral Effects of Smokeless Tobacco Source: Journal of the Canadian Dental Association. 66(1): 22-25. January 2000. Contact: Available from Canadian Dental Association. 1815 Alta Vista Drive, Ottowa, ON K1G 3Y6. (613) 523-1770. E-mail: [email protected]. Website: www.cda-adc.ca. Summary: Smokeless tobacco (ST) use has increased rapidly in North America. This form of tobacco use has many oral effects including leukoplakia, oral cancer, loss of periodontal support (recession of the gums), and staining of teeth and composite restorations. Systemic effects such as nicotine dependence, transient hypertension (high blood pressure), and cardiovascular disease may also result from smokeless tobacco use. This article guides dental practitioners in the identification of oral lesions that occur due to the use of ST. The authors also offer guidelines on how to counsel patients who express a desire to stop using ST products. If the health risks and periodontal risks are explained to patients, particularly young patients, the result may be many long term benefits and a prevention of future oral carcinomas. 47 references.

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Nicotine and Smokeless Tobacco Effects on Gingival and Peripheral Blood Mononuclear Cells Source: Journal of Clinical Periodontology. 25(3): 246-252. March 1998. Contact: Available from Munksgaard International Publishers Ltd. Commerce Place, 350 Main Street, Malden, MA 02148-5018. (781) 388-8273. Fax (781) 388-8274. Summary: The pathogenesis of tobacco-related periodontal diseases is not well understood. This article reports on a study undertaken to investigate smokeless tobacco (ST) extract and nicotine effects on prostaglandin E2 (PGE2) and interleukin-1beta (IL-

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1beta) secretion by peripheral blood mononuclear cells (PBMC, consisting of monocytes and lymphocytes) and gingival mononuclear cells (GMC). Both peripheral blood and gingival tissue adjacent to the alveolar crest were taken from nonsmoking adult periodontitis patients and studied. Tissue was cultured with ST extract, nicotine, and Porphyromonas gingivalis lipopolysaccharide (LPS). Treatments were compared by repeated analysis. Results showed that 100 micrograms per ml nicotine and 1 percent ST significantly increased secretion of PGE2 by PBMC relative to control cultures. The same amounts of nicotine and ST however, had no effect on IL-1beta secretion by PMBC. Enhanced PGE2 secretion also was seen when PBMC were treated with P. gingivalis and nicotine, relative to P. gingivalis alone. These data indicate that while nicotine and ST can stimulate PBMC to secrete PGE2, they cannot activate further mononuclear cells extracted from gingiva, possibly due to maximal previous stimulation in the periodontitis lesion. 4 figures. 43 references. (AA-M). •

Oral Spit Tobacco: Addiction, Prevention, and Treatment Source: Nicotine and Tobacco Research. 1(1): 21-44. March 1999. Contact: Available from Carfax Publishing. Taylor and Francis Ltd., Customer Service Department, Rankine Road, Basingstoke, Hants RG24 8PR, United Kingdom. +44 (0)1256 813000. Fax +44 (0)1256 330245. Summary: The prevalence of smokeless tobacco (ST) is significant and reaches as high as 17 percent use in the past month in white males aged 18 to 25 years. ST is of concern because of the potential for addiction and the associated negative health consequences. This article reviews the basis for addiction, examining the nicotine content in ST products, pharmacokinetics, psychoactive effects, tolerance, and withdrawal. The authors also explore the negative health consequences, which include a number of oral pathologies and increased cardiovascular risk factors. Furthermore, they examine the factors associated with the initiation of ST use and current prevention programs that address these factors. Current treatment approaches, as well as predictions for abstinence, are also discussed. Finally, the authors note future directions in light of the limited amount of research conducted in the ST area, particularly related to prevention and treatment. 4 tables. 173 references.

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Smokeless Tobacco: Epidemiology, Health Effects and Cessation Strategies Source: American Family Physician. 52(5): 1421-1430. October 1995. Summary: This article examines the epidemiology of smokeless or spit tobacco use and its adverse health consequences. The authors also present prevention and cessation strategies that may be incorporated into family practice. Health risks of smokeless tobacco include leukoplakia, oral cancer, and systemic nicotine effects such as elevated blood pressure and serum cholesterol levels. To avoid or control these effects, family physicians should identify patients who use smokeless tobacco and encourage and support cessation efforts. Patients who are unsure about quitting need the risks of their habit personalized, and those who are actively trying to stop using smokeless tobacco need emotional and, in some cases, therapeutic support (e.g., nicotine replacement therapy). The authors conclude that all smokeless tobacco users, regardless of their motivation to quit, need to be followed to ensure compliance with cessation advice or to detect medical complications from use of this form of tobacco. 8 figures. 1 table. 36 references. (AA-M).

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Prevention and Treatment of Smokeless Tobacco Use Source: Advances in Dental Research. 11(3): 342-349. September 1997. Contact: Available from International Association for Dental Research. 1619 Duke Street, Alexandria, VA 22314-3406. (703) 548-0066. Fax (703) 548-1883. Summary: This article is a review of the literature examining school-based prevention and treatment intervention programs for smokeless tobacco users. Although few schoolbased prevention studies have been conducted, the results are promising. Many of the treatment studies that have been conducted are limited due to the sample size and the lack of a control group. However, of the studies that have not had these limitations, the results are also promising. In general, studies show that intervention in the dental office can be effective and that group behavioral treatment may also improve cessation rates over minimal contact. On the other hand, pharmacological treatment, which has primarily focused on 2 mg nicotine gum, has not been found to be an effective treatment. Dentists are in an ideal position to advise and assist smokeless tobacco users to quit. The majority of smokeless tobacco users want advice and help from their dentists, and a significant number indicate that discussion of the negative oral effects from the use of smokeless tobacco has an impact on their desire to quit. 2 tables. 24 references. (AA-M).

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Spit Tobacco Intervention in Dental Practice: Recommendations for Clinicians Source: Texas Dental Journal. 115(6): 59-63. June 1998. Contact: Available from Texas Dental Association. 1946 South Interregional Highway, Austin, TX 78704-3698. Summary: This article outlines some recommendations aimed at more effective and practical smokeless tobacco (ST or spit tobacco) intervention strategies used by clinicians in dental practice. The authors undertook a critical review of the ST literature, including evaluation of clinic and school based smoking prevention and cessation programs (due to the small number of ST-specific intervention studies). After the review, techniques and strategies for ST intervention were developed. This process established varying levels of scientific evidence in support of the recommendations. Evidence ranged from strong (research studies with an ST focus) to relatively weak (professional opinion or anecdotal evidence from clinicians and tobacco prevention or cessation investigators). The recommendations for clinicians integrate prevention and cessation strategies. The strategies are categorized into six components: Ask, Advise, Assist, Arrange, Adopt, and Act. This article discusses each of these components briefly. The authors conclude that in order to address ST use effectively, awareness regarding its harmful effects and addictive nature needs to be raised. Although many of the strategies require training and time, the authors emphasize that even minimal intervention can be effective in combating ST use. 29 references.

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Legal and Scientific Basis for FDA's Assertion of Jurisdiction Over Cigarettes and Smokeless Tobacco Source: JAMA. Journal of American Medical Association. 277(5): 405-409. February 5, 1997. Summary: This article outlines the legal and scientific basis for the U.S. Food and Drug Administration's (FDA) assertion of jurisdiction over cigarettes and smokeless tobacco (spit tobacco). On August 28, 1996 the FDA determined that the nicotine in cigarettes and spit tobacco does 'affect the structure or any function of the body' (as required by

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the Federal Food, Drug, and Cosmetic Act) because nicotine causes addiction and other pharmacologic effects. The FDA then determined that these pharmacologic effects are 'intended' because a scientific consensus has emerged that nicotine is addictive. Recent studies have shown that most consumers use cigarettes and spit tobacco for pharmacological purposes, including satisfying their addiction to nicotine. Newly disclosed evidence has revealed that the manufacturers know that nicotine causes pharmacological effects, including addiction, and design their products to provide pharmacologically active doses of nicotine. The FDA thus concluded that cigarettes and smokeless tobacco are subject to FDA jurisdiction because they contain a 'drug,' nicotine, and a 'device' for delivering this drug to the body. 60 references. (AA). •

Prevalence of Spit Tobacco Use Across Studies of Professional Baseball Players Source: CDA Journal. Journal of the California Dental Association. 26(5): 358-364. May 1998. Contact: Available from California Dental Association (CDA). 1201 K Street, Sacramento, CA 95814. (916) 443-0505. Summary: This article reports on a review of published data which, together with previously unpublished information, shows that the use of spit tobacco (smokeless tobacco, or ST) among professional baseball players continues to be alarmingly high. In spite of efforts to make players aware of the harmful effects, approximately 35 to 40 percent of professional baseball players still use ST, and about half of them have associated lesions. The authors report on the history of research into ST use in this population. When the authors first began to look into this problem in 1986, major league baseball locker rooms were stocked with free samples of dip and chewing tobacco provided by the tobacco companies. In addition to tobacco use, the prevalence of tobacco-related oral lesions in professional baseball players continues to be very high among current users, regardless of their major or minor league status. The authors note that one of the reasons that change seems slow to come in this population is that an attempt is being made to change the social norms of an essentially closed society where spit tobacco use has been commonplace and condoned for many year. However, current efforts of the National Spit Tobacco Education Program (NSTEP), Major League Baseball, the Professional Baseball Athletic Trainers Society and the Major League Baseball Players Association are expected to result in a significant reduction in spit tobacco use in this population in the next decade. 2 figures. 2 tables. 15 references.

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Effective Smokeless Tobacco Intervention for Dental Hygiene Patients Source: Journal of Dental Hygiene. 66(4): 185-190. May 1992. Summary: This article reports on a study designed to test the effectiveness of a smokeless tobacco (ST) intervention delivered in the oral health care office setting. A total of 518 male ST users were identified by questionnaire in clinic waiting rooms and then randomly assigned to either a usual-care control group or a special intervention group. Dental hygienists took the primary role in delivering the intervention, which consisted of a soft-tissue examination with special attention to oral lesions, advice to quit ST, distribution of self-help materials, a short video on why and how to stop using ST, and encouragement to set a quit date. Follow-up assessments conducted three months after the office visit showed that a significantly greater proportion of intervention group patients had stopped using ST (32 percent of the intervention group participants versus 21 percent of control group patients). The intervention protocol is

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described in detail so that dental hygienists may adapt it for use in their practice. 4 tables. 45 references. (AA). •

Oral Leukoplakia Status Six Weeks After Cessation of Smokeless Tobacco Use Source: JADA. Journal of the American Dental Association. 130(7): 945-954. July 1999. Summary: This article reports on a study that evaluated the prevalence and risk of developing oral leukoplakia in smokeless tobacco (ST) users, and the response of these leukoplakia lesions after six weeks of involuntary tobacco cessation. U.S. Air Force basic military training provided an environment of a mandatorily tobacco free setting. The authors designed their investigation as a case control study with a nested cohort study. The principal investigator conducted oral examinations of 3,051 male military trainees. Using a questionnaire, the investigator obtained detailed information concerning subjects' ST use patterns before basic training. Clinical photos were taken of all leukoplakia lesions identified in ST users at the initial examination and again six weeks later. Of the 3,051 male trainees examined (mean age = 19.5 years), 9.9 percent (302 men) were identified as current ST users. Among these current users, 39.4 percent (119 out of 302 men) had leukoplakia versus 1.5 percent (42 out of 2,749 men) of nonusers of ST. At the end of the involuntary cessation of tobacco use, 97.5 percent of these leukoplakia lesions had complete clinical resolution. The type of ST used (snuff versus chewing tobacco), the amount used, length of use, number of days since last use, and brand of snuff used were significantly associated with the risk of developing leukoplakia lesions among ST users. The authors conclude that the important new finding from this investigation is that if a young, otherwise healthy man with leukoplakia lesions stops using tobacco for six weeks, most of his leukoplakia lesions will resolve clinically. Use of ST, specifically snuff, is strongly associated with development of oral leukoplakia in young adult men. 4 tables. 37 references.

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Cytologic Study of Oral Mucosal Cell Alterations in Smokeless Tobacco Users and Efficacy of a Related Cessation Program Source: Journal of Dental Hygiene. 73(1): 12-16. Winter 1999. Contact: Available from American Dental Hygienists' Association. Subscription Department, 444 North Michigan Avenue, Suite 3400, Chicago, IL 60611. (312) 440-8900. Summary: This article reports on a study undertaken to determine if oral tissue changes, as documented by cytologic study and reported to the smokeless tobacco (ST) user, provide incentive to discontinue use of ST products. ST users who presented for treatment in a dental hygiene clinic served as the 10 subjects for this one year study. Cellular specimens were collected from the oral mucosa of subjects at the site of ST placement and a clear site as control. Specimens were collected by a moistened tongue blade scrape, then fixed, stained, and diagnosed by faculty in the department of pathology (University of Arkansas). Subjects participated in a cessation program: a standardized session in which results of the cytologic findings and risks of ST usage were discussed, using visuals and pamphlets. The subjects, with the exception of the last, were contacted at three and six month intervals to determine their compliance with cessation recommendations. Three of the 10 subjects displayed significant tissue changes; these subjects discontinued ST use. The cytologic studies of the other seven subjects revealed only various amounts of hyperkeratosis. The authors note that while their sample size of 10 is certainly not large, a trend was noted that provides support for the hypothesis of the study. Patients with the greatest oral tissue changes, as identified by cytologic study, were the ones who discontinued ST use upon being informed of

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those changes. The authors consider this work a pilot study but still conclude that including a cytologic study and presenting results to the patient is a valuable component of an ST cessation program. 1 table. 22 references. (AA-M). •

Smokeless Tobacco Habits and Oral Mucosal Lesions in Dental Patients Source: Journal of Public Health Dentistry. 53(5): 269-276. Fall 1992. Summary: This article reports on part of a smokeless tobacco (ST) intervention study in which the authors collected data on tobacco use habits and oral health for 245 male ST users aged 15 to 77. The study sample was identified during routine dental office visits and represents a relatively diverse population of patients. Results show that 78.6 percent of ST users had observable oral lesions, 23.6 percent of which were in the most clinically advanced category (degree III). Of the lesions noted, 85 percent were in the same location the patient identified as his primary area of ST placement. In a comparison sample of 223 non-ST-users with the same age distribution, only 6.3 percent had observable lesions. A multiple logistic regression model for ST users showed that lesion presence and severity were most significantly related to current frequency of ST use. 3 figures. 4 tables. 38 references. (AA).

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Smokeless Tobacco: From Backyard to Boardroom? Source: Texas Dental Journal. 113(6): 21-22. June 1996. Contact: Available from Texas Dental Association. 1946 South Interregional Highway, Austin, TX 78704-3698. (512) 443-3675. Summary: This article reports on recent indications from a Texas epidemiological study that spit tobacco (ST or smokeless tobacco) use is increasing, particularly in settings where cigarette smoking is no longer permitted. Data from the Texas Behavioral Risk Factor Surveillance System (BRFSS) was used to estimate the ST use prevalence from years 1987 and 1988. ST use was assessed by asking questions during a telephone interview about previous and current use of ST. Overall ST use prevalence for Texas during 1987 and 1988 was 4.6 percent. This compares with a median national ST use prevalence of 3.1 percent in 1987 and 3.0 percent in 1988. The authors discuss other findings that did not reach statistical significance (perhaps due to sample size), but that may be of particular interest for evaluating trends. Findings of interest include the considerable differences in ST use prevalence among different household income levels. Respondents who reported more than $50,000 per year in total household income showed a ST use prevalence of 6.2 percent. This compares with a 4.1 percent prevalence among persons reporting less than $10,000 per year total household income. This finding seems contrary to the widely reported finding that persons of lower socioeconomic status are more likely to use ST. In addition, ST users reported ST use to cut down on or avoid smoking. More and more Texas cities (approximately 233 to date) are enacting smoking ordinances restricting smoking in public places and access by minors to cigarettes. This trend may actually be encouraging an increase in ST use, especially by those who choose to treat their nicotine addiction with ST rather than by lighting up. Also of concern are statements by ST users who believe ST decreases their risk of cancer compared to smoking. What these ST users do not know is that ST contains considerably more nicotine and nitrosamines than cigarettes. The authors conclude by encouraging further research in this area and by providing the contact information for the Smokeless Tobacco Education Program (888-443-CHEW). 8 references.

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Smokeless Tobacco

Short Term Changes a Surprise With Smokeless Tobacco: Oral Lesions Source: JADA. Journal of the American Dental Association. 122(1): 62-64. January 1991. Summary: This article reports on the findings from a study of 131 smokeless tobaccousing players from 7 major-league baseball teams. In order to determine the frequency and course of the smokeless tobacco-related oral lesions, players were examined 1 to 21 days after an initial examination. Players also completed a questionnaire that included demographic data and information on cigarette smoking, alcohol consumption, and dental hygiene, with detailed information about patterns of smokeless tobacco use including amount, duration, and type used (chewing tobacco or snuff). The authors discuss the results and conclude that the smokeless tobacco-associated oral lesions observed in the baseball players appeared to be irritant lesions that are reversible upon cessation of tobacco use. However, long-term use of snuff is strongly associated with increased risk of oral cancer, indicating that at some point in the natural history of such lesions they are no longer reversible. 12 references.

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Implications of Smokeless Tobacco Use in Athletes Source: Dental Clinics of North America. 35(4): 797-808. October 1991. Summary: This article, from a special issue on sports dentistry, explores the implications of smokeless or spit tobacco use in athletes. Topics covered include the history of smokeless tobacco use; the association between athletics and smokeless tobacco; initiation and habituation; the systemic effects of nicotine; smokeless tobacco and carcinogenesis; the dental effects of smokeless tobacco; interventions in smokeless tobacco use; and the role of the dentist. The author extols the dental professional team to actively strive to prevent smokeless tobacco use and to assist with cessation of this habit. 2 figures. 64 references.

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Report of a Pilot Study: A Program to Help Major League Baseball Players Quit Using Spit Tobacco Source: JADA. Journal of the American Dental Association. 125(5): 559-568. May 1994. Summary: This paper reports data from a pilot study undertaken to determine the effectiveness of two dental-oriented interventions to promote cessation of smokeless tobacco (ST) use among major league baseball players. A total of 96 players who used ST were placed into a minimum intervention group (n = 50) or an extended intervention group (n = 46). The article describes the interventions used and the success rates obtained. The authors conclude that interventions involving an oral examination and advice to quit, combined with behavioral counseling, may effectively decrease ST use among professional baseball players. 6 tables. 34 references. (AA-M).

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Oral Effects of Smokeless Tobacco Use By Professional Baseball Players Source: Advances in Dental Research. 11(3): 307-312. September 1997. Contact: Available from International Association for Dental Research. 1619 Duke Street, Alexandria, VA 22314-3406. (703) 548-0066. Fax (703) 548-1883. Summary: This review article covers studies conducted from 1988 to 1990 on the oral consequences of snuff and chewing tobacco use among professional baseball players. About half of the players studied were smokeless tobacco (ST) users, the majority of whom used snuff. Compared with nonusers, players who used ST showed a significantly higher prevalence of leukoplakia, which was related to placement of the ST

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quid, and the frequency, amount, duration, and type of ST used. Sites adjacent to these mucosal lesions showed an increased prevalence of gingival recession with associated attachment loss, cervical abrasion, and root caries than did comparable sites in nonusers. Extrinsic stain and occlusal attrition were also more frequent in ST users than in nonusers. While ST use placed players at significantly increased risk for mucosal lesions and other oral problems, no differences were found between ST nonusers and users in measurements of batting, fielding, and pitching performance during the baseball season. 3 figures. 18 references. (AA).

Federally Funded Research on Smokeless Tobacco The U.S. Government supports a variety of research studies relating to smokeless tobacco. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.2 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions. Search the CRISP Web site at http://crisp.cit.nih.gov/crisp/crisp_query.generate_screen. You will have the option to perform targeted searches by various criteria, including geography, date, and topics related to smokeless tobacco. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally funded studies use animals or simulated models to explore smokeless tobacco. The following is typical of the type of information found when searching the CRISP database for smokeless tobacco: •

Project Title: CLINICAL MODELS FOR EVALUATING PREPS FOR TOBACCO USERS Principal Investigator & Institution: Eissenberg, Thomas Evan.; Assistant Professor; Psychology; Virginia Commonwealth University Richmond, Va 232980568 Timing: Fiscal Year 2004; Project Start 15-FEB-2004; Project End 31-JAN-2009 Summary: (provided by applicant): Use of cigarettes and smokeless tobacco (SLT) in the U.S. costs over 400,000 lives and $100 billion annually. These tobacco-related deaths and health care costs are due to tobacco-delivered toxicants, especially carcinogens. Tobacco cessation is the most effective way of reducing toxicant exposure, though relapse rates are high. High relapse rates and continued tobacco use have provoked interest in harm reduction for people who continue to use tobacco. Harm reduction for tobacco users can involve lowering the total adverse health consequences of continued tobacco use by reducing toxicant exposure. The tobacco industry appears to embrace this type of harm reduction, and markets several potential reduced exposure products (PREPs) for smokers and SLT users. The National Cancer Institute and Institute of Medicine argue for objective testing of these PREPs. No accepted testing method exists, though we have had success using a short-term clinical model for evaluating cigarette-like PREPs for smokers. This short-term model could be improved and must be adapted to evaluate oral PREPs for SLT users and smokers. A longer-term model is necessary to measure

2

Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).

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PREP-induced reductions in carcinogen exposure. The specific aims of this proposal are to: (1) Improve the short-term clinical model for evaluating cigarette-like PREPs by allowing ad libitum puffing so that PREP-induced changes in smoking behavior can be measured, and introducing pre- and post-exposure blood sampling so that PREP nicotine delivery can be assessed. (2) Adapt the short-term clinical model so that it can be used to evaluate oral products intended for SLT users and/or smokers, and (3) Develop a longer-term clinical model for evaluating PREP carcinogen delivery. This project's overarching goal is to establish a clinical model that can be used to evaluate the marketing claims and harm reduction potential of PREPs for tobacco users. The project is consistent with NCI's Plans and Priorities for Cancer Research in 2004: "Smokers may feel a false sense of security that they can significantly reduce their risk of disease by using these new products [PREPs], when no data exists to suggest that they are in fact less harmful. Scientists must examine the toxicity of these products as well as evaluate whether or not 'harm reduction' is a viable public health strategy." This proposal's clinical model will likely be an important component of a comprehensive approach to predict if PREPs for tobacco users increase, decrease, or fail to change tobacco's health risks. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: DEVELOPMENT OF A WEB BASED TOBACCO CESSATION CURRICULUM Principal Investigator & Institution: Spangler, John G.; Associate Professor; Family and Community Medicine; Wake Forest University Health Sciences Winston-Salem, Nc 27157 Timing: Fiscal Year 2003; Project Start 01-JUL-2003; Project End 30-JUN-2008 Summary: (provided by applicant): Tobacco use is a leading cause of preventable death in the U.S., and despite its known health hazards many individuals continue use. In fact, use may increasing among certain demographic groups, and the national per capita consumption of smokeless tobacco has tripled in the past several decades. Nonetheless, a large proportion of smokers would like to quit smoking but are not advised to do so by their physicians. Clinicians, on the other hand, note that a major impediment to successfully counseling patients to quit using tobacco is a lack of training. Indeed, national research has documented that US medical schools are deficient in adequately preparing graduates to deal with tobacco dependence. Explicit national guidelines are available to train physicians in tobacco cessation. In addition, patients centered methods have been developed to train medical students in smoking cessation. Using a combination of these guidelines, methods, standardized patient instructors, role playing, and specific instruction, medical educators have shown that smoking cessation training can be easily inserted into medical school curricula and that students retain this information for the near term. Lacking in these tobacco educational interventions, however, have been attempts: 1) to integrate tobacco dependence throughout all 4 years of medical school curricula; 2) to include specific training in smokeless tobacco use and cessation given this product's unique addictive and epidemiology characteristics; and 3) to develop culturally relevant tobacco cessation materials for health care providers. To address these gaps in medical school curricula on tobacco cessation, nationally, we propose: 1) to develop a comprehensive web-based and culturally relevant tobacco cessation curriculum that is highly portable; 2) to implement the tobacco cessation curriculum within all four years of the medical school curricula; and 3) to evaluate the tobacco cessation curriculum through process, impact, and outcome evaluations. The

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ultimate goal will be to develop a highly portable tobacco cessation curriculum that can be used a variety of educational settings. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: EFFICACY OF BUPROPION FOR TREATING SPIT TOBACCO USERS Principal Investigator & Institution: Dale, Lowell C.; Mayo Clinic Rochester 200 1St St Sw Rochester, Mn 55905 Timing: Fiscal Year 2002; Project Start 01-MAY-2002; Project End 30-APR-2006 Summary: Although overall rates of cigarette smoking have declined over the past 40 years, the use of spit tobacco (ST) has tripled. The use of ST can lead to nicotine addiction and physical dependence. ST use is known to increase the risk of periodontal disease and oral cancer. Moreover, ST use increases the risk for cancer of the esophagus, larynx, stomach and pancreas and the risk of cardiovascular disease. Effective interventions are needed to assist ST users to stop. Bupropion, a monocyclic antidepressant that inhibits the neuronal re-uptake of norepinephrine and dopamine and may also selectively inhibit neuronal nicotinic receptors, has demonstrated efficacy for smoking cessation. In a placebo-controlled pilot study, we have shown possible treatment effects of sustained release bupropion (SR) in ST user. Our aims are: 1) To evaluate the efficacy of a 12-week course of bupropion SR rates of abstinence from all tobacco use; 2) To evaluate the efficacy of a 12-week course of bupropion SR compared to placebo on the end of treatment and 12- month rates of abstinence from all tobacco use; 2) To evaluate the efficacy of a 12-week course of bupropion SR compare to placebo on the end of treatment and 12-month rates of abstinence from ST; 3) To determine what baseline characteristics in addition to medication assignment are associated with abstinence from all tobacco and from ST, at the end of treatment and at 12 months; 4) To determine the association between baseline urine tobacco alkaloids with self-reported tobacco use behavior and level of nicotine dependence assessed using the Fagerstrom Tolerance Questionnaire modified for ST users; 6) To determine if ST users successful in abstaining from ST switch to a nicotine-replacement product or a different tobacco product (cigarettes, pipe, or cigars). In a randomized, double-blind, placebo-controlled trial, we will compare bupropion SR to placebo in 320 regular users of ST. Active or placebo bupropion will be taken for a total of 12 consecutive weeks starting one week before the target quit date. Behavioral intervention will be provided for all subjects. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: PATHOLOGY

EPITHELIAL

ACETYLCHOLINE

ORAL

BIOLOGY

AND

Principal Investigator & Institution: Grando, Sergei A.; Dermatology; University of California Davis Sponsored Programs, 118 Everson Hall Davis, Ca 95616 Timing: Fiscal Year 2002; Project Start 01-APR-2002; Project End 31-MAR-2007 Summary: (provided by applicant): PURPOSE: To identify the medical and biological significance of the novel non-neuronal cholinergic system of the upper digestive tract, and elucidate the effects of pure nicotine (Nic) vs. tobacco products on nicotinic and muscarinic acetylcholine receptors (nAChR and mAChR) expressed by oral and esophageal keratinocytes (KC). BACKGROUND: ACh regulates vital functions of KC including proliferation, adhesion, migration, differentiation and apoptosis. The alpha3, alpha5, alpha7, alpha9, beta2, and beta4 nAChR subunits, the m2, m3, m4 and m5 mAChR subtypes, as well as the synthesizing enzyme choline acetyltransferase and the degrading enzyme acetylcholinesterase are expressed and function in human oral KC,

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and may target KC for direct effects of Nic. PRELIMINARY OBSERVATIONS: Concomitant emergence of different ACh receptors in the course of KC differentiation allows ACh to exhibit diverse and temporally regulation of the developing mucosal epithelium. A stimulatory effect of ACh on Ca2+ influx, mediated by nAChR, balances an inhibitory effect, mediated by mAChR, and simultaneous activation of both receptors produces a kind of a yin yang regulatory balance in KC. HYPOTHESES: 1) Each ACh receptor expressed by oral KC regulates uniquely the cell cycle progression so that the differentiation-determined changes in the repertoire of ACh receptors in a single keratinocyte can diversify the biological effects of ACh. 2) Chronic exposure to Nic disturbs the dynamic equilibrium between the nicotinic and the muscarinic pathways of keratinocyte control by ACh, leading to an aberrant cell cycle. SPECIFIC AIMS: 1) Identify contribution of each ACh receptor to the cell cycle progression using subtypeselective agonists and antagonists, antisence oligonucleotides, and knockout mice. 2) Identify long-term effects of Nic vs. aqueous extract of smokeless tobacco vs. environmental tobacco smoke on expression/function of keratinocyte ACh receptors and the Ca2+ pathways subserving ACh signaling in KC. METHODOLOGY: A combination of molecular biological (RT-PCR, real-time TaqMan PCR, Northern blots), immunological (immunohistochemistry, Western blots, ELISA), pharmacological and biological assays will be employed to quantitate ACh receptor-mediated changes of the cell cycle progression (Aim #1) as well as effects of Nic and tobacco products on the structure and function of keratinocyte ACh receptors (Aim #2). SIGNIFICANCE: The role of non-neuronal ACh in oral cell biology and pathology will be elucidated, which will help explain some of the mechanisms of deleterious effects of tobacco products in the upper digestive tract. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: HEALTHCARE TEAM APPROACH TO TOBACCO CESSATION Principal Investigator & Institution: Prokhorov, Alexander V.; Associate Professor; Behavioral Science; University of Texas Md Anderson Can Ctr Cancer Center Houston, Tx 77030 Timing: Fiscal Year 2002; Project Start 07-AUG-2002; Project End 31-JUL-2006 Description (provided by applicant): Physicians are in a unique position to serve as a cornerstone for the nation's tobacco prevention and cessation efforts, having both access to the entire inventory of quitting aids and commanding a level of respect which makes them particularly influential. While influential, however, studies show that the majority of physicians report not counseling patients in smoking cessation due to lack of time, training and reimbursement. Increased physician/pharmacist collaboration can be used to address time constraints, since pharmacists have been identified as the most accessible health care providers in the community. In addition, training of physicians, their support staff, and pharmacists has been shown to improve skills and motivation for cessation counseling. The proposed project, a collaborative effort of researchers at the M. D. Anderson Cancer Center (Houston, TX) and SRI International (Menlo Park, CA), will integrate and enhance three existing initiatives for training health care providers in effective tobacco cessation counseling. The creation and implementation of specialty-specific training modules (one for physicians and their staff, one for pharmacists) will establish a network of trained providers, and a linkage system facilitated by media communications will be used to facilitate referrals and support among providers. Additional media will be used to inform community members (potential patients in need of cessation support) of the availability of the trained healthcare provider network. This combination of training health care providers and

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informing all levels of patient and provider networks is expected to greatly increase both delivery and utilization of the Clinical Practice Guidelines for Treating Tobacco Use and Dependence. Cohort, cross-sectional and pre-post measures will be used. Health care provider practices, patient tobacco use behavior change, and communitylevel outreach will be examined. Specific aims of this study are: AIM 1: To develop an accredited continuing education training program for each of the target health care provider groups. AIM 2: To implement the training program among a minimum of 560 providers (280 physicians and 280 pharmacists) in seven communities located throughout Texas, using live presentations, broadcasts via satellite, videotaped presentations, and web-based training. AIM 3: AIM 3: To evaluate the impact of the training program in group-randomized trials among healthcare providers and their patients, comparing seven trained and networked intervention communities to seven control communities. AIM 4: To use media and opinion leader networking channels to facilitate linkages among health care practitioners and between practitioners and the community publicizing a web of trained and accessible tobacco cessation counselors. Also, to encourage and facilitate health care provider outreach in the community. AIM 5: To evaluate the proposed tobacco cessation counseling strategies for their costs and benefits. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: HIGH DOSE NICOTINE PATCH THERAPY FOR SPIT TOBACCO USERS Principal Investigator & Institution: Ebbert, Jon O.; Mayo Clinic Rochester 200 1St St Sw Rochester, Mn 55905 Timing: Fiscal Year 2002; Project Start 15-JUL-2002; Project End 30-JUN-2005 Summary: (provided by applicant): According to the 1999 National Household Survey on Drug Abuse, an estimated 7.6 million of the United States population 12 years of age and older (3.4%) currently use spit tobacco (ST). Long-term ST use increases the risk of developing oral leukoplakia, oropharyngeal cancer, and periodontal disease. Few studies of interventions for ST users have been conducted. A novel treatment approach for ST users employing existing pharmacotherapeutic agents is high dose nicotine patch therapy. Nicotine replacement therapy using standard dose nicotine patch therapy has not been shown to be effective for increasing tobacco abstinence rates in ST users. Our previous research in smokers shows that a high proportion of tobacco users have inadequate replacement of baseline serum nicotine levels with a standard nicotine patch dose and that higher doses (up to 44 mg/d) reduce nicotine withdrawal symptoms and increase tobacco abstinence rates. Since total daily nicotine exposure among ST users may be higher than in smokers, we propose that high dose nicotine patch therapy will improve withdrawal symptom relief, be safe and well-tolerated, increase tobacco abstinence rates and increase the replacement of baseline serum nicotine levels in ST users. To test these hypotheses, we will conduct a 3-phase study in which 60 adult ST users will be randomized to placebo or 3 different nicotine patch doses (21, 42, or 63 mg/d) with monitoring in our General Clinical Research Center (GCRC). Withdrawal symptom data will be collected using an Electronic Diary (ED). All subjects will receive a behavioral intervention during participation in the study. This ROl pilot study will serve as the foundation upon which the Principal Investigator will build a line of research committed to the health promotion and disease prevention objectives of Healthy People 2000. Our goal is to reduce the prevalence of ST use and decrease the incidence of oropharyngeal cancer through the development of effective treatment options for ST users.

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Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: INTERNET BASED SMOKING EDUCATION FOR COLLEGE STUDENTS Principal Investigator & Institution: Chiauzzi, Emil J.; Director of Multimedia Development; Inflexxion, Inc. Newton, Ma 02464 Timing: Fiscal Year 2002; Project Start 15-AUG-2000; Project End 31-MAY-2004 Summary: (provided by applicant): This application proposes the development of an interactive, Web-based, multimedia program called MyStudentBody: Tobacco. The program is designed to be offered through colleges and universities to help students understand, reduce, and stop the use of tobacco. MyStudentBody: Tobacco, based at its own website, will allow students to develop a personalized tobacco page that is relevant to their concerns, while presenting material in an engaging, dramatic format. MyStudentBody: Tobacco utilizes a Rate Yourself module to help students create a personalized tobacco page, which contains a tailored tobacco profile, articles based on personal risks, Shockwave peer stories, e-mail features and reminders, and written and graphical motivational feedback. This website will allow students to receive empiricallybased information in a confidential manner, acknowledging their desire for self-help methods. Phase II will involve finalizing the content, interface, and interactive features of the website through discussions with an advisory group of college peer educators and consultation with tobacco experts. We will produce a prototype website and field test it in comparison to a control website consisting of standard text-based tobacco information. Finally, we will gather satisfaction data from participating students and acceptance feedback from health professionals at participating colleges. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: MECHANISM OF NICOTINE INHIBITION OF APOPTOSIS Principal Investigator & Institution: Wright, Susan C.; Senior Scientist; Palo Alto Institute/Molecular Medicine Molecular Medicine Mountain View, Ca 94043 Timing: Fiscal Year 2002; Project Start 01-APR-2000; Project End 31-MAR-2004 Summary: Apoptosis is a form of physiological cell death that is thought to be an important mechanism for the elimination of abnormal or transformed cells. It is also the form of death induced in cancer cells by chemotherapeutic drugs and gammairradiation. An agent which interferes with the process of apoptosis could potentially promote tumor formation as well as interfere with cancer therapies. Our previous studies demonstrated that nicotine inhibits cytokine and chemotherapeutic druginduced apoptosis of a ability of nicotine to inhibit apoptosis may promote tobaccorelated carcinogenesis as well as decrease the efficacy of cancer therapies. Our previous studies demonstrated that nicotine inhibits cytokine and chemotherapeutic druginduced apoptosis of a variety of tumor cell lines, including those types related to tobacco use. We hypothesize that the ability of nicotine to inhibit to inhibit apoptosis may promote tobacco-related carcinogenesis as well as decrease the efficacy of cancer therapies. The aims of this proposal are: 1) to further define the conditions under which nicotine inhibits apoptosis in tumor cell lines and in normal epithelial cells; 2) investigate the molecular mechanism in which nicotine obstructs the apoptotic pathway; 3) determine if nicotine will decrease the efficacy of chemotherapy in a mouse model. We will examine the effects of acuter high dose, chronic low dose exposure, and the reversibility of nicotine's ability to inhibit apoptosis in tumor cell lines and normal lung epithelial cells. We will test the effects of nicotine on different inducers of apoptosis in

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tumor cell lines and normal lung epithelial cells. We will test the effects of nicotine on different inducers of apoptosis including ionizing radiation, chemotherapeutic drugs, and anoikis (enforced cell detachment). We will analyze the mechanism of inhibition with special focus on signal transduction pathways that have been implicated as negative modulators of apoptosis. Studies will analyze the effects of nicotine on expression of Bcl-2, protein kinase C activity, the mitogen activated protein kinase pathway, and the PI3-kinase/Akt kinase pathway. Mice bearing transplantable tumors will be treated with different chemotherapeutic drugs with and without coadministration of nicotine to determine if there is a reduction in the therapeutic effect. The results of these studies should increase our understanding of the mechanisms underlying development of cancer in cigarette smokers and in smokeless tobacco users. This investigation will also provide insight into the potential hazards of continued tobacco use in patients undergoing cancer therapy. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: METABOLISM NITROSAMINES

OF

CARCINOGENIC

TOBACCO

SPECIFIC

Principal Investigator & Institution: Hecht, Stephen S.; Wallin Professor; None; University of Minnesota Twin Cities 200 Oak Street Se Minneapolis, Mn 554552070 Timing: Fiscal Year 2002; Project Start 01-APR-1999; Project End 31-JAN-2004 Summary: Cigarette smoking causes approximately 30% of all cancer death in the U.S. It is responsible for 85% of the 160,000 lung cancer deaths expected in 1998. Snuff-dipping is an acknowledged cause of oral cavity cancer and the use of moist snuff in the U.S. has increased remarkably in recent years. In spite of advances in tobacco control and smoking cessation, there are still 48 million smokers in the U.S., about 25% of the adult population. Approximately 500 billion cigarettes and 121 million pounds of smokeless tobacco were consumed in 1997 in the U.S. Tobacco-specific N-nitrosamines are formed from tobacco alkaloids during the curing and processing of tobacco products. Two of these, 4(methylnitro-samino)-1-(3-pyridyl)-1-butanone (NNK) and Nnitrosonornicotine (NNN), are present in substantial quantities and are strong carcinogens. NNK is a potent pulmonary carcinogen in rodents and also induces tumors of the pancreas, nasal mucosa, and liver. NNN causes tumors of the esophagus and nasal mucosa in rats and respiratory tract tumors in mice and hamsters. A mixture of NNK and NNN induces oral tumors in rats. Based on their carcinogenic activities, the extensive data on the occurrence of NNK and NNN in tobacco products, and on biochemical studies, it is our hypothesis that these compounds play a significant role as causative factors in human cancers associated with tobacco use. Although there are parallels between NNK and NNN metabolism in rodents and humans which support our hypothesis, there are key aspects which must be explored to further evaluate our hypothesis. Therefore, our specific aims are: 1) investigate stereoselectivity on the metabolism of NNK and NNN by delineating differences in the formation and further metabolism of enantiomers of the major NNK metabolite NNAL, determining differences in the stereoselectivity of metabolic activation of NNK, and examining differences in the metabolic activation and carcinogenicity of NNN enantiomers; 2) investigate DNA and protein pyridyloxo-butylation by NNK and NNN by elucidating the structures of the major adducts formed with DNA and hemoglobin; and 3) investigate the metabolism of NNK and NNN in humans by determining levels of NNN metabolites in human urine, characterizing previously unknown NNN metabolites, and examining NNK metabolites in the urine of snuff-dippers to determine their persistence after cessation and their amounts as a function of dose. The overall theme of this

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proposal is mechanistic studies of NNK and NNN metabolism and adduct formation, in order to further evaluate the carcinogenic potential of NNK and NNN in humans exposed to tobacco products. We believe that an understanding of the mechanisms by which tobacco smoke carcinogens cause cancer will lead to new insights on individual cancer susceptibility and development of innovative strategies to prevent tobacco related cancers. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: NICOTINE DERIVED NITROSAMINES & TOBACCO RELATED CANCERS Principal Investigator & Institution: O'connor, Timothy R.; Professor; City of Hope National Medical Center Duarte, Ca 91010 Timing: Fiscal Year 2002; Project Start 01-MAY-2001; Project End 30-APR-2006 Summary: (Provided by Applicant): Direct use of tobacco products increases an individual's susceptibility to cancer. Nicotine-derived nitrosamines are cancer suspect agents that are found in tobacco, smokeless tobacco, tobacco smoke, and sidestream (environmental or secondary) smoke. The pervasive nature of these compounds has generated interest in their role as causative factors in tobacco-related malignancies. Although much work has addressed the carcinogenic nature of the nicotine-derived nitrosamines, little work has appeared in the literature connecting adducts formed by these compounds to tumorigenesis at the molecular level. Knowledge concerning DNA damage and repair following exposure to carcinogens is critical to understanding the persistence of adducts in DNA, and as a consequence, the formation of mutations leading to neoplasia. The compound 4-(methylnitrosamino)-l-(3-pyridyl)-l-butanone (NNK) is considered the most carcinogenic of the nicotine-derived nitrosamines. We will map the adducts formed by NNK that are repaired by base excision repair, nucleotide excision repair, and O6-methyguanine-DNA methyltransferase at nucleotide resolution in human cells in two genes closely associated with tumorigenesis: P53 and Ki-Ras. Ultimately, we will compare damage and repair rates in our experiments to the mutations found in those genes in tobacco-related tumors. We will also determine the contribution of different DNA repair systems to the eradication of adducts formed by NNK. The goal of this project is to establish the role of NNK in the etiology of tobaccorelated, tobacco smoke-related, and secondary tobacco smoke-related cancers. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: PREVENTION OF TOBACCO USE IN RURAL ETHNIC AMERICAN YOUTH Principal Investigator & Institution: Kelly, Kathleen; Colorado State University Fort Collins, Co 80523 Timing: Fiscal Year 2002 Summary: (Applicant?s Abstract) Project IV: This project will determine whether localized media campaigns aimed at rural 7th and 8th grade Mexican American and White non-Hispanic students can influence their attitudes toward tobacco use and the subsequent use of tobacco (smoking cigarettes and smokeless tobacco). The primary target will be young women, where smoking produces potentially greater damage due to harmful effects to the fetus, newborn, and infant among pregnant smoking females. However, media messages will not be focused solely on females, and effects on males are expected such as reduction of smokeless tobacco. An effective and relatively low cost media campaign would be a valuable asset for rural communities that usually do

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not have the financial and technical resources for costly prevention efforts. However, typical media campaigns may not be useful for rural communities who may view their problems as more limited or unique compared to urban environments. The media campaigns that will be tested, therefore, will be localized to include local smoking data, identification with local situations, and images of local landmarks. There is evidence that prevention efforts may be enhanced by the use of peers; therefore, the effect of the media campaign alone (MEDIA) will be compared with the effect of the media campaign when local peers are added as an integral part of the media campaign (MEDIA+). In these MEDIA+ communities, a team of local peers (11th grade women) will be trained to present and monitor the media campaign. In addition, they will make radio spots, be names in news releases, and will be included in local visual references. The addition of this social influence from older females will be tested for its ability to reduce cigarette use and smokeless tobacco among younger females and males, over and above effects obtained in the MEDIA condition. Both experimental conditions will be compared to a control condition in which pre- and post assessments are obtained, with no intervention. Media components that can be localized to rural ethnic minority communities have been developed and tested, and the training program for peer involvement in media campaigns has been tested by the investigators. The programs are designed so that, if successful, technology transfer through extension services or 4H organizations would be feasible. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: PRIMARY CARE AND SELF HELP INTERVENTION FOR TEEN SMOKERS Principal Investigator & Institution: Ossip-Klein, Deborah J.; Research Associate Professor; Community and Prev Medicine; University of Rochester Orpa - Rc Box 270140 Rochester, Ny 14627 Timing: Fiscal Year 2002; Project Start 30-SEP-1998; Project End 31-JUL-2003 Summary: (Applicant's Description) Over 3 million adolescents smoke cigarettes, with 3,000 starting each day. Most will continue to smoke, and an estimated 5 million people ages 0-17 in 1995 will ultimately die from a smoking-related disease. Although research efforts have focused on methods for preventing adolescent smoking, there are little data available on how to help the one-third of adolescents who smoke. Effective cessation interventions are key to reducing smoking prevalence in this population. Both clinicianand self-help interventions are particularly appropriate to this population, as they allow for targeting large and geographically diverse populations, while maintaining confidential contact that is developmentally important to this age group. The proposed study will examine the effectiveness of a health care provider-based intervention with self help adjuncts for adolescent smokers ages 14-18. Ninety pediatric and adolescent practices will be recruited in a 6 county area, with 20 adolescents/practice for a total of 1800 subjects. Practices will be blocked on key variables and randomized to: 1) Intervention - physician, nurse practitioner, and physician assistant training in smoking intervention (following NCI and AHCPR guidelines), and self-help adjuncts (self-help manual, hotline, proactive calls, Internet resources) or 2) Usual care. Interventions and practice level implementation will be guided by focus group feedback in year 1. Subjects will be followed by telephone at 3 and 12 months for determination of smoking status, use of self-help resources, and other smoking/health variables. Health care providers will be surveyed pre- and post training and at 12 month follow-up to regarding selfreported smoking screening and intervention with adolescents; adolescent subjects will also be queried regarding receipt of these services. This study will provide evidence for

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effective smoking cessation interventions for adolescents, and will assist in planning future intervention efforts with this population. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: RISK OF ORAL EPITHELIAL DYSPLASIA IN PUERTO RICO Principal Investigator & Institution: Morse, Douglas E.; Assistant Professor; New York University 15 Washington Place New York, Ny 10003 Timing: Fiscal Year 2002; Project Start 01-AUG-2002; Project End 31-JUL-2003 Summary: Oral and pharyngeal cancer incidence in Puerto Rican males is notably higher than among white males living on the U.S. Oral epithelial dysplasia (OED) is a histopathological diagnosis characterized by cellular changes and maturational disturbances. A diagnosis of OED is significant in that it is associated with an elevated risk factors for OED, and non such studies have carried out in an Hispanic population. The primary aim of this study is to estimate the association between OED and the use of smoking tobacco and alcoholic beverages in an Hispanic population living in Puerto Rico. On an exploratory basis the proposed investigation will (a) examine the presence of a dose-response relationship as regards OED and both smoking tobacco and alcohol use, (b) test for a synergistic relationship between alcohol and smoking with regard to OED, (c) evaluate smokeless tobacco, mouthwash use and dentures and OED risk factors, (d) evaluate dietary habits as risk/protective factors for OED, and (e) examine whether polymorphisms in genes that code for enzymes active will be identified in the carcinogen activation and detoxification pathways are associated with OED. OED cases (aged 20-79) will be identified by reviewing biopsy reports generated by pathology laboratories on the Island. The control series, frequency matched 1:1 to cases on age, gender, gender, and geographic region, will consist of persons diagnosed with an irritation fibrinoma via the same pathology laboratories. Environmental risk factor data will be obtained using a structured questionnaire. Oral cells will be obtained for DNA extraction and used in studies of genetic polymorphisms while paraffin-embedded tissue from cases and controls will be available for immunohistochemical and molecular analyses. Adjusted odds ratios will be obtained from logistic regression models. Information obtained from this study will further our understanding of the etiology of OED, provide possible explanations for the high rates of oral and pharyngeal cancer in Puerto Rico, and suggest opportunities for the primary prevention of OED and oral cancer. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: SMOKELESS TOBACCO USE AND CESSATION IN RURAL APPALACHIA Principal Investigator & Institution: Wewers, Mary Ellen.; Professor; None; Ohio State University 1960 Kenny Road Columbus, Oh 43210 Timing: Fiscal Year 2002; Project Start 01-SEP-2001; Project End 30-JUN-2004 Summary: (provided by applicant): It is well documented that smokeless tobacco use is a major risk factor for a variety of oral pathoses such as gingival recession, leukoplakia and cancers of the mouth and pharynx. Rural Appalachians are at risk for tobaccorelated diseases and very little is known about their smokeless tobacco use characteristics, especially as these variables relate to oral health status. The purpose of this NIDCR Clinical Trial Pilot Grant are to compare the oral health status of rural adult Appalachian smokeless tobacco users and never-users, characterize smokeless tobacco consumption patterns, and refine a scientifically-valid AHRQ cessation intervention for

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use with smokeless tobacco users. Oral health indicators that determine the success of the intervention will be developed and tested. The intervention combines existing local agencies, such as a County Nurse and a County Extension Agent, with a lay facilitation model, and may represent an effective mechanism for reaching rural populations. Two rural Appalachian counties in the State of Ohio will participate in this study. One county will be assigned to an intervention, while the other will serve as the control county. Eligible adult smokeless tobacco users in both counties will be assessed for oral health status and smokeless tobacco use characteristics. Intervention county residents will receive a locally-based cessation intervention that will be managed by the County Nurse in the intervention county and delivered by trained lay educators. The County Extension Agent will be responsible for recruitment and retention efforts in this project. At end-of-treatment, and 6 and 12 months, participants from the intervention and control counties will be reassessed for tobacco use, using self-report and biochemical confirmation by saliva cotinine analysis. Comparisons of quit rates will be performed by Chi-square statistical techniques to detect a treatment effect. Multivariate logistic regression analyses will be performed to describe a model of quitter versus continuing user. Oral health status will also be evaluated at 12 months post intervention. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: SPIT TOBACCO USE PREVENTION/CESSATION Principal Investigator & Institution: Walsh, Margaret M.; University of California San Francisco 500 Parnassus Ave San Francisco, Ca 941222747 Timing: Fiscal Year 2002 Summary: Use of spit (smokeless) tobacco (ST) is increasing in prevalence among young American males, is especially prevalent among those residing in rural areas, and puts them at risk of oral cancer, and periodontal tissue destruction. This proposal has the following specific aims: (1) to determine the efficacy of a school-based nurse-directed, per- and dentist-assisted ST intervention program among male students in 28 high schools in rural areas of California and (2) to determine predictors of successful ST cessation among male students in rural high schools. The intervention is based on Cognitive Social Learning Theory and Diffusion of Innovation Theory and applies a public health perspective by approaching ST users in their environment and Innovation Theory and applies a public health perspective by approaching ST users in their environment and attempting to change social norms to effect behavioral change. Twenty-eight rural high schools in California will be stratified on baseline prevalence of male ST use and size of enrollment and randomly assigned within strata to either the intervention or the control group. The intervention will consists of a school advisory board; peer-led educational sessions; an oral exam and advice to quit or to stay tobaccofree by a school nurse who points out any ST-associated lesions to users by their own mouths or in photographs, provides brief cessation counseling, and facilitates three group follow-up relapse prevention sessions, conducts 1-week follow-up examines of students with ST-related oral lesions, and schedules students with persistent lesions for evaluation by a dentist; and, two follow-up telephone cells by a peer to prevent relapse. Biochemically validated self-reported quit rates and self reported initiation rates at the end of the intervention and 1 year later will be compared between groups. Baseline and follow-up questionnaire assessments of ST use will be analyzed to identify individual characteristics that are associated with quitting ST use. Results will contribute to the body of knowledge related to tobacco prevention and cessation and thereby to the primary and secondary prevention of oral cancer and other negative oral health effects associated with tobacco use.

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Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: MORTALITY

STRENGTHENING

MONITORING

OF

INDIAN

TOBACCO

Principal Investigator & Institution: Jha, Prabhat; St. Michael's Hospital 30 Bond St Toronto, Timing: Fiscal Year 2002; Project Start 01-JUL-2002; Project End 30-JUN-2007 Summary: (provided by applicant): The project will aim to strengthen and expand India's Sample Registration System (SRS) to obtain reliable estimates of cause-specific mortality from tobacco smoking and chewing in various parts of India by age, gender and socioeconomic group. The SRS is the primary system for collection of Indian mortality data. It is a large demographic survey to provide annual estimates of birth, death and other fertility and mortality indicators at the national and state level. The SRS consists of 6,671 sample units (4,436 rural and 2,235 urban) covering 1.1 million households and a population of about six million. Sample units are selected from the preceding census frame to be representative of the population. The SRS sampling frame will be soon expanded to over 8,000 units, covering over seven million people. Specific goals of the project are: implementing a validated verbal autopsy instrument in the SRS so as to obtain reliable information on the cause of death (for tobacco as well as numerous other causes); determining past tobacco use for adult deaths and current use from living controls within the dead person's household (so as to provide retrospective case-control data annually); specific addition of questions to the baseline questionnaire of the SRS on tobacco and other risk factors, so as to turn the SRS into a uniquely large, reliable and representative prospective study; and follow-up of deaths by cause of a 1998 Special Fertility and Mortality Survey that obtained data on smoking from about two million adults within the current SRS sampling frame (including one million males of whom 40% would smoke). Pilot studies would begin in Andhra Pradesh, Karnataka, and Tamil Nadu, home to 191 million people and about one in six of the SRS units. The project will build sustained capacity within India's flagship mortality surveillance system to monitor a heterogeneous and growing tobacco epidemic, evaluate the effectiveness of control policies and create reliable information for individuals and policy makers. Specific steps will be taken to translate the research findings for state and national policy makers. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: TREATMENT OF SMOKELESS TOBACCO USERS Principal Investigator & Institution: Hatsukami, Dorothy K.; Professor of Psychiatry; Psychiatry; University of Minnesota Twin Cities 200 Oak Street Se Minneapolis, Mn 554552070 Timing: Fiscal Year 2002; Project Start 15-AUG-2001; Project End 31-MAY-2006 Summary: Although a significant number of smokeless tobacco (ST) users recognize the importance of quitting, many do not want to quit in the immediate future or perceive themselves as unable to quit. For these individuals, no intermediate or alternative treatment approaches have been studied. Tobacco reduction may be an important transitional goal for these individuals prior to becoming abstinent or even as a treatment endpoint. This 5-year grant proposal will examine whether effective approaches are available that can reduce the level of ST use as well as toxicity and facilitate cessation in those ST users unwilling or unable to quit ST use. Four studies are proposed. The first three studies will examine the efficacy of various strategies to reduce tobacco use and

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toxicity. These strategies involve: 1) reducing the level of nicotine while retaining sensory aspects and frequency of use; and 2) maintaining nicotine levels while reducing the frequency of use. ST users will be required to reduce their intake by 50 percent and then by 75 percent over an eight-week period. Subjects will then be followed at 12 and 26 weeks after the initiation of treatment. The first study will examine switching to a lower nicotine-containing ST product. The second and third studies will examine the effects of substituting tobacco free snuff and nicotine gum, respectively, for ST dips. The primary outcome measures across all studies include: the percent reduction in use; toxicity profile, e.g., NNK (4- [methylnitrosamino]-1-[3-pyridyl]-1-butanon) metabolites; the number who make greater than or equal to 24 hour quit attempts; and percent who achieve abstinence. The fourth study will examine whether a tobacco reduction strategy would be detrimental to cessation attempts. Subjects will be randomly assigned to usual care that emphasizes abstinence compared to a tobacco reduction strategy. In the tobacco reduction group, subjects will be required to reduce by at least 50 percent. The primary outcome variables are the percent who attained abstinence, time to drop-out and among those who were not able to quit, percent reduction in use. These studies will determine whether reduction approaches are effective in decreasing levels of exposure to tobacco and toxicity, as well as enhancing motivation to quit and number of quit attempts. In addition, this proposal will determine whether recommending a tobacco reduction strategy among ST users, unable or unwilling to quit, will facilitate or deter abstinence from use compared to an abstinence treatment approach. The results of this study will determine the potential for an alternative and viable method for treating ST users. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: WEB BASED SUPPORT--COMMUNITY TOBACCO CONTROL COALITIONS Principal Investigator & Institution: Buller, David B.; Senior Scientist and Vice President; Cooper Institute Dallas, Tx 75230 Timing: Fiscal Year 2002; Project Start 29-AUG-2000; Project End 31-JUL-2004 Summary: Internet, web-based communications technology has the potential to improve technical assistance to local coalitions working on health promotion and disease control. A collaborative project between the AMC Cancer Research Center, Colorado ASSIST Study, and the Coalition for Tobacco-Free Colorado is proposed. It will test whether a web-based technical assistance program on community tobacco control can be used effectively by state tobacco control professionals and local tobacco control coalition members to achieve gains in community tobacco control. The two-phase project will involve communities throughout Colorado. In Phase I, we will (a) conduct a community needs analysis of eligible Colorado cities to identify current tobacco control plans and activities, and technical assistance needs; (b) produce the web-based technical assistance program containing on-line training courses, an on-line resource center, an on-line selfassessment for local coalitions, and interactive communication features to link local coalitions and state tobacco control professionals; (c) test the website for usability; and (d) identify six existing local tobacco control coalitions funded by ASSIST and form 14 new coalitions for the randomized trial. In Phase II, the web-based technical assistance program will be evaluated in a randomized, controlled trial, in 20 matched pairs of cities in Colorado. The primary outcome will be changes in local tobacco control policy by government, business, and homes. A multi-level composite policy score will be based on interviews with samples of elected officials, business owners/managers, and residents and analysis of written tobacco control policies in participating cities. Secondary

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outcomes will include measures of support for tobacco control policies and assessments of coalition functioning, including analysis of newspaper articles/editorials on tobacco control. The tertiary outcome will be changes in prevalence of tobacco use (smoking and smokeless tobacco). All interviews will be conducted by telephone. In addition, we will test whether changes in intervention cities are associated with baseline readiness to adopt tobacco control policies and whether secular changes in tobacco control policies in control cities are predicted by baseline readiness to adopt, similarity, proximity, and contact with intervention cities, and exposure to tobacco control information, including newspaper articles/editorials on tobacco control. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: XCHEW NET--INTERNET SMOKELESS TOBACCO CESSATION Principal Investigator & Institution: Severson, Herbert H.; Senior Research Scientist; Oregon Research Institute 1715 Franklin Blvd Eugene, or 97403 Timing: Fiscal Year 2002; Project Start 01-APR-2001; Project End 31-MAR-2005 Summary: While cigarette smoking has steadily declined for several years, the use of smokeless tobacco (ST) is increasing. Many ST users wish to quit but lack resources. There is a need for innovative, validated, and widely applicable low-cost interventions to facilitate ST cessation. An effective interactive Internet-based cessation program could meet this need. This proposed study will compare the efficacy of a tailored Internetbased interactive ST cessation program with a Web site that provides typical cessation materials and links to other Web-based ST resources. Smokeless tobacco users who wish to quit will be recruited to our Web site and randomized to receive either the personalized, interactive multimedia program plus links to other Web-based resources (Tailored Condition) or a cessation information site with links to other Web-based resources (Usual Care Condition). The Tailored Condition will be based on empirically validated ST cessation programs and will take advantage of the unique properties of the Internet to provide individualized cessation assistance, and social support via forums and chat rooms. After completion of entry criteria questions and informed consent, 2,400 ST users aged 18 and older will be equally randomized to either the Usual Care Condition or the Tailored intervention Condition. Cessation outcomes will be evaluated at 6 weeks, 6 months, and 12 months post-enrollment via Internet surveys. The primary outcomes are tobacco cessation at 6- and 12-month follow-up, with quit rates expected to be higher in subjects in the Tailored Condition. The study will also investigate baseline subject characteristics, program utilization, social support, and process variables as predictive of cessation outcomes. A cost analysis will determine the cost per quit and relative cost-effectiveness of the two conditions. The public health potential of the proposed Web-based application to promote smokeless tobacco cessation is great. The use of the Internet as a resource for health care information continues to grow. An empirical evaluation of this delivery system for smokeless tobacco cessation is warranted and timely. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

E-Journals: PubMed Central3 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National 3

Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html.

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Library of Medicine (NLM).4 Access to this growing archive of e-journals is free and unrestricted.5 To search, go to http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Pmc, and type “smokeless tobacco” (or synonyms) into the search box. This search gives you access to full-text articles. The following is a sample of items found for smokeless tobacco in the PubMed Central database: •

Bacillus Species Are Present in Chewing Tobacco Sold in the United States and Evoke Plasma Exudation from the Oral Mucosa. by Rubinstein I, Pedersen GW.; 2002 Sep; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=120061

The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine.6 The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to use. If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with smokeless tobacco, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “smokeless tobacco” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for smokeless tobacco (hyperlinks lead to article summaries): •

A comparison of cancer educational resources to prevent smokeless tobacco usage in India and the United States. Author(s): Narayanan RS. Source: Journal of Cancer Education : the Official Journal of the American Association for Cancer Education. 1988; 3(4): 257-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3275247&dopt=Abstract

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A comparison of male and female smokeless tobacco use. Author(s): Cohen-Smith D, Severson HH. Source: Nicotine & Tobacco Research : Official Journal of the Society for Research on Nicotine and Tobacco. 1999 September; 1(3): 211-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11072417&dopt=Abstract

4

With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 5 The value of PubMed Central, in addition to its role as an archive, lies in the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print. 6 PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.

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A comparison of smokeless tobacco and smoking practices of university varsity and intramural baseball players. Author(s): Gingiss PL, Gottlieb NH. Source: Addictive Behaviors. 1991; 16(5): 335-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1776549&dopt=Abstract

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A comparison of sustained-release bupropion and placebo for smokeless tobacco cessation. Author(s): Glover ED, Glover PN, Sullivan CR, Cerullo CL, Hobbs G. Source: American Journal of Health Behavior. 2002 September-October; 26(5): 386-93. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12206448&dopt=Abstract

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A cytologic study of oral mucosal cell alterations in smokeless tobacco users and efficacy of a related cessation program. Author(s): Goral V, Culbreth W, Green C, Nelms T, Truax K. Source: Journal of Dental Hygiene : Jdh / American Dental Hygienists' Association. 1999 Winter; 73(1): 12-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10634116&dopt=Abstract

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A pilot study of smokeless tobacco in smoking cessation. Author(s): Tilashalski K, Rodu B, Cole P. Source: The American Journal of Medicine. 1998 May; 104(5): 456-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9626029&dopt=Abstract

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A pilot study of the use of smokeless tobacco. Author(s): Fant RV, Henningfield JE, Tomar SL. Source: The American Journal of Medicine. 1999 August; 107(2): 184-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10460055&dopt=Abstract

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A pilot study of the use of smokeless tobacco. Author(s): Pfister AK. Source: The American Journal of Medicine. 1999 August; 107(2): 184; Author Reply 185. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10460054&dopt=Abstract

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A report of two smokeless tobacco surveys and associated intervention strategies among Utah adolescents. Author(s): Leopardi EA, Poulson TC, Neiger BL, Lindenmuth JE, Greer RO Jr. Source: Journal of Cancer Education : the Official Journal of the American Association for Cancer Education. 1989; 4(2): 125-34. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2641328&dopt=Abstract

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A self-help cessation program for smokeless tobacco users: comparison of two interventions. Author(s): Severson HH, Andrews JA, Lichtenstein E, Gordon JS, Barckley M, Akers L. Source: Nicotine & Tobacco Research : Official Journal of the Society for Research on Nicotine and Tobacco. 2000 November; 2(4): 363-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11197317&dopt=Abstract

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A survey of whether medical and dental students are being taught to ask their patients about smokeless tobacco use. Author(s): Ricer RE, Wohlwend JR. Source: Academic Medicine : Journal of the Association of American Medical Colleges. 1993 October; 68(10): 811. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8397619&dopt=Abstract

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Activity involvement, risk-taking, demographic variables, and other drug use: prediction of trying smokeless tobacco. Author(s): Sussman S, Holt L, Dent CW, Flay BR, Graham JW, Hansen WB, Johnson CA. Source: Nci Monogr. 1989; (8): 57-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2785652&dopt=Abstract

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Adolescent smokeless tobacco use. Author(s): Olds RS. Source: The New York State Dental Journal. 1988 December; 54(10): 33-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3205528&dopt=Abstract

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Adolescent smokeless tobacco use: future research needs. Author(s): Chassin L, Presson CC, Sherman SJ, Steinberg L. Source: Nci Monogr. 1989; (8): 101-5. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2654649&dopt=Abstract

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Adolescent smokeless tobacco use: relationship between epidemiologic and cognitive factors. Author(s): Williams NJ, Arreola M, Covington JS, Arheart K, Mills K. Source: Prog Clin Biol Res. 1989; 293: 211-20. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2726935&dopt=Abstract

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Adolescents' first and most recent use situations of smokeless tobacco and cigarettes: similarities and differences. Author(s): Hahn G, Charlin VL, Sussman S, Dent CW, Manzi J, Stacy AW, Flay B, Hansen WB, Burton D. Source: Addictive Behaviors. 1990; 15(5): 439-48. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2248117&dopt=Abstract

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Adult smokeless tobacco use and age of onset. Author(s): Riley WT, Kaugars GE, Grisius TM, Page DG, Burns JC, Svirsky JA. Source: Addictive Behaviors. 1996 January-February; 21(1): 135-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8729715&dopt=Abstract

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Advertising and promotion of smokeless tobacco products. Author(s): Ernster VL. Source: Nci Monogr. 1989; (8): 87-94. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2654652&dopt=Abstract

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Age of initiation and switching patterns between smokeless tobacco and cigarettes among college students in the United States. Author(s): Glover ED, Laflin M, Edwards SW. Source: American Journal of Public Health. 1989 February; 79(2): 207-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2913845&dopt=Abstract

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Ambulatory 24-h blood pressure monitoring in healthy, middle-aged smokeless tobacco users, smokers, and nontobacco users. Author(s): Bolinder G, de Faire U. Source: American Journal of Hypertension : Journal of the American Society of Hypertension. 1998 October; 11(10): 1153-63. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9799031&dopt=Abstract

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An epilogue to evaluating the impact of P.L. 99-252 on decreasing smokeless tobacco use. Author(s): Chen MS Jr, Schroeder KL. Source: J Public Health Dent. 1990 Winter; 50(1): 101-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2295996&dopt=Abstract

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An exploratory study on gutkha and smokeless tobacco consumption. Author(s): Bansode NN. Source: The Nursing Journal of India. 2002 June; 93(6): 127-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12649939&dopt=Abstract

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An in-depth analysis of male adolescent smokeless tobacco users: interviews with users and their fathers. Author(s): Ary DV, Lichtenstein E, Severson H, Weissman W, Seeley JR. Source: Journal of Behavioral Medicine. 1989 October; 12(5): 449-67. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2614822&dopt=Abstract

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An interpretative review of smokeless tobacco research in the United States: Part I. Author(s): Glover ED, Schroeder KL, Henningfield JE, Severson HH, Christen AG. Source: Journal of Drug Education. 1988; 18(4): 285-310. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3065469&dopt=Abstract

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An interpretative review of smokeless tobacco research in the United States: Part II. Author(s): Glover ED, Schroeder KL, Henningfield JE, Severson HH, Christen AG. Source: Journal of Drug Education. 1989; 19(1): 1-19. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2656965&dopt=Abstract

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Anti-smoking programs need to incorporate smokeless tobacco education. Author(s): Glover ED. Source: The Journal of School Health. 1988 September; 58(7): 266. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3172718&dopt=Abstract

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Apply federal research rules on deception to misleading health information: an example on smokeless tobacco and cigarettes. Author(s): Kozlowski LT, O'Connor RJ. Source: Public Health Reports (Washington, D.C. : 1974). 2003 May-June; 118(3): 187-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12766212&dopt=Abstract

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Assessing skills for refusing cigarettes and smokeless tobacco. Author(s): Sallis JF, Elder JP, Wildey MB, de Moor C, Young RL, Shulkin JJ, Helme JM. Source: Journal of Behavioral Medicine. 1990 October; 13(5): 489-503. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2273526&dopt=Abstract

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Association between smokeless tobacco use and breast cancer among NativeAmerican women in North Carolina. Author(s): Spangler JG, Michielutte R, Bell RA, Dignan MB. Source: Ethn Dis. 2001 Winter; 11(1): 36-43. Erratum In: Ethn Dis 2002 Winter; 12(1): 1589. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11289249&dopt=Abstract

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Attenuation of the natural course of herpes simplex virus infection in human oral epithelial cell cultures by smokeless tobacco extracts suggests the possibility of a synergistic mechanism for carcinogenesis. Author(s): Murrah VA, Gilchrist EP, Moyer MP. Source: Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics. 1996 January; 81(1): 63-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8850486&dopt=Abstract

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Bimodal initiation of smokeless tobacco usage: implications for cancer education. Author(s): Schroeder KL, Iaderosa GB, Chen MS Jr, Glover ED, Edmundson EW. Source: Journal of Cancer Education : the Official Journal of the American Association for Cancer Education. 1987; 2(1): 15-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3274964&dopt=Abstract

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Biological effects of smokeless tobacco. Author(s): Bartley MH. Source: J Oreg Dent Assoc. 1986 Fall; 56(1): 36-8. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3464729&dopt=Abstract

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Bladder cancer risk and pipes, cigars, and smokeless tobacco. Author(s): Hartge P, Hoover R, Kantor A. Source: Cancer. 1985 February 15; 55(4): 901-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3967183&dopt=Abstract

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Buccal absorption of nicotine from smokeless tobacco sachets. Author(s): Russell MA, Jarvis MJ, West RJ, Feyerabend C. Source: Lancet. 1985 December 14; 2(8468): 1370. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2866424&dopt=Abstract

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Can smokeless tobacco rid us of tobacco smoke? Author(s): Fagerstrom KO, Ramstrom L. Source: The American Journal of Medicine. 1998 May; 104(5): 501-3. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9626038&dopt=Abstract

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Carcinoma of buccal mucosa in smokeless tobacco users: a preliminary study of the use of cytology for early detection. Author(s): Erenmemisoglu A, Ustun H, Kartal M. Source: Cytopathology : Official Journal of the British Society for Clinical Cytology. 1995 December; 6(6): 403-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8770541&dopt=Abstract

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Carotid and femoral atherosclerosis, cardiovascular risk factors and C-reactive protein in relation to smokeless tobacco use or smoking in 58-year-old men. Author(s): Wallenfeldt K, Hulthe J, Bokemark L, Wikstrand J, Fagerberg B. Source: Journal of Internal Medicine. 2001 December; 250(6): 492-501. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11902817&dopt=Abstract

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Case #6. Smokeless tobacco keratosis. Author(s): Haring JI. Source: Rdh. 1993 June; 13(6): 10, 12. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8234877&dopt=Abstract

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Cessation related perceptions and behavior of former and current smokeless tobacco users. Author(s): Chakravorty B, Chakravorty S. Source: Journal of American College Health : J of Ach. 1997 November; 46(3): 133-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9394091&dopt=Abstract

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Characteristics of smokeless tobacco use among high school football players as related to type of smokeless tobacco and period of use. Author(s): Creath CJ, Wright JT, Wisniewski JF. Source: Journal of Drug Education. 1992; 22(1): 69-85. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1593389&dopt=Abstract

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Characteristics of smokeless tobacco users seeking treatment. Author(s): Hatsukami DK, Jensen J, Boyle R, Grillo M, Bliss R. Source: Addictive Behaviors. 1999 July-August; 24(4): 551-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10466850&dopt=Abstract

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Chemical composition and carcinogenicity of smokeless tobacco. Author(s): Hoffmann D, Djordjevic MV. Source: Advances in Dental Research. 1997 September; 11(3): 322-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9524432&dopt=Abstract

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Chewing tobacco use: perceptions and knowledge in rural adolescent youths. Author(s): Campbell-Grossman C, Hudson DB, Fleck MO. Source: Issues in Comprehensive Pediatric Nursing. 2003 January-March; 26(1): 13-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12623732&dopt=Abstract

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Chronic disease mortality in a cohort of smokeless tobacco users. Author(s): Accortt NA, Waterbor JW, Beall C, Howard G. Source: American Journal of Epidemiology. 2002 October 15; 156(8): 730-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12370161&dopt=Abstract

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Cigarette and smokeless tobacco use among Connecticut adolescents. Author(s): Kegeles SS, Burleson JA, Miozza J. Source: American Journal of Public Health. 1989 October; 79(10): 1413-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2782515&dopt=Abstract

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Clinical pharmacokinetics of theophylline and levels of alpha 1-acid glycoprotein in smokeless tobacco users. Author(s): Parish RC, Terrell JR, Brown WJ Jr. Source: Chest. 1989 June; 95(6): 1253-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2721260&dopt=Abstract

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Coaches' attitudes toward smokeless tobacco and intentions to intervene with athletes. Author(s): Horn KA, Maniar SD, Dino GA, Gao X, Meckstroth RL. Source: The Journal of School Health. 2000 March; 70(3): 89-94. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10763476&dopt=Abstract

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Company plans to sell snuff as “smokeless tobacco”. Author(s): Josefson D. Source: Bmj (Clinical Research Ed.). 2003 August 2; 327(7409): 247. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12896920&dopt=Abstract

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Comparative patterns of smokeless tobacco usage among major league baseball personnel. Author(s): Wisniewski JF, Bartolucci AA. Source: Journal of Oral Pathology & Medicine : Official Publication of the International Association of Oral Pathologists and the American Academy of Oral Pathology. 1989 July; 18(6): 322-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2810130&dopt=Abstract

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Comparison of oral carcinomas in smokeless tobacco users and nonusers. Author(s): Link JO, Kaugars GE, Burns JC. Source: Journal of Oral and Maxillofacial Surgery : Official Journal of the American Association of Oral and Maxillofacial Surgeons. 1992 May; 50(5): 452-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1573481&dopt=Abstract

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Concomitant use of cigarettes and smokeless tobacco: prevalence, correlates, and predictors of tobacco cessation. Author(s): Wetter DW, McClure JB, de Moor C, Cofta-Gunn L, Cummings S, Cinciripini PM, Gritz ER. Source: Preventive Medicine. 2002 June; 34(6): 638-48. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12052025&dopt=Abstract

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Conducting smokeless tobacco cessation clinics. Author(s): Glover ED. Source: American Journal of Public Health. 1986 February; 76(2): 207. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3946706&dopt=Abstract

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Co-occurrence of alcohol, smokeless tobacco, cigarette, and illicit drug use by lower ranking military personnel. Author(s): Kao TC, Schneider SJ, Hoffman KJ. Source: Addictive Behaviors. 2000 March-April; 25(2): 253-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10795949&dopt=Abstract

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Correlates of adolescents' use of smokeless tobacco. Author(s): Colborn JW, Cummings KM, Michalek AM. Source: Health Educ Q. 1989 Spring; 16(1): 91-100. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2703352&dopt=Abstract

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Correlates of exclusive or combined use of cigarettes and smokeless tobacco among male adolescents. Author(s): Simon TR, Sussman S, Dent CW, Burton D, Flay BR. Source: Addictive Behaviors. 1993 November-December; 18(6): 623-34. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8178701&dopt=Abstract

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Correlates of smokeless tobacco use in a male adolescent population. Author(s): Jones RB, Moberg DP. Source: American Journal of Public Health. 1988 January; 78(1): 61-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3337307&dopt=Abstract

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Correlates of use and expected use of smokeless tobacco among kindergarten children. Author(s): Young M, Williamson D. Source: Psychological Reports. 1985 February; 56(1): 63-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3872466&dopt=Abstract

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Correlates of youth smokeless tobacco use. Author(s): Goebel LJ, Crespo RD, Abraham RT, Masho SW, Glover ED. Source: Nicotine & Tobacco Research : Official Journal of the Society for Research on Nicotine and Tobacco. 2000 November; 2(4): 319-25. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11197311&dopt=Abstract

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Daily use of smokeless tobacco: systemic effects. Author(s): Benowitz NL, Jacob P 3rd, Yu L. Source: Annals of Internal Medicine. 1989 July 15; 111(2): 112-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2742246&dopt=Abstract

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Demographic and predictive correlates of smokeless tobacco use in elementary school children. Author(s): Lisnerski DD, McClary CL, Brown TL, Martin JP, Jones DR. Source: American Journal of Health Promotion : Ajhp. 1991 July-August; 5(6): 426-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10146841&dopt=Abstract

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Dental implications of smokeless tobacco use. Author(s): Rinchuse DJ. Source: Penn Dent J (Phila). 1995 March-April; 62(2): 33-6. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9526255&dopt=Abstract

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Detection of human papillomavirus-genomic DNA in oral epithelial dysplasias, oral smokeless tobacco-associated leukoplakias, and epithelial malignancies. Author(s): Greer RO Jr, Eversole LR, Crosby LK. Source: Journal of Oral and Maxillofacial Surgery : Official Journal of the American Association of Oral and Maxillofacial Surgeons. 1990 November; 48(11): 1201-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2170606&dopt=Abstract

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Determinants of youth tobacco use in West Virginia: a comparison of smoking and smokeless tobacco use. Author(s): Horn KA, Gao X, Dino GA, Kamal-Bahl S. Source: The American Journal of Drug and Alcohol Abuse. 2000 February; 26(1): 125-38. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10718168&dopt=Abstract

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Developing provider partnerships in the detection of oral cancer and the prevention of smokeless tobacco use. Author(s): Messer NC, Yant WR, Archer RD. Source: Md Med J. 1995 October; 44(10): 788-91. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7476001&dopt=Abstract

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Development and evaluation of a smokeless tobacco cessation program: a pilot study. Author(s): Eakin E, Severson H, Glasgow RE. Source: Nci Monogr. 1989; (8): 95-100. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2716855&dopt=Abstract

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Development of a validation test for self-reported abstinence from smokeless tobacco products: preliminary results. Author(s): Robertson JB, Bray JT. Source: Preventive Medicine. 1988 July; 17(4): 496-502. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3217380&dopt=Abstract

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Development of smokeless tobacco-induced oral mucosal lesions. Author(s): Johnson GK, Payne JB, Fili JM, Reinhardt RA, Organ CC, Slager SL. Source: Journal of Oral Pathology & Medicine : Official Publication of the International Association of Oral Pathologists and the American Academy of Oral Pathology. 1998 September; 27(8): 388-94. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9736428&dopt=Abstract

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Differentiating withdrawal patterns between smokers and smokeless tobacco users. Author(s): McChargue DE, Collins FL Jr. Source: Experimental and Clinical Psychopharmacology. 1998 May; 6(2): 205-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9608352&dopt=Abstract

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Does smokeless tobacco cause hypertension? Author(s): Westman EC. Source: Southern Medical Journal. 1995 July; 88(7): 716-20. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7597474&dopt=Abstract

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Eating behavior and weight control among women using smokeless tobacco, cigarettes, and normal controls. Author(s): Gerend MA, Boyle RG, Peterson CB, Hatsukami DK. Source: Addictive Behaviors. 1998 March-April; 23(2): 171-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9573421&dopt=Abstract

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Effect of ingestion of smokeless tobacco on motor distal latency of the median nerve. Author(s): Lester MJ, Jacobson BH, Edwards SW. Source: Percept Mot Skills. 1988 August; 67(1): 283-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2850531&dopt=Abstract

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Effect of non-nicotinic moist snuff replacement and lobeline on withdrawal symptoms during 48-h smokeless tobacco deprivation. Author(s): McChargue DE, Collins FL Jr, Cohen LM. Source: Nicotine & Tobacco Research : Official Journal of the Society for Research on Nicotine and Tobacco. 2002 May; 4(2): 195-200. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12028852&dopt=Abstract

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Effect of smokeless tobacco extract on human gingival keratinocyte levels of prostaglandin E2 and interleukin-1. Author(s): Johnson GK, Poore TK, Payne JB, Organ CC. Source: J Periodontol. 1996 February; 67(2): 116-24. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8667131&dopt=Abstract

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Effect of smokeless tobacco on plasma lipoproteins in adolescents. Author(s): Beiraghi SM, Wilson S, Cornhill JF, Sloan H. Source: Pediatr Dent. 1988 March; 10(1): 19-21. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3268792&dopt=Abstract

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Effect of smokeless tobacco use in humans on mucosal immune factors. Author(s): Gregory RL, Kindle JC, Hobbs LC, Malmstrom HS. Source: Archives of Oral Biology. 1991; 36(1): 25-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1707269&dopt=Abstract

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Effective smokeless tobacco intervention for dental hygiene patients. Author(s): Little SJ, Stevens VJ, Severson HH, Lichtenstein E. Source: Journal of Dental Hygiene : Jdh / American Dental Hygienists' Association. 1992 May; 66(4): 185-90. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1625002&dopt=Abstract

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Effectiveness of video instruction in educating teenagers about the health risks of smokeless tobacco use. Author(s): Greer RO Jr. Source: Journal of Cancer Education : the Official Journal of the American Association for Cancer Education. 1989; 4(1): 33-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2641506&dopt=Abstract

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Effects of behavioral and pharmacological treatment on smokeless tobacco users. Author(s): Hatsukami D, Jensen J, Allen S, Grillo M, Bliss R. Source: Journal of Consulting and Clinical Psychology. 1996 February; 64(1): 153-61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8907095&dopt=Abstract

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Effects of smokeless tobacco and tumor promoters on cell population growth and apoptosis of B lymphocytes infected with epstein-barr virus types 1 and 2. Author(s): Jenson HB, Baillargeon J, Heard P, Moyer MP. Source: Toxicology and Applied Pharmacology. 1999 October 15; 160(2): 171-82. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10527916&dopt=Abstract

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Effects of smokeless tobacco on the ability of secretory component to bind to the IgA/J chain complex. Author(s): Gregory RL, Kindle JC, Hobbs LC, VanTo T, Malmstrom HS. Source: Hum Antibodies Hybridomas. 1990; 1(3): 126-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1966476&dopt=Abstract

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Effects of smokeless tobacco on the oral cavity. Author(s): Rohrer MD, Young SK. Source: J Okla Dent Assoc. 1982 Fall; 73(2): 13-6. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6958828&dopt=Abstract

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Effects of smokeless tobacco on the periodontal, mucosal and caries status of adolescent males. Author(s): Offenbacher S, Weathers DR. Source: J Oral Pathol. 1985 February; 14(2): 169-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3920367&dopt=Abstract

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Effects of smokeless tobacco-related sensory and behavioral cues on urge, affect, and stress. Author(s): Coffey SF, Lombardo TW. Source: Experimental and Clinical Psychopharmacology. 1998 November; 6(4): 406-18. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9861555&dopt=Abstract

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Effects of tobacco excise taxes on the use of smokeless tobacco products in the USA. Author(s): Ohsfeldt RL, Boyle RG, Capilouto E. Source: Health Economics. 1997 September-October; 6(5): 525-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9353656&dopt=Abstract

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Effects of treatment on cardiovascular risk among smokeless tobacco users. Author(s): Allen SS, Hatsukami D, Jensen J, Grillo M, Bliss R. Source: Preventive Medicine. 1995 July; 24(4): 357-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7479625&dopt=Abstract

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Effects of using a different kind of smokeless tobacco on cardiac parameters: “Maras Powder”. Author(s): Guven A, Koksal N, Buyukbese MA, Cetinkaya A, Sokmen G, Aksu E, Caglayan CE. Source: Anadolu Kardiyoloji Dergisi : Akd = the Anatolian Journal of Cardiology. 2003 September; 3(3): 230-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12967890&dopt=Abstract

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Effects of varying doses of smokeless tobacco at rest and during brief, high-intensity exercise. Author(s): Baldini FD, Skinner JS, Landers DM, O'Connor JS. Source: Military Medicine. 1992 February; 157(2): 51-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1603386&dopt=Abstract

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Epidemiology of cancer and other systemic effects associated with the use of smokeless tobacco. Author(s): Winn DM. Source: Advances in Dental Research. 1997 September; 11(3): 313-21. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9524431&dopt=Abstract

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Epidemiology of smokeless tobacco use: a national study. Author(s): Rouse BA. Source: Nci Monogr. 1989; (8): 29-33. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2785648&dopt=Abstract

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Evaluating the impact of P.L. 99-252 on decreasing smokeless tobacco use. Author(s): Chen MS Jr. Source: J Public Health Dent. 1990 Winter; 50(1): 65-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2296004&dopt=Abstract

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Evaluating two self-help interventions for smokeless tobacco cessation. Author(s): Severson HH, Akers L, Andrews JA, Lichtenstein E, Jerome A. Source: Addictive Behaviors. 2000 May-June; 25(3): 465-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10890303&dopt=Abstract

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Evaluation of risk factors in smokeless tobacco-associated oral lesions. Author(s): Kaugars GE, Brandt RB, Chan W, Carcaise-Edinboro P. Source: Oral Surg Oral Med Oral Pathol. 1991 September; 72(3): 326-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1923420&dopt=Abstract

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Evaluation of the effect of smokeless tobacco purified products and extracts on latent Epstein-Barr virus. Author(s): Jenson HB, Heard P, Moyer MP. Source: Toxicology. 1999 March 1; 133(1): 35-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10413192&dopt=Abstract

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Evidence that smokeless tobacco use is a gateway for smoking initiation in young adult males. Author(s): Haddock CK, Weg MV, DeBon M, Klesges RC, Talcott GW, Lando H, Peterson A. Source: Preventive Medicine. 2001 March; 32(3): 262-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11277684&dopt=Abstract

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Excess mortality in smokeless tobacco users not meaningful. Author(s): Rodu B, Cole P. Source: American Journal of Public Health. 1995 January; 85(1): 118-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7832248&dopt=Abstract

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Experimentation with smokeless tobacco and cigarettes by children and adolescents: relationship to beliefs, peer use, and parental use. Author(s): Cohen RY, Sattler J, Felix MR, Brownell KD. Source: American Journal of Public Health. 1987 November; 77(11): 1454-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3661802&dopt=Abstract

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Extracts of smokeless tobacco induce pro-inflammatory changes in cultured human vascular endothelial cells. Author(s): Furie MB, Raffanello JA, Gergel EI, Lisinski TJ, Horb LD. Source: Immunopharmacology. 2000 April; 47(1): 13-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10708806&dopt=Abstract

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Focus on smokeless tobacco. Author(s): McGuirt WF. Source: N C Med J. 1992 October; 53(10): 509. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1436134&dopt=Abstract

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Forearm endothelial response in smokeless tobacco users compared with cigarette smokers and nonusers of tobacco. Author(s): Granberry MC, Smith ES 3rd, Troillett RD, Eidt JF. Source: Pharmacotherapy. 2003 August; 23(8): 974-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12921243&dopt=Abstract

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Gas chromatographic-mass spectrometric method for determination of anabasine, anatabine and other tobacco alkaloids in urine of smokers and smokeless tobacco users. Author(s): Jacob P 3rd, Yu L, Liang G, Shulgin AT, Benowitz NL. Source: Journal of Chromatography. 1993 September 8; 619(1): 49-61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8245163&dopt=Abstract

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Gender differences and low birth weight with maternal smokeless tobacco use in pregnancy. Author(s): Krishnamurthy S, Joshi S. Source: Journal of Tropical Pediatrics. 1993 August; 39(4): 253-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8411321&dopt=Abstract

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Georgia pharmacists' attitudes toward cigarettes and smokeless tobacco. Author(s): Parish RC, Terrell JC. Source: Am Pharm. 1989 September; Ns29(9): 41-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2801498&dopt=Abstract

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Gustatory function and dietary habits in users and nonusers of smokeless tobacco. Author(s): Mela DJ. Source: The American Journal of Clinical Nutrition. 1989 March; 49(3): 482-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2923081&dopt=Abstract

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Hazards of smokeless tobacco. Author(s): Eskow RN. Source: The New England Journal of Medicine. 1987 November 5; 317(19): 1229. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3657900&dopt=Abstract

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Health consequences of using smokeless tobacco: summary of the Advisory Committee's report to the Surgeon General. Author(s): Cullen JW, Blot W, Henningfield J, Boyd G, Mecklenburg R, Massey MM. Source: Public Health Reports (Washington, D.C. : 1974). 1986 July-August; 101(4): 35573. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3090602&dopt=Abstract

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Health effects associated with smokeless tobacco: a systematic review. Author(s): Critchley JA, Unal B. Source: Thorax. 2003 May; 58(5): 435-43. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12728167&dopt=Abstract

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Health effects of smokeless tobacco. Author(s): Schinke SP, Schilling RF 2nd, Gilchrist LD, Ashby MR. Source: Jama : the Journal of the American Medical Association. 1987 February 13; 257(6): 781. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3806853&dopt=Abstract

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Health implications of smokeless tobacco. US National Institutes of Health Consensus Development Conference. Author(s): Stephen KW. Source: British Dental Journal. 1986 June 7; 160(11): 370-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3459486&dopt=Abstract

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Health implications of smokeless tobacco: a National Institutes of Health Consensus Development Conference. Author(s): Nash DB. Source: Annals of Internal Medicine. 1986 March; 104(3): 436-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3946985&dopt=Abstract

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Health-risk warning labels on smokeless tobacco products: are they effective? Author(s): Brubaker RG, Mitby SK. Source: Addictive Behaviors. 1990; 15(2): 115-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2343784&dopt=Abstract

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Hemodynamic effects of oral smokeless tobacco in dogs and young adults. Author(s): Squires WG Jr, Brandon TA, Zinkgraf S, Bonds D, Hartung GH, Murray T, Jackson AS, Miller RR. Source: Preventive Medicine. 1984 March; 13(2): 195-206. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6539915&dopt=Abstract

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Histological alterations following short-term smokeless tobacco exposure in humans. Author(s): Payne JB, Johnson GK, Reinhardt RA, Schmid M. Source: Journal of Periodontal Research. 1998 July; 33(5): 274-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9777594&dopt=Abstract

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Histopathology of smokeless tobacco lesions in professional baseball players. Associations with different types of tobacco. Author(s): Daniels TE, Hansen LS, Greenspan JS, Grady DG, Hauck WW, Greene JC, Ernster VL. Source: Oral Surg Oral Med Oral Pathol. 1992 June; 73(6): 720-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1279496&dopt=Abstract

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Hypertension from smokeless tobacco. Author(s): Wells DG, Rustick JM. Source: Anesthesiology. 1986 September; 65(3): 339. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3752585&dopt=Abstract

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Identification of human papillomavirus DNA in smokeless tobacco-associated keratoses from juveniles, adults and older adults using immunocytochemical and in situ DNA hybridization techniques. Author(s): Greer RO, Eversole LR, Poulson TC, Boone ME, Lindenmuth JE, Crosby L. Source: Gerodontics. 1987 October; 3(5): 201-8. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2450801&dopt=Abstract

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Impact of smokeless tobacco use on smoking in northern Sweden. Author(s): Rodu B, Stegmayr B, Nasic S, Asplund K. Source: Journal of Internal Medicine. 2002 November; 252(5): 398-404. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12528757&dopt=Abstract

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Impact of smoking and smokeless tobacco on the risk of cancer of the head and neck. Author(s): Stockwell HG, Lyman GH. Source: Head Neck Surg. 1986 November-December; 9(2): 104-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3623935&dopt=Abstract

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Implications of smokeless tobacco use in athletes. Author(s): Guggenheimer J. Source: Dent Clin North Am. 1991 October; 35(4): 797-808. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1936412&dopt=Abstract

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In vitro effects of a smokeless tobacco extract on the production of reactive oxygen species by human oral epidermal cells and rat hepatic mitochondria and microsomes, and peritoneal macrophages. Author(s): Bagchi M, Bagchi D, Stohs SJ. Source: Archives of Environmental Contamination and Toxicology. 1996 March; 30(3): 418-22. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8854974&dopt=Abstract

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Incidence and predictors of smokeless tobacco use among US youth. Author(s): Tomar SL, Giovino GA. Source: American Journal of Public Health. 1998 January; 88(1): 20-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9584028&dopt=Abstract

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Increasing use of smokeless tobacco leads to fears of young lives being 'snuffed out'. Author(s): Goldsmith MF. Source: Jama : the Journal of the American Medical Association. 1988 September 16; 260(11): 1511-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3411725&dopt=Abstract

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Induction of micronuclei by smokeless tobacco on buccal mucosa cells of habitual users. Author(s): Ozkul Y, Donmez H, Erenmemisoglu A, Demirtas H, Imamoglu N. Source: Mutagenesis. 1997 July; 12(4): 285-7. Erratum In: Mutagenesis 1997 November; 12(6): 470. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9237775&dopt=Abstract

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Induction of nuclear aberrations by smokeless tobacco in epithelial cells of human oral mucosa. Author(s): Livingston GK, Reed RN, Olson BL, Lockey JE. Source: Environmental and Molecular Mutagenesis. 1990; 15(3): 136-44. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2331982&dopt=Abstract

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Influence of smokeless tobacco exposure on detoxification status and chromosomal damage in male and female habitues. Author(s): Mahimkar MB, Buch SC, Samant TA, Kapoor MD, Bhisey RA. Source: Mutation Research. 2001 April 5; 491(1-2): 111-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11287304&dopt=Abstract

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Inhibition of human lymphokine-activated killer activity by smokeless tobacco (snuff) extract. Author(s): Lindemann RA, Park NH. Source: Archives of Oral Biology. 1988; 33(5): 317-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3263850&dopt=Abstract

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Initial characterization of the complement activating compounds in extracts of smokeless tobacco. Author(s): Chan WS, Chowdhry S, Chang T, Kew RR. Source: Immunobiology. 1999 September; 201(1): 64-73. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10532281&dopt=Abstract

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Initiation and use of smokeless tobacco in relation to smoking. Author(s): Peterson AV, Marek PM, Mann SL. Source: Nci Monogr. 1989; (8): 63-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2785653&dopt=Abstract

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Injury proneness in infantry conscripts undergoing a physical training programme: smokeless tobacco use, higher age, and low levels of physical fitness are risk factors. Author(s): Heir T, Eide G. Source: Scandinavian Journal of Medicine & Science in Sports. 1997 October; 7(5): 30411. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9338950&dopt=Abstract

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Inoculating students against using smokeless tobacco. Author(s): Noland MP, Riggs RS. Source: Health Educ. 1989 April-May; 20(2): 52-3. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2516033&dopt=Abstract

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Is smokeless tobacco less harmful than smoking? Author(s): Tabak L. Source: Anadolu Kardiyoloji Dergisi : Akd = the Anatolian Journal of Cardiology. 2003 September; 3(3): 236-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12967891&dopt=Abstract

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Is use of smokeless tobacco a risk factor for cigarette smoking? The U.S. experience. Author(s): Tomar SL. Source: Nicotine & Tobacco Research : Official Journal of the Society for Research on Nicotine and Tobacco. 2003 August; 5(4): 561-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12959794&dopt=Abstract

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Knowledge and use of smokeless tobacco by visitors to a state fair oral health exhibit. Author(s): Hastreiter RJ, Bakdash MB, Roesch MH, Daly KA, Harty KC. Source: Northwest Dent. 1990 July-August; 69(4): 25-8. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2216696&dopt=Abstract

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Knowledge, intent to use, and use of smokeless tobacco among sixth grade schoolchildren in six selected U.S. sites. Author(s): Backinger CL, Bruerd B, Kinney MB, Szpunar SM. Source: Public Health Reports (Washington, D.C. : 1974). 1993 September-October; 108(5): 637-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8210262&dopt=Abstract

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Learner characteristics associated with responses to film and interactive video lessons on smokeless tobacco. Author(s): Levenson PM, Morrow JR Jr. Source: Preventive Medicine. 1987 January; 16(1): 52-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3547386&dopt=Abstract

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Lessons reinforce the dangers of smokeless tobacco. Author(s): Haywood CC, Benson RA. Source: Rdh. 1993 April; 13(4): 20-4. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8332776&dopt=Abstract

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Locus of control and smokeless tobacco use among adolescents. Author(s): Dignan M, Block G, Steckler A, Howard G, Cosby M. Source: Adolescence. 1986 Summer; 21(82): 377-81. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3739832&dopt=Abstract

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Longitudinal patterns of cigarette smoking and smokeless tobacco use in youth: the Bogalusa Heart Study. Author(s): Hunter SM, Croft JB, Burke GL, Parker FC, Webber LS, Berenson GS. Source: American Journal of Public Health. 1986 February; 76(2): 193-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3484908&dopt=Abstract

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Long-term use of smokeless tobacco and physical performance in middle-aged men. Author(s): Bolinder G, Noren A, Wahren J, De Faire U. Source: European Journal of Clinical Investigation. 1997 May; 27(5): 427-33. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9179551&dopt=Abstract

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Marketing smokeless tobacco in California communities: implications for health education. Author(s): Braverman MT, D'Onofrio CN, Moskowitz JM. Source: Nci Monogr. 1989; (8): 79-85. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2785655&dopt=Abstract

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Measuring dependence in smokeless tobacco users. Author(s): Boyle RG, Jensen J, Hatsukami DK, Severson HH. Source: Addictive Behaviors. 1995 July-August; 20(4): 443-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7484325&dopt=Abstract

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Media manipulation of adolescents' personal level judgements regarding consequences of smokeless tobacco use. Author(s): Sussman S, Dent CW, Flay BR, Burton D, Craig S, Mestel-Rauch J, Holden S. Source: Journal of Drug Education. 1989; 19(1): 43-57. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2723951&dopt=Abstract

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Metabolites of a tobacco-specific nitrosamine, 4-(methylnitrosamino)- 1-(3-pyridyl)-1butanone (NNK), in the urine of smokeless tobacco users: relationship between urinary biomarkers and oral leukoplakia. Author(s): Kresty LA, Carmella SG, Borukhova A, Akerkar SA, Gopalakrishnan R, Harris RE, Stoner GD, Hecht SS. Source: Cancer Epidemiology, Biomarkers & Prevention : a Publication of the American Association for Cancer Research, Cosponsored by the American Society of Preventive Oncology. 1996 July; 5(7): 521-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8827356&dopt=Abstract

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Midproject findings from a study of the National Collegiate Athletic Association's policy on smokeless tobacco use. Author(s): Chakravorty B, Ahmed A, Buchanan RJ. Source: Substance Use & Misuse. 2000 August; 35(10): 1431-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10921433&dopt=Abstract

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Minor tobacco alkaloids as biomarkers for tobacco use: comparison of users of cigarettes, smokeless tobacco, cigars, and pipes. Author(s): Jacob P 3rd, Yu L, Shulgin AT, Benowitz NL. Source: American Journal of Public Health. 1999 May; 89(5): 731-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10224986&dopt=Abstract

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Modeling nicotine arterial-venous differences to predict arterial concentrations and input based on venous measurements: application to smokeless tobacco and nicotine gum. Author(s): Pitsiu M, Gries JM, Benowitz N, Gourlay SG, Verotta D. Source: Journal of Pharmacokinetics and Pharmacodynamics. 2002 August; 29(4): 383402. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12518710&dopt=Abstract

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Monitoring of smokeless tobacco consumers using cytogenetic endpoints. Author(s): Trivedi AH, Dave BJ, Adhvaryu SG. Source: Anticancer Res. 1993 November-December; 13(6A): 2245-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8297140&dopt=Abstract

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Morphologic and growth effects of tobacco-associated chemical carcinogens and smokeless tobacco extracts on human oral epithelial cells in culture. Author(s): Murrah VA, Gilchrist EP, Moyer MP. Source: Oral Surg Oral Med Oral Pathol. 1993 March; 75(3): 323-32. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8469543&dopt=Abstract

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Morphologic and immunohistochemical evidence of human papillomavirus capsid antigen in smokeless tobacco keratoses from juveniles and adults. Author(s): Greer RO Jr, Schroeder KL, Crosby L. Source: Journal of Oral and Maxillofacial Surgery : Official Journal of the American Association of Oral and Maxillofacial Surgeons. 1988 November; 46(11): 919-29. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2846804&dopt=Abstract

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Most smokeless tobacco use is not a causal gateway to cigarettes: using order of product use to evaluate causation in a national US sample. Author(s): Kozlowski LT, O'Connor RJ, Edwards BQ, Flaherty BP. Source: Addiction (Abingdon, England). 2003 August; 98(8): 1077-85. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12873242&dopt=Abstract

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Multivariate analysis of smokeless tobacco use by adolescents in grades four through twelve. Author(s): Bonaguro JA, Pugh M, Bonaguro EW. Source: Health Educ. 1986 April-May; 17(2): 4-7. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3152310&dopt=Abstract

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Native youth and smokeless tobacco: prevalence rates, gender differences, and descriptive characteristics. Author(s): Schinke SP, Schilling RF 2nd, Gilchrist LD, Ashby MR, Kitajima E. Source: Nci Monogr. 1989; (8): 39-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2785650&dopt=Abstract

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Nicotine absorption and cardiovascular effects with smokeless tobacco use: comparison with cigarettes and nicotine gum. Author(s): Benowitz NL, Porchet H, Sheiner L, Jacob P 3rd. Source: Clinical Pharmacology and Therapeutics. 1988 July; 44(1): 23-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3391001&dopt=Abstract

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Nicotine and smokeless tobacco effects on gingival and peripheral blood mononuclear cells. Author(s): Bernzweig E, Payne JB, Reinhardt RA, Dyer JK, Patil KD. Source: Journal of Clinical Periodontology. 1998 March; 25(3): 246-52. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9543195&dopt=Abstract

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Nicotine and smokeless tobacco. Author(s): Benowitz NL. Source: Ca: a Cancer Journal for Clinicians. 1988 July-August; 38(4): 244-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3135084&dopt=Abstract

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On smokeless tobacco, addictive behavior and warning labels. Author(s): Shaffer HJ. Source: Journal of Substance Abuse Treatment. 1986; 3(1): 41-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3735476&dopt=Abstract

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On the measurement of tobacco use by adolescents. Validity of self-reports of smokeless tobacco use and validity of cotinine as an indicator of cigarette smoking. Author(s): Bauman KE, Koch GG, Bryan ES, Haley NJ, Downton MI, Orlandi MA. Source: American Journal of Epidemiology. 1989 August; 130(2): 327-37. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2665477&dopt=Abstract

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Oral cancer and smokeless tobacco. Author(s): Elzay RP. Source: Va Med. 1987 February; 114(2): 84-90. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3564649&dopt=Abstract

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Oral effects of smokeless tobacco use by professional baseball players. Author(s): Robertson PB, Walsh MM, Greene JC. Source: Advances in Dental Research. 1997 September; 11(3): 307-12. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9524430&dopt=Abstract

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Oral effects of smokeless tobacco use. Author(s): Johnson R, Herzog A. Source: Dent Hyg (Chic). 1987 August; 61(8): 354-9. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3311838&dopt=Abstract

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Oral effects of smokeless tobacco--update. Author(s): McDaniels RK. Source: J Gt Houst Dent Soc. 1989 December; 61(5): 30-3. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2638852&dopt=Abstract

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Oral health effects of smokeless tobacco use in Navajo Indian adolescents. Author(s): Wolfe MD, Carlos JP. Source: Community Dentistry and Oral Epidemiology. 1987 August; 15(4): 230-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3476250&dopt=Abstract

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Oral leukoplakia and adolescent smokeless tobacco use. Author(s): Creath CJ, Cutter G, Bradley DH, Wright JT. Source: Oral Surg Oral Med Oral Pathol. 1991 July; 72(1): 35-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1891243&dopt=Abstract

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Oral leukoplakia status six weeks after cessation of smokeless tobacco use. Author(s): Martin GC, Brown JP, Eifler CW, Houston GD. Source: The Journal of the American Dental Association. 1999 July; 130(7): 945-54. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10422398&dopt=Abstract

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Oral manifestations of smokeless tobacco. Author(s): Duncan JM. Source: Tex Dent J. 1986 June; 103(6): 10-2. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3461572&dopt=Abstract

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Oral manifestations of the smokeless tobacco habit. Author(s): Hall EH, Terezhalmy GT. Source: Us Navy Med. 1984 May-June; 75(3): 4-6. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6592888&dopt=Abstract

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Oral mucosal changes and nicotine disposition in users of Swedish smokeless tobacco products: a comparative study. Author(s): Andersson G, Bjornberg G, Curvall M. Source: Journal of Oral Pathology & Medicine : Official Publication of the International Association of Oral Pathologists and the American Academy of Oral Pathology. 1994 April; 23(4): 161-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8046653&dopt=Abstract

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Oral mucosal changes related to smokeless tobacco usage: research findings in Scandinavia. Author(s): Axell TE. Source: European Journal of Cancer. Part B, Oral Oncology. 1993 October; 29B(4): 299302. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11706425&dopt=Abstract

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Oral mucosal lesions found in smokeless tobacco users. Author(s): Grady D, Greene J, Daniels TE, Ernster VL, Robertson PB, Hauck W, Greenspan D, Greenspan J, Silverman S Jr. Source: The Journal of the American Dental Association. 1990 July; 121(1): 117-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2370378&dopt=Abstract

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Oral mucosal lesions in smokeless tobacco users. Author(s): Holmstrup P, Pindborg JJ. Source: Ca: a Cancer Journal for Clinicians. 1988 July-August; 38(4): 230-5. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3135082&dopt=Abstract

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Oral mucosal smokeless tobacco lesions among adolescents in the United States. Author(s): Tomar SL, Winn DM, Swango PA, Giovino GA, Kleinman DV. Source: Journal of Dental Research. 1997 June; 76(6): 1277-86. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9168861&dopt=Abstract

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Oral tissue alterations associated with the use of smokeless tobacco by teen-agers. Part I. Clinical findings. Author(s): Greer RO Jr, Poulson TC. Source: Oral Surg Oral Med Oral Pathol. 1983 September; 56(3): 275-84. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6195576&dopt=Abstract

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Overreporting of smokeless tobacco use by adolescent males. Author(s): Cohen SJ, Katz BP, Drook CA, Christen AG, McDonald JL, Olson BL, Cloys LA, Stookey GK. Source: Journal of Behavioral Medicine. 1988 August; 11(4): 383-93. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3266254&dopt=Abstract

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P.L. 99-252 and the roles of state and local governments in decreasing smokeless tobacco use. Author(s): Capwell EM. Source: J Public Health Dent. 1990 Winter; 50(1): 70-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2296005&dopt=Abstract

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Pacific northwest native American youth and smokeless tobacco use. Author(s): Schinke SP, Schilling RF 2nd, Gilchrist LD, Ashby MR, Kitajima E. Source: Int J Addict. 1987 September; 22(9): 881-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3500137&dopt=Abstract

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Parent characteristics, perceived health risk, and smokeless tobacco use among white adolescent males. Author(s): Bauman KE, Koch GG, Lentz GM. Source: Nci Monogr. 1989; (8): 43-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2716854&dopt=Abstract

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Pathologic quiz case: a 30-year-old man with a white plaque in the oral mucosa. Smokeless tobacco keratosis. Author(s): Sheth PD, Youngberg GA. Source: Archives of Pathology & Laboratory Medicine. 2004 January; 128(1): E17-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14692835&dopt=Abstract

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Patterns and correlates of smoking and smokeless tobacco use among continuation high school students. Author(s): de Moor C, Johnston DA, Werden DL, Elder JP, Senn K, Whitehorse L. Source: Addictive Behaviors. 1994 March-April; 19(2): 175-84. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8036964&dopt=Abstract

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Patterns and prevalence of smokeless tobacco use by high school seniors in New York. Author(s): Olds RS. Source: The Journal of School Health. 1988 November; 58(9): 374-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3230878&dopt=Abstract

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Patterns of cigarette and smokeless tobacco use among children and adolescents. Author(s): Brownson RC, DiLorenzo TM, Van Tuinen M, Finger WW. Source: Preventive Medicine. 1990 March; 19(2): 170-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2359740&dopt=Abstract

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Patterns of smokeless tobacco use among university athletes. Author(s): Levenson-Gingiss P, Morrow JR Jr, Dratt LM. Source: Journal of American College Health : J of Ach. 1989 September; 38(2): 87-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2778229&dopt=Abstract

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Patterns of smokeless tobacco use in a population of high school students. Author(s): Marty PJ, McDermott RJ, Williams T. Source: American Journal of Public Health. 1986 February; 76(2): 190-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3946700&dopt=Abstract

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Perceived smokeless tobacco addiction among adolescents. Author(s): Riley WT, Barenie JT, Woodard CE, Mabe PA. Source: Health Psychology : Official Journal of the Division of Health Psychology, American Psychological Association. 1996 July; 15(4): 289-92. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8818675&dopt=Abstract

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Periodontal effects associated with the use of smokeless tobacco. Author(s): Robertson PB, Walsh M, Greene J, Ernster V, Grady D, Hauck W. Source: J Periodontol. 1990 July; 61(7): 438-43. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2388141&dopt=Abstract

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Personality and smokeless tobacco use. Author(s): Jacobs GA, Neufeld VA, Sayers S, Spielberger CD, Weinberg H. Source: Addictive Behaviors. 1988; 13(4): 311-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3239462&dopt=Abstract

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Personality profiles associated with smokeless tobacco use patterns. Author(s): Edmundson EW, Glover ED, Holbert D, Alston PP, Schroeder KL. Source: Addictive Behaviors. 1988; 13(2): 219-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3369335&dopt=Abstract

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Personality traits of smokeless tobacco users and nonusers: a comparison. Author(s): Edmundson EW, Glover ED, Alston PP, Holbert D. Source: Int J Addict. 1987 July; 22(7): 671-83. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3623750&dopt=Abstract

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Physiologic and subjective changes from smokeless tobacco withdrawal. Author(s): Hatsukami DK, Gust SW, Keenan RM. Source: Clinical Pharmacology and Therapeutics. 1987 January; 41(1): 103-7. Erratum In: Clin Pharmacol Ther 1989 March; 45(3): 284. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3802698&dopt=Abstract

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Pilot evaluation of a population-based health intervention for reducing use of smokeless tobacco. Author(s): Cigrang JA, Severson HH, Peterson AL. Source: Nicotine & Tobacco Research : Official Journal of the Society for Research on Nicotine and Tobacco. 2002 February; 4(1): 127-31. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11906689&dopt=Abstract

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Placebo control study of acute smokeless tobacco abstinence in young adult men. Author(s): Gire JT, Eissenberg T. Source: Psychology of Addictive Behaviors : Journal of the Society of Psychologists in Addictive Behaviors. 2000 December; 14(4): 356-66. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11130154&dopt=Abstract

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Practicing dentist and smokeless tobacco. Author(s): Burleson JA, Kegeles SS, Miozza J. Source: Compendium. 1990 October; 11(10): 629-32. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2088614&dopt=Abstract

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Prevalence and correlates of smokeless tobacco use in a sample of Connecticut students. Author(s): Coogan PF, Geller A, Adams M. Source: Journal of Adolescence. 2000 April; 23(2): 129-35. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10831138&dopt=Abstract

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Prevalence and patterns of smokeless tobacco use in a southeastern university. Author(s): Glover ED, Edmundson EW, Alston PP, Holbert D, Schroeder KL. Source: Journal of Drug Education. 1987; 17(3): 201-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3681594&dopt=Abstract

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Prevalence and predictors of smokeless tobacco use: Iowa's program against smoking. Author(s): Burke JA, Arbogast R, Becker SL, Naughton M, Lauer RM. Source: Nci Monogr. 1989; (8): 71-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2785654&dopt=Abstract

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Prevalence of cigarette and smokeless tobacco use among students in rural Oregon. Author(s): Salehi SO, Elder NC. Source: Family Medicine. 1995 February; 27(2): 122-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7737445&dopt=Abstract

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Prevalence of smokeless tobacco consumption at a southwestern university. Author(s): Lopez LC. Source: Psychological Reports. 1990 August; 67(1): 225-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2236401&dopt=Abstract

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Prevalence of smokeless tobacco use in Pitt County, North Carolina. Author(s): Glover ED, O'Brien K, Holbert D. Source: Int J Addict. 1987 June; 22(6): 557-65. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3679628&dopt=Abstract

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Proposed definition of a smokeless tobacco user based on “potential” nicotine consumption. Author(s): Schroeder KL, Chen MS Jr, Iaderosa GR, Glover ED, Edmundson EW. Source: Addictive Behaviors. 1988; 13(4): 395-400. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3239472&dopt=Abstract

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Prospective correlates of exclusive or combined adolescent use of cigarettes and smokeless tobacco: a replication-extension. Author(s): Simon TR, Sussman S, Dent CW, Burton D, Flay BR. Source: Addictive Behaviors. 1995 July-August; 20(4): 517-24. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7484333&dopt=Abstract

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Prostaglandin E2 and interleukin-1 levels in smokeless tobacco-induced oral mucosal lesions. Author(s): Johnson GK, Poore TK, Squier CA, Wertz PW, Reinhardt RA, Vincent SD. Source: Journal of Periodontal Research. 1994 November; 29(6): 430-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7877079&dopt=Abstract

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Protective effects of antioxidants against smokeless tobacco-induced oxidative stress and modulation of Bcl-2 and p53 genes in human oral keratinocytes. Author(s): Bagchi M, Kuszynski CA, Balmoori J, Joshi SS, Stohs SJ, Bagchi D. Source: Free Radical Research. 2001 August; 35(2): 181-94. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11697199&dopt=Abstract

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Psychosocial factors in the use of smokeless tobacco and their implications for P.L. 99252. Author(s): Severson HH. Source: J Public Health Dent. 1990 Winter; 50(1): 90-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2404114&dopt=Abstract

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Psychosocial factors influencing smokeless tobacco use by teen-age military dependents. Author(s): Lee S, Raker T, Chisick MC. Source: Military Medicine. 1994 February; 159(2): 112-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8202235&dopt=Abstract

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Quantitation of metabolites of 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone after cessation of smokeless tobacco use. Author(s): Hecht SS, Carmella SG, Ye M, Le KA, Jensen JA, Zimmerman CL, Hatsukami DK. Source: Cancer Research. 2002 January 1; 62(1): 129-34. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11782369&dopt=Abstract

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Re: chronic disease mortality in a cohort of smokeless tobacco users. Author(s): Ebbert JO, Yang P, Tomar SL. Source: American Journal of Epidemiology. 2003 November 15; 158(10): 1021; Author Reply 1021-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14607811&dopt=Abstract

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Re: Turkish smokeless tobacco “Maras Powder”. Author(s): Erenmemisoglu A. Source: Preventive Medicine. 1999 June; 28(6): 616-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10404560&dopt=Abstract

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Recall of health warnings in smokeless tobacco ads. Author(s): Truitt L, Hamilton WL, Johnston PR, Bacani CP, Crawford SO, Hozik L, Celebucki C. Source: Tobacco Control. 2002 June; 11 Suppl 2: Ii59-63. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12034984&dopt=Abstract

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Reduction of Langerhans cells in smokeless tobacco-associated oral mucosal lesions. Author(s): Daniels TE, Chou L, Greenspan JS, Grady DG, Hauck WW, Greene JC, Ernster VL. Source: Journal of Oral Pathology & Medicine : Official Publication of the International Association of Oral Pathologists and the American Academy of Oral Pathology. 1992 March; 21(3): 100-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1374796&dopt=Abstract

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Regular smokeless tobacco use is not a reliable predictor of smoking onset when psychosocial predictors are included in the model. Author(s): O'Connor RJ, Flaherty BP, Quinio Edwards B, Kozlowski LT. Source: Nicotine & Tobacco Research : Official Journal of the Society for Research on Nicotine and Tobacco. 2003 August; 5(4): 535-43. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12959791&dopt=Abstract

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Relationship between cigarette, smokeless tobacco, and cigar use, and other health risk behaviors among U.S. high school students. Author(s): Everett SA, Malarcher AM, Sharp DJ, Husten CG, Giovino GA. Source: The Journal of School Health. 2000 August; 70(6): 234-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10937370&dopt=Abstract

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Relationship between physical activity level and cigarette, smokeless tobacco, and marijuana use among public high school adolescents. Author(s): Winnail SD, Valois RF, McKeown RE, Saunders RP, Pate RR. Source: The Journal of School Health. 1995 December; 65(10): 438-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8789710&dopt=Abstract

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Research on the sale of smokeless tobacco to adolescents. Author(s): Xaverius PK, Billows WD, Jason LA, King C. Source: Tobacco Control. 1996 Spring; 5(1): 69-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8795864&dopt=Abstract

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Resources for smokeless tobacco education. Author(s): Laflin M, Glover ED, McKenzie JF. Source: The Journal of School Health. 1987 May; 57(5): 191-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3647191&dopt=Abstract

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Results of a self-help pilot study for smokeless tobacco users. Author(s): Boyle RG, Hatsukami DK. Source: American Journal of Preventive Medicine. 1996 November-December; 12(6): 447. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8955773&dopt=Abstract

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Review of the evidence that pH is a determinant of nicotine dosage from oral use of smokeless tobacco. Author(s): Tomar SL, Henningfield JE. Source: Tobacco Control. 1997 Autumn; 6(3): 219-25. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9396107&dopt=Abstract

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Role of nitric oxide in the induction of apoptosis by smokeless tobacco extract. Author(s): Mangipudy RS, Vishwanatha JK. Source: Molecular and Cellular Biochemistry. 1999 October; 200(1-2): 51-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10569183&dopt=Abstract

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Sister-chromatid exchange inducing effect of smokeless tobacco using on Tlymphocyte chromosomes. Author(s): Ozkul Y, Erenmemisoglu A, Cucer N, Menevse A, Saatci CA. Source: Mutation Research. 1995 April; 334(2): 209-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7885374&dopt=Abstract

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Smokeless tobacco and cardiovascular disease. Author(s): Asplund K. Source: Progress in Cardiovascular Diseases. 2003 March-April; 45(5): 383-94. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12704595&dopt=Abstract

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Smokeless tobacco and cigarette use among black secondary school students in South Africa. Author(s): Peltzer K. Source: Substance Use & Misuse. 2003 June; 38(7): 1003-16. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12801153&dopt=Abstract

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Smokeless tobacco and oral disease. Author(s): Singleton JC. Source: Alaska Med. 1996 January-March; 38(1): 35, 51. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8936102&dopt=Abstract

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Smokeless tobacco and oral leukoplakia. Author(s): Towle WM. Source: Aviation, Space, and Environmental Medicine. 1996 July; 67(7): 662-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8967889&dopt=Abstract

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Smokeless tobacco as a possible risk factor for stroke in men: a nested case-control study. Author(s): Asplund K, Nasic S, Janlert U, Stegmayr B. Source: Stroke; a Journal of Cerebral Circulation. 2003 July; 34(7): 1754-9. Epub 2003 May 29. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12775887&dopt=Abstract

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Smokeless tobacco as a smoking cessation strategy. Author(s): Rodu B. Source: Adv Nurse Pract. 2003 July; 11(7): 18; Author Reply 18. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12886730&dopt=Abstract

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Smokeless tobacco cessation: report of a preliminary trial using nicotine chewing gum. Author(s): Sinusas K, Coroso JG. Source: The Journal of Family Practice. 1993 September; 37(3): 264-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8409878&dopt=Abstract

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Smokeless tobacco consumption by Mexican-American University students. Author(s): Lopez LC. Source: Psychological Reports. 1994 August; 75(1 Pt 1): 279-84. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7984739&dopt=Abstract

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Smokeless tobacco consumption by Mexican-Americans and Anglo-Americans in southwestern New Mexico. Author(s): Lopez LC, Sanchez-Rico K. Source: Int J Addict. 1994 August; 29(10): 1305-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7995673&dopt=Abstract

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Smokeless tobacco effects on monocyte secretion of PGE2 and IL-1 beta. Author(s): Payne JB, Johnson GK, Reinhardt RA, Maze CR, Dyer JK, Patil KD. Source: J Periodontol. 1994 October; 65(10): 937-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7823275&dopt=Abstract

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Smokeless tobacco usage associated with oral carcinoma. Incidence, treatment, outcome. Author(s): Wray A, McGuirt WF. Source: Archives of Otolaryngology--Head & Neck Surgery. 1993 September; 119(9): 929-33. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8357593&dopt=Abstract

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Smokeless tobacco usage: a growing and menacing addiction among Hoosier children and young adults. Author(s): Christen AG. Source: Indiana Med. 1996 March-April; 89(2): 176-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8867418&dopt=Abstract

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Smokeless tobacco use among adults in Kentucky: 1994. Author(s): McKnight RH, Koetke CA, Mays JR. Source: J Ky Med Assoc. 1995 October; 93(10): 459-64. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8558056&dopt=Abstract

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Smokeless tobacco use among rural Kadazan women in Sabah, Malaysia. Author(s): Gan CY. Source: Southeast Asian J Trop Med Public Health. 1995 June; 26(2): 291-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8629063&dopt=Abstract

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Smokeless tobacco use and increased cardiovascular mortality among Swedish construction workers. Author(s): Bolinder G, Alfredsson L, Englund A, de Faire U. Source: American Journal of Public Health. 1994 March; 84(3): 399-404. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8129055&dopt=Abstract

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Smokeless tobacco use and oral cancer. Author(s): Gupta PC, Sankaranarayanan R, Vainio H. Source: European Journal of Cancer. Part B, Oral Oncology. 1994 September; 30B(5): 3656. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7703809&dopt=Abstract

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Smokeless tobacco use is a significant predictor of smoking when appropriately modeled. Author(s): Tomar SL. Source: Nicotine & Tobacco Research : Official Journal of the Society for Research on Nicotine and Tobacco. 2003 August; 5(4): 571-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12959795&dopt=Abstract

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Smokeless tobacco use: how it affects the performance of major league baseball players. Author(s): Robertson PB, DeRouen TA, Ernster V, Grady D, Greene J, Mancl L, McDonald D, Walsh MM. Source: The Journal of the American Dental Association. 1995 August; 126(8): 1115-21; Discussion 1121-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7560568&dopt=Abstract

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Smokeless tobacco. Author(s): Ten Pas WS. Source: Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics. 1996 April; 81(4): 376-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8705576&dopt=Abstract

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Smokeless tobacco. Author(s): Dunlap C. Source: Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics. 1996 April; 81(4): 376; Author Reply 377. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8705575&dopt=Abstract

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Smokeless tobacco. Author(s): Pershagen G. Source: British Medical Bulletin. 1996 January; 52(1): 50-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8746296&dopt=Abstract

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Smokeless tobacco. Author(s): Castiglia PT. Source: Journal of Pediatric Health Care : Official Publication of National Association of Pediatric Nurse Associates & Practitioners. 1994 November-December; 8(6): 274-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7799202&dopt=Abstract

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Smokeless tobacco. Author(s): Shedden AI, Johnson MH. Source: Ajr. American Journal of Roentgenology. 1994 February; 162(2): 470-1. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8310959&dopt=Abstract

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Smokeless tobacco. Author(s): DelGrippo G Jr. Source: The Journal of Family Practice. 1994 January; 38(1): 14. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8289044&dopt=Abstract

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Smokeless tobacco: epidemiology, health effects and cessation strategies. Author(s): Spangler JG, Salisbury PL 3rd. Source: American Family Physician. 1995 October; 52(5): 1421-30, 1433-4. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7572565&dopt=Abstract

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Smokeless tobacco: friend or foe? Author(s): Britton J. Source: Addiction (Abingdon, England). 2003 September; 98(9): 1199-201; Discussion 1204-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12930205&dopt=Abstract

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Smokeless tobacco--a challenging smoke. Author(s): Bhatia RS. Source: J Assoc Physicians India. 1994 April; 42(4): 344. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7860568&dopt=Abstract

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Snuffing it out: a smokeless tobacco intervention with athletes at a small private college. Author(s): Darmody DL, Ehrich B. Source: Journal of American College Health : J of Ach. 1994 July; 43(1): 27-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8077520&dopt=Abstract

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Surveying smokeless tobacco use, oral lesions and cessation among high school boys. Author(s): Daughety VS, Levy SM, Ferguson KJ, Pomrehn PR, Becker SL. Source: The Journal of the American Dental Association. 1994 February; 125(2): 173-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8113525&dopt=Abstract

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The acute effects of smokeless tobacco (snuff) on gingival blood flow in man. Author(s): Mavropoulos A, Aars H, Brodin P. Source: Journal of Periodontal Research. 2001 August; 36(4): 221-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11519694&dopt=Abstract

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The acute effects of smokeless tobacco on transport and barrier function of buccal mucosa. Author(s): Tobey NA, Schreiner VJ, Readling RD, Orlando RC. Source: Journal of Dental Research. 1988 November; 67(11): 1414-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3183160&dopt=Abstract

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The American Academy of Oral Medicine has adopted a position condemning the use of smokeless tobacco products. Author(s): Eskow RN. Source: Head Neck Surg. 1988 January-February; 10(3): 204. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3235348&dopt=Abstract

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The American Academy of Oral Medicine on the use of smokeless tobacco. Author(s): Eskow RN. Source: J Public Health Dent. 1988 Winter; 48(1): 6. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3422319&dopt=Abstract

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The effects of short-term smokeless tobacco deprivation on performance. Author(s): Keenan RM, Hatsukami DK, Anton DJ. Source: Psychopharmacology. 1989; 98(1): 126-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2498956&dopt=Abstract

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The effects of smokeless tobacco on clinical parameters of inflammation and gingival crevicular fluid prostaglandin E2, interleukin-1 alpha, and interleukin-1 beta. Author(s): Poore TK, Johnson GK, Reinhardt RA, Organ CC. Source: J Periodontol. 1995 March; 66(3): 177-83. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7776161&dopt=Abstract

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The FDA's enforcement of age restrictions on the sale of cigarettes and smokeless tobacco. Author(s): Natanblut SL, Mital M, Zeller MR. Source: Journal of Public Health Management and Practice : Jphmp. 2001 May; 7(3): 1-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11338081&dopt=Abstract

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The hazardous effects of smokeless tobacco on the oral cavity. Author(s): Dietz ER. Source: Dental Assistant (Chicago, Ill. : 1994). 1987 March-April; 56(2): 7-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3470216&dopt=Abstract

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The inside scoop on the stuff called snuff: an interview study of 94 adult male smokeless tobacco users. Author(s): Severson HH, Eakin EG, Lichtenstein E, Stevens VJ. Source: Journal of Substance Abuse. 1990; 2(1): 77-85. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2136105&dopt=Abstract

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The nature of smokeless tobacco and patterns of use. Author(s): Squier CA. Source: Ca: a Cancer Journal for Clinicians. 1988 July-August; 38(4): 226-9. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3135081&dopt=Abstract

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The need to identify smokeless tobacco users. Author(s): Ricer R. Source: American Family Physician. 1995 October; 52(5): 1271-2, 1274. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7572546&dopt=Abstract

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The oral effects of smokeless tobacco. Author(s): Walsh PM, Epstein JB. Source: Journal (Canadian Dental Association). 2000 January; 66(1): 22-5. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10680329&dopt=Abstract

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The organizational implications of smokeless tobacco use in the lumber mill industry. Author(s): Donaldson SI, Dent CW, Sussman S, Stoddard JL, Severson HH. Source: Addictive Behaviors. 1996 March-April; 21(2): 259-67. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8730529&dopt=Abstract

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The patterns and predictors of smokeless tobacco onset among urban public school teenagers. Author(s): Hu FB, Hedeker D, Flay BR, Sussman S, Day LE, Siddiqui O. Source: American Journal of Preventive Medicine. 1996 January-February; 12(1): 22-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8776291&dopt=Abstract

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The prevalence of smokeless tobacco use among adolescent male athletes. Author(s): Creath CJ, Shelton WO, Wright JT, Bradley DH, Feinstein RA, Wisniewski JF. Source: The Journal of the American Dental Association. 1988 January; 116(1): 43-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3422665&dopt=Abstract

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The prevalence of smokeless tobacco use in native children in northern Saskatchewan, Canada. Author(s): Hoover J, McDermott R, Hartsfield T. Source: Canadian Journal of Public Health. Revue Canadienne De Sante Publique. 1990 September-October; 81(5): 350-2. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2253151&dopt=Abstract

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The prevalence, attitudes and perceptions of smokeless tobacco use by 5th, 8th and 11th grade urban boys in central Indiana. Author(s): Lucas BK, Christen AG. Source: J Indiana Dent Assoc. 1988 May-June; 67(3): 9-15. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3216249&dopt=Abstract

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The reemergence of smokeless tobacco. Implications for dental hygiene practice. Author(s): McDermott RJ, Clark BJ, McCormack KR. Source: Dent Hyg (Chic). 1987 August; 61(8): 348-53. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3311837&dopt=Abstract

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The role of race and ethnic status on the psychosocial correlates of smokeless tobacco use in adolescent males. Author(s): Riley WT, Barenie JT, Mabe PA, Myers DR. Source: The Journal of Adolescent Health : Official Publication of the Society for Adolescent Medicine. 1991 January; 12(1): 15-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2007147&dopt=Abstract

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The smokeless tobacco problem. Author(s): Melrose RJ. Source: Cda J. 1987 February; 15(2): 23-7. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3467857&dopt=Abstract

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The smokeless tobacco 'time bomb'. Author(s): Christen AG, McDaniel RK, McDonald JL Jr. Source: Postgraduate Medicine. 1990 May 15; 87(7): 69-74. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2188242&dopt=Abstract

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The social image of smokeless tobacco use in three different types of teenagers. Author(s): Chassin L, Presson CC, Sherman SJ, Margolis S. Source: Addictive Behaviors. 1988; 13(1): 107-12. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3364218&dopt=Abstract

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The spitting image of smokeless tobacco. Author(s): Fisher L. Source: Cancer Causes & Control : Ccc. 2000 October; 11(9): 877-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11075879&dopt=Abstract

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Thromboangiitis obliterans (Buerger's disease) and smokeless tobacco. Author(s): Lie JT. Source: Arthritis and Rheumatism. 1988 June; 31(6): 812-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3382454&dopt=Abstract

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Thromboangiitis obliterans (Buerger's disease) and smokeless tobacco. Author(s): O'Dell JR, Linder J, Markin RS, Moore GF. Source: Arthritis and Rheumatism. 1987 September; 30(9): 1054-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3663253&dopt=Abstract

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Topographical features of smokeless tobacco use. Author(s): Hatsukami DK, Keenan RM, Anton DJ. Source: Psychopharmacology. 1988; 96(3): 428-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3146780&dopt=Abstract

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Treating cigarette smoking with smokeless tobacco: a flawed recommendation. Author(s): Jorenby DE, Fiore MC, Smith SS, Baker TB. Source: The American Journal of Medicine. 1998 May; 104(5): 499-500. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9626037&dopt=Abstract

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Treatment of smokeless tobacco addiction with bupropion and behavior modification. Author(s): Berigan TR, Deagle EA 3rd. Source: Jama : the Journal of the American Medical Association. 1999 January 20; 281(3): 233. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9918477&dopt=Abstract

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Two biochemical markers effectively used to separate smokeless tobacco users from smokers and nonusers. Author(s): Holiday DB, McLarty JW, Yanagihara RH, Riley L, Shepherd SB. Source: Southern Medical Journal. 1995 November; 88(11): 1107-13. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7481979&dopt=Abstract

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Typology and correlates of smokeless tobacco use. Author(s): Riley WT, Barenie JT, Myers DR. Source: J Adolesc Health Care. 1989 September; 10(5): 357-62. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2808079&dopt=Abstract

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U of Alabama smokeless tobacco study under fire. Author(s): Nelson C. Source: Journal of the National Cancer Institute. 1994 August 17; 86(16): 1193. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8040885&dopt=Abstract

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Undocumented smokeless tobacco use in a family practice population. Author(s): Feierabend RH Jr. Source: Southern Medical Journal. 1997 December; 90(12): 1225-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9404910&dopt=Abstract

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Urinary cotinine levels of smokeless tobacco (Maras powder) users. Author(s): Cok I, Ozturk R. Source: Human & Experimental Toxicology. 2000 November; 19(11): 650-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11211244&dopt=Abstract

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Use in 1992 of tranquilizers and smokeless tobacco among Miami's public school students. Author(s): Yarnold BM. Source: Psychological Reports. 1999 February; 84(1): 218-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10203954&dopt=Abstract

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Use of smokeless tobacco among adolescents. Author(s): Berman EJ, Fischer PM, Richards JW Jr, Strickman-Levitas B. Source: Jama : the Journal of the American Medical Association. 1986 June 20; 255(23): 3245. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3712673&dopt=Abstract

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Use of smokeless tobacco among children and adolescents in the United States. Author(s): Boyd G. Source: Preventive Medicine. 1987 May; 16(3): 402-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3588578&dopt=Abstract

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Use of smokeless tobacco among conscripts: a cross-sectional study of Norwegian army conscripts. Author(s): Schei E, Fonnebo V, Aaro LE. Source: Preventive Medicine. 1990 November; 19(6): 667-74. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2263577&dopt=Abstract

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Use of smokeless tobacco among male adolescents: concurrent and prospective relationships. Author(s): Ary DV. Source: Nci Monogr. 1989; (8): 49-55. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2785651&dopt=Abstract

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Use of smokeless tobacco and cigarettes--effects on plasma levels of antioxidant vitamins. Author(s): Stegmayr B, Johansson I, Huhtasaari F, Moser U, Asplund K. Source: Int J Vitam Nutr Res. 1993; 63(3): 195-200. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8300330&dopt=Abstract

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Use of smokeless tobacco by age, race, and gender in ten standard metropolitan statistical areas of the southeast United States. Author(s): Bauman KE, Koch GG, Fisher LA, Bryan ES. Source: Nci Monogr. 1989; (8): 35-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2785649&dopt=Abstract

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Use of smokeless tobacco by Mexican-American high school students. Author(s): Lopez LC, Hamlin PA. Source: Psychological Reports. 1995 December; 77(3 Pt 1): 808-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8559918&dopt=Abstract

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Use of smokeless tobacco by young adult females. Author(s): Boyle RG, Gerend MA, Peterson CB, Hatsukami DK. Source: Journal of Substance Abuse. 1998; 10(1): 19-25. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9720003&dopt=Abstract

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Use of smokeless tobacco in a group of professional baseball players. Author(s): Cummings KM, Michalek AM, Carl W, Wood R, Haley NJ. Source: Journal of Behavioral Medicine. 1989 December; 12(6): 559-67. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2634109&dopt=Abstract

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Use of smokeless tobacco in major-league baseball. Author(s): Ernster VL, Grady DG, Greene JC. Source: The New England Journal of Medicine. 1988 October 13; 319(15): 1015. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3419470&dopt=Abstract

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Use of smokeless tobacco in major-league baseball. Author(s): Connolly GN, Orleans CT, Kogan M. Source: The New England Journal of Medicine. 1988 May 12; 318(19): 1281-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3362186&dopt=Abstract

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Use of smokeless tobacco in the 1986 World Series. Author(s): Jones RB. Source: The New England Journal of Medicine. 1987 April 9; 316(15): 952. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3821849&dopt=Abstract

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Use of smokeless tobacco in the United States: recent estimates from the current population survey. Author(s): Marcus AC, Crane LA, Shopland DR, Lynn WR. Source: Nci Monogr. 1989; (8): 17-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2785646&dopt=Abstract

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Use of smokeless tobacco in the World Series, 1986 through 1993. Author(s): Jones RB. Source: American Journal of Public Health. 1995 January; 85(1): 117-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7832247&dopt=Abstract

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Use of smokeless tobacco is condemned. Author(s): Eskow RN. Source: Postgraduate Medicine. 1987 December; 82(8): 40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3684825&dopt=Abstract

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Use of smokeless tobacco products. Author(s): Eskow RN. Source: Otolaryngology and Head and Neck Surgery. 1988 March; 98(3): 267. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3155444&dopt=Abstract

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Use of smokeless tobacco, cigarette smoking, and hypercholesterolemia. Author(s): Tucker LA. Source: American Journal of Public Health. 1989 August; 79(8): 1048-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2751026&dopt=Abstract

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Utility of the PRECEDE model in differentiating users and nonusers of smokeless tobacco. Author(s): Polcyn MM, Price JH, Jurs SG, Roberts SM. Source: The Journal of School Health. 1991 April; 61(4): 166-71. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1857107&dopt=Abstract

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Visuo-motor adaptation in smokeless tobacco users. Author(s): Contreras-Vidal JL, Van den Heuvel CE, Teulings HL, Stelmach GE. Source: Nicotine & Tobacco Research : Official Journal of the Society for Research on Nicotine and Tobacco. 1999 September; 1(3): 219-27. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11072418&dopt=Abstract

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What have we learned from 20 years of research on smokeless tobacco cessation? Author(s): Severson HH. Source: The American Journal of the Medical Sciences. 2003 October; 326(4): 206-11. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14557736&dopt=Abstract

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Who enrolls in a self-help cessation program for smokeless tobacco? Author(s): Andrews JA, Severson HH, Akers L, Lichtenstein E, Barckley M. Source: Addictive Behaviors. 2001 September-October; 26(5): 757-64. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11676385&dopt=Abstract

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CHAPTER 2. NUTRITION AND SMOKELESS TOBACCO Overview In this chapter, we will show you how to find studies dedicated specifically to nutrition and smokeless tobacco.

Finding Nutrition Studies on Smokeless Tobacco The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements; National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: 301-435-2920, Fax: 301-480-1845, E-mail: [email protected]). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.7 The IBIDS includes references and citations to both human and animal research studies. As a service of the ODS, access to the IBIDS database is available free of charge at the following Web address: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. Now that you have selected a database, click on the “Advanced” tab. An advanced search allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “smokeless tobacco” (or synonyms) into the search box, and click “Go.” To narrow the search, you can also select the “Title” field.

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Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.

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The following information is typical of that found when using the “Full IBIDS Database” to search for “smokeless tobacco” (or a synonym): •

An interpretative review of smokeless tobacco research in the United States: Part II. Source: Glover, E D Schroeder, K L Henningfield, J E Severson, H H Christen, A G JDrug-Educ. 1989; 19(1): 1-19 0047-2379

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Characteristics of smokeless tobacco users seeking treatment. Author(s): Department of Psychiatry, University of Minnesota, Minneapolis 55455, USA. [email protected] Source: Hatsukami, D K Jensen, J Boyle, R Grillo, M Bliss, R Addict-Behavolume 1999 Jul-August; 24(4): 551-7 0306-4603

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Eating behavior and weight control among women using smokeless tobacco, cigarettes, and normal controls. Author(s): University of Minnesota, USA. Source: Gerend, M A Boyle, R G Peterson, C B Hatsukami, D K Addict-Behavolume 1998 Mar-April; 23(2): 171-8 0306-4603

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Effect of non-nicotinic moist snuff replacement and lobeline on withdrawal symptoms during 48-h smokeless tobacco deprivation. Author(s): Department of Psychology, University of Illinois at Chicago, 1007 W Harrison Street, Chicago, IL 60607-7137, USA. [email protected] Source: McChargue, Dennis E Collins, Frank L Jr Cohen, Lee M Nicotine-Tob-Res. 2002 May; 4(2): 195-200 1462-2203

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Effects of smokeless tobacco on the ability of secretory component to bind to the IgA/J chain complex. Author(s): Department of Oral Biology, Emory University, Atlanta, Georgia 30322. Source: Gregory, R L Kindle, J C Hobbs, L C VanTo, T Malmstrom, H S HumAntibodies-Hybridomas. 1990; 1(3): 126-31 0956-960X

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Evaluation of the effect of smokeless tobacco purified products and extracts on latent Epstein-Barr virus. Author(s): Department of Pediatrics, The University of Texas Health Science Center at San Antonio, 78284-7811, USA. [email protected] Source: Jenson, H B Heard, P Moyer, M P Toxicology. 1999 March 1; 133(1): 35-42 0300483X

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Health risks and nutritional implications of smokeless tobacco. Source: Environ-Nutr-Newsl. New York : Environmental Nutrition, Inc. June 1985. volume 8 (6) page 1-2, 5. 0195-4024

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High frequency mutation in codons 12 and 61 of H-ras oncogene in chewing tobaccorelated human oral carcinoma in India. Author(s): Cell and Developmental Pathology Division, Cancer Research Institute, Bombay, India. Source: Saranath, D Chang, S E Bhoite, L T Panchal, R G Kerr, I B Mehta, A R Johnson, N W Deo, M G Br-J-Cancer. 1991 April; 63(4): 573-8 0007-0920

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Histological alterations following short-term smokeless tobacco exposure in humans. Author(s): Department of Surgical Specialties, University of Nebraska Medical Center, College of Dentistry, Lincoln 68583-0757, USA. Source: Payne, J B Johnson, G K Reinhardt, R A Schmid, M J-Periodontal-Res. 1998 July; 33(5): 274-9 0022-3484

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Implications of smokeless tobacco use in athletes. Author(s): Department of Diagnostic Services, School of Dental Medicine, University of Pittsburgh, Pennsylvania. Source: Guggenheimer, J Dent-Clin-North-Am. 1991 October; 35(4): 797-808 0011-8532

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Initial characterization of the complement activating compounds in extracts of smokeless tobacco. Author(s): Department of Pathology, School of Medicine, State University of New York at Stony Brook 11794-8691, USA. Source: Chan, W S Chowdhry, S Chang, T Kew, R R Immunobiology. 1999 September; 201(1): 64-73 0171-2985

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Notice regarding requirement for annual submission of the quantity of nicotine contained in smokeless tobacco products manufactured, imported, or packaged in the United States. Centers for Disease Control and Prevention (CDC), Department of Health and Human Services. Notice. Source: Anonymous Fed-Regist. 1999 March 23; 64(55): 14085-96 0097-6326

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Ohio dental association not giving lip service to new smokeless tobacco product. Source: Anonymous Oncology-(Huntingt). 2001 November; 15(11): 1390 0890-9091

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Oral mucosal findings associated with chewing tobacco in Sweden--a clinical and histological study. Author(s): Lund University, Malmo, Sweden. Source: Axell, T Andersson, G Larsson, A J-Dent-Assoc-S-Afr. 1992 May; 47(5): 194-6 0011-8516

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Role of reactive oxygen species in the development of cytotoxicity with various forms of chewing tobacco and pan masala. Author(s): Creighton University School of Pharmacy and Allied Health Professions, Omaha, NE 68178, USA. Source: Bagchi, M Balmoori, J Bagchi, D Stohs, S J Chakrabarti, J Das, D K Toxicology. 2002 October 15; 179(3): 247-55 0300-483X

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Smokeless tobacco and premalignant and malignant lesions of the oral cavity. Author(s): Department of Pathology, Chittaranjan National Cancer Institute, Calcutta. Source: Chakrabarti, R N Dutta, K Sikdar, S Ghosh, K Indian-J-Med-Sci. 1991 October; 45(10): 273-5 0019-5359

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Smokeless tobacco extract decreases IL-12 production from LPS-stimulated but increases IL-12 from IFN-gamma-stimulated macrophages. Author(s): Department of Oral Biology, College of Dentistry, University of Nebraska Medical Center, Lincoln 68583-0740, USA. Source: Petro, Thomas M Anderson, Lisa L Gowler, Jamie S Liu, Xiao Juan Schwartzbach, Steven D Int-Immunopharmacol. 2002 February; 2(2-3): 345-55 1567-5769

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Smokeless tobacco spoils more than the world series. Source: Feldman, R M Todays-FDA. 1990 December; 2(12): 1D 1048-5317

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Smokeless tobacco, oral cancer and the law. Author(s): University of Michigan School of Dentistry. Source: Rowe, N H J-Mich-Dent-Assoc. 1991 October; 73(8): 44-7 0026-2102

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Spit tobacco prevention and cessation counseling: statewide survey of health-care professionals and educators. Author(s): Department of Behavioral Science, University of Texas M. D. Anderson Cancer Center, Houston 77030, USA. [email protected]

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Source: Prokhorov, Alexander V Wetter, David W Padgett, Diana de, Moor Carl Le, Tao Kitzman, Heather Subst-Use-Misuse. 2002 January; 37(2): 171-97 1082-6084 •

Stamp out smokeless tobacco and snuff in baseball. Source: Green, D CDS-Revolume 1998 Jul-August; 91(5): 10-2 0091-1666

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Subchronic effects of smokeless tobacco extract (STE) on hepatic lipid peroxidation, DNA damage and excretion of urinary metabolites in rats. Author(s): Department of Pharmaceutical and Administrative Sciences, Creighton University Health Sciences Center, Omaha, NE 68178, USA. Source: Bagchi, M Bagchi, D Hassoun, E A Stohs, S J Toxicology. 1998 May 15; 127(1-3): 29-38 0300-483X

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The acute effects of smokeless tobacco (snuff) on gingival blood flow in man. Author(s): Department of Oral Biology, Faculty of Dentistry, University of Oslo, Norway. Source: Mavropoulos, A Aars, H Brodin, P J-Periodontal-Res. 2001 August; 36(4): 221-6 0022-3484

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The inside scoop on the stuff called snuff: an interview study of 94 adult male smokeless tobacco users. Author(s): Oregon Research Institute, Eugene 97401. Source: Severson, H H Eakin, E G Lichtenstein, E Stevens, V J J-Subst-Abuse. 1990; 2(1): 77-85 0899-3289

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The smokeless tobacco 'time bomb'. Author(s): Department of Preventive and Community Dentistry, Indiana University School of Dentistry, Indianapolis 46202. Source: Christen, A G McDaniel, R K McDonald, J L Postgrad-Med. 1990 May 15; 87(7): 69-74 0032-5481

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Tobacco and oral health. Smokeless tobacco--the fire without the smoke. Source: Anonymous J-Dent-Assoc-S-Afr. 1992 July; 47(7): 340-1 0011-8516

Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: •

healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0

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The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov

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The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov

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The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/

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The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/

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Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/

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Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/

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Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/

Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats

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Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html

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Google: http://directory.google.com/Top/Health/Nutrition/

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Healthnotes: http://www.healthnotes.com/

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Open Directory Project: http://dmoz.org/Health/Nutrition/

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Yahoo.com: http://dir.yahoo.com/Health/Nutrition/

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WebMDHealth: http://my.webmd.com/nutrition

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

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CHAPTER 3. ALTERNATIVE MEDICINE AND SMOKELESS TOBACCO Overview In this chapter, we will begin by introducing you to official information sources on complementary and alternative medicine (CAM) relating to smokeless tobacco. At the conclusion of this chapter, we will provide additional sources.

National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov/) has created a link to the National Library of Medicine’s databases to facilitate research for articles that specifically relate to smokeless tobacco and complementary medicine. To search the database, go to the following Web site: http://www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “smokeless tobacco” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine that are related to smokeless tobacco: •

32P-postlabelling analysis of aromatic DNA adducts in human oral mucosal cells. Author(s): Dunn BP, Stich HF. Source: Carcinogenesis. 1986 July; 7(7): 1115-20. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3719906&dopt=Abstract

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A baseline study of tobacco use among the staff of Aligarh Muslim University, Aligarh, India. Author(s): Yunus M, Khan Z. Source: J R Soc Health. 1997 December; 117(6): 359-65. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9519673&dopt=Abstract

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A case-control study of oral submucous fibrosis with special reference to the etiologic role of areca nut.

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Author(s): Sinor PN, Gupta PC, Murti PR, Bhonsle RB, Daftary DK, Mehta FS, Pindborg JJ. Source: Journal of Oral Pathology & Medicine : Official Publication of the International Association of Oral Pathologists and the American Academy of Oral Pathology. 1990 February; 19(2): 94-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2341977&dopt=Abstract •

A comparative study of common modes of tobacco use on pulse, blood pressure, electrocardiogram and blood coaguability in patients with coronary artery disease. Author(s): Bordia A, Purbiya SL, Khabya BL, Arora SK, Hatimi IH, Singh SV. Source: J Assoc Physicians India. 1977 June; 25(6): 395-401. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=565769&dopt=Abstract

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A multidisciplinary overview of intoxicating snuff rituals in the western hemisphere. Author(s): de Smet PA. Source: Journal of Ethnopharmacology. 1985 March; 13(1): 3-49. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3887041&dopt=Abstract

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A self-help cessation program for smokeless tobacco users: comparison of two interventions. Author(s): Severson HH, Andrews JA, Lichtenstein E, Gordon JS, Barckley M, Akers L. Source: Nicotine & Tobacco Research : Official Journal of the Society for Research on Nicotine and Tobacco. 2000 November; 2(4): 363-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11197317&dopt=Abstract

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A survey on the control of oral cancer in India. Author(s): Stanley K, Stjernsward J. Source: Indian Journal of Cancer. 1986 June; 23(2): 105-11. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=3570348&dopt=Abstract

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Alcohol as an additional risk factor in laryngopharyngeal cancer in Mumbai--a casecontrol study. Author(s): Rao DN, Desai PB, Ganesh B. Source: Cancer Detection and Prevention. 1999; 23(1): 37-44. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9892989&dopt=Abstract

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An assessment of the quality and usability of smoking cessation information on the Internet. Author(s): Cheh JA, Ribisl KM, Wildemuth BM. Source: Health Promotion Practice. 2003 July; 4(3): 278-87. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14610998&dopt=Abstract

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Anticarcinogenic effect of betel leaf extract against tobacco carcinogens. Author(s): Padma PR, Lalitha VS, Amonkar AJ, Bhide SV. Source: Cancer Letters. 1989 June; 45(3): 195-202. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2731162&dopt=Abstract

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Attenuation of the natural course of herpes simplex virus infection in human oral epithelial cell cultures by smokeless tobacco extracts suggests the possibility of a synergistic mechanism for carcinogenesis. Author(s): Murrah VA, Gilchrist EP, Moyer MP. Source: Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics. 1996 January; 81(1): 63-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8850486&dopt=Abstract

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Betel nut and tobacco chewing; potential risk factors of cancer of oesophagus in Assam, India. Author(s): Phukan RK, Ali MS, Chetia CK, Mahanta J. Source: British Journal of Cancer. 2001 September 1; 85(5): 661-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11531248&dopt=Abstract

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Betel-quid and tobacco chewing among the United Kingdom's Bangladeshi community. Author(s): Bedi R. Source: Br J Cancer Suppl. 1996 September; 29: S73-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8782804&dopt=Abstract

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Cancer and precancer in India. Author(s): Gill D. Source: Dent Update. 1996 May; 23(4): 149-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8948175&dopt=Abstract

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Carcinoma of the oral cavity and oropharynx in Karachi (Pakistan). An appraisal. Author(s): Jafarey NA, Zaidi SH. Source: Trop Doct. 1976 April; 6(2): 63-7. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=944473&dopt=Abstract

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Caries experience, tooth loss and oral health-related behaviours among Bangladeshi women resident in West Yorkshire, UK. Author(s): Williams SA, Summers RM, Ahmed IA, Prendergast MJ. Source: Community Dent Health. 1996 September; 13(3): 150-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8897738&dopt=Abstract

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Case-control study of Meige's syndrome. Result of a pilot study. Author(s): Behari M, Sharma AK, Changkakoti S, Sharma N, Pandey RM.

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Source: Neuroepidemiology. 2000 September-October; 19(5): 275-80. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10965240&dopt=Abstract •

Chemopreventive trials with vitamin A and beta-carotene: some unresolved issues. Author(s): Stich HF, Brunnemann KD, Mathew B, Sankaranaryanan R, Nair MK. Source: Preventive Medicine. 1989 September; 18(5): 732-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2616546&dopt=Abstract

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Clinical analysis of irritating chewing habits. Author(s): Pathak JN, Boghani CP. Source: J Indian Dent Assoc. 1979 June; 51(6): 173-6. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=296211&dopt=Abstract

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Coca-leaf chewing: a public health assessment. Author(s): Negrete JC. Source: Bull Pan Am Health Organ. 1978; 12(3): 211-8. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=570438&dopt=Abstract

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Co-expression of colligin and collagen in oral submucous fibrosis: plausible role in pathogenesis. Author(s): Kaur J, Rao M, Chakravarti N, Mathur M, Shukla NK, Sanwal BD, Ralhan R. Source: Oral Oncology. 2001 April; 37(3): 282-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11287283&dopt=Abstract

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Correlation between p53 gene mutations and circulating antibodies in betel- and tobacco-consuming North Indian population. Author(s): Ralhan R, Agarwal S, Nath N, Mathur M, Wasylyk B, Srivastava A. Source: Oral Oncology. 2001 April; 37(3): 243-50. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11287278&dopt=Abstract

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Cultural and dietary risk factors of oral cancer and precancer--a brief overview. Author(s): Zain RB. Source: Oral Oncology. 2001 April; 37(3): 205-10. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11287272&dopt=Abstract

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Cytogenetic investigations on patients with oral submucous fibrosis. Author(s): Verma A. Source: J Indian Med Assoc. 1998 February; 96(2): 51-2, 57. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9715026&dopt=Abstract

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Cytogenetic studies reveal increased genomic damage among 'pan masala' consumers. Author(s): Dave BJ, Trivedi AH, Adhvaryu SG.

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Source: Mutagenesis. 1991 March; 6(2): 159-63. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2056918&dopt=Abstract •

Cytogenetic surveillance of tobacco-areca nut (mava) chewers, including patients with oral cancers and premalignant conditions. Author(s): Adhvaryu SG, Dave BJ, Trivedi AH. Source: Mutation Research. 1991 September; 261(1): 41-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1881407&dopt=Abstract

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Dental service use and the implications for oral cancer screening in a sample of Bangladeshi adult medical care users living in Tower Hamlets, UK. Author(s): Pearson N, Croucher R, Marcenes W, O'Farrell M. Source: British Dental Journal. 1999 May 22; 186(10): 517-21. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10379085&dopt=Abstract

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Does smokeless tobacco cause hypertension? Author(s): Westman EC. Source: Southern Medical Journal. 1995 July; 88(7): 716-20. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7597474&dopt=Abstract

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Effect of non-nicotinic moist snuff replacement and lobeline on withdrawal symptoms during 48-h smokeless tobacco deprivation. Author(s): McChargue DE, Collins FL Jr, Cohen LM. Source: Nicotine & Tobacco Research : Official Journal of the Society for Research on Nicotine and Tobacco. 2002 May; 4(2): 195-200. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12028852&dopt=Abstract

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Effects of smokeless tobacco-related sensory and behavioral cues on urge, affect, and stress. Author(s): Coffey SF, Lombardo TW. Source: Experimental and Clinical Psychopharmacology. 1998 November; 6(4): 406-18. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9861555&dopt=Abstract

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Evaluating two self-help interventions for smokeless tobacco cessation. Author(s): Severson HH, Akers L, Andrews JA, Lichtenstein E, Jerome A. Source: Addictive Behaviors. 2000 May-June; 25(3): 465-70. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10890303&dopt=Abstract

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Immunotoxic effects of smokeless tobacco on the accessory cell function of rat oral epithelium. Author(s): Hasseus B, Wallstrom M, Osterdahl BG, Hirsch JM, Jontell M.

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Source: European Journal of Oral Sciences. 1997 February; 105(1): 45-51. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9085028&dopt=Abstract •

Initial characterization of the complement activating compounds in extracts of smokeless tobacco. Author(s): Chan WS, Chowdhry S, Chang T, Kew RR. Source: Immunobiology. 1999 September; 201(1): 64-73. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10532281&dopt=Abstract

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Modulatory potential of smokeless tobacco on the garlic, mace or black mustardaltered hepatic detoxication system enzymes, sulfhydryl content and lipid peroxidation in murine system. Author(s): Singh A, Singh SP. Source: Cancer Letters. 1997 September 16; 118(1): 109-14. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9310267&dopt=Abstract

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Oral fibrosis among teenagers chewing tobacco, areca nut, and Pan masala. Author(s): Babu S, Sesikeran B, Bhat RV. Source: Lancet. 1996 September 7; 348(9028): 692. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8782787&dopt=Abstract

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Role of reactive oxygen species in the development of cytotoxicity with various forms of chewing tobacco and pan masala. Author(s): Bagchi M, Balmoori J, Bagchi D, Stohs SJ, Chakrabarti J, Das DK. Source: Toxicology. 2002 October 15; 179(3): 247-55. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=12270596&dopt=Abstract

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Smokeless tobacco and aerodigestive tract cancers: recent research directions. Author(s): Winn DM. Source: Advances in Experimental Medicine and Biology. 1992; 320: 39-46. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=1442283&dopt=Abstract

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Smokeless tobacco effects on monocyte secretion of PGE2 and IL-1 beta. Author(s): Payne JB, Johnson GK, Reinhardt RA, Maze CR, Dyer JK, Patil KD. Source: J Periodontol. 1994 October; 65(10): 937-41. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=7823275&dopt=Abstract

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Smokeless tobacco extract decreases IL-12 production from LPS-stimulated but increases IL-12 from IFN-gamma-stimulated macrophages. Author(s): Petro TM, Anderson LL, Gowler JS, Liu XJ, Schwartzbach SD.

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Source: International Immunopharmacology. 2002 February; 2(2-3): 345-55. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11811937&dopt=Abstract •

Smokeless tobacco use among adolescents: correlates and concurrent predictors. Author(s): Botvin GJ, Baker E, Tortu S, Dusenbury L, Gessula J. Source: Journal of Developmental and Behavioral Pediatrics : Jdbp. 1989 August; 10(4): 181-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2768485&dopt=Abstract

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Smokeless tobacco, oxidative stress, apoptosis, and antioxidants in human oral keratinocytes. Author(s): Bagchi M, Balmoori J, Bagchi D, Ray SD, Kuszynski C, Stohs SJ. Source: Free Radical Biology & Medicine. 1999 April; 26(7-8): 992-1000. Erratum In: Free Radic Biol Med 1999 June; 26(11-12): 1599. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=10232844&dopt=Abstract

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Smokeless tobacco: a product for the new generation of tobacco users. Dipping and chewing in the Northwest Territories, Canada, and its global relevance. Author(s): Peterson JS, Barreto LA, Brunnemann KD. Source: Arctic Med Res. 1990; 49 Suppl 2: 32-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=2354001&dopt=Abstract

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Smokeless tobacco: betel quid chewing among adult women in Lao People's Democratic Republic. Author(s): Asma S. Source: Tobacco Control. 1997 Summer; 6(2): 157-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9291231&dopt=Abstract

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Smokeless tobacco: the folklore and social history of snuffing, sneezing, dipping, and chewing. Author(s): Christen AG, Swanson BZ, Glover ED, Henderson AH. Source: The Journal of the American Dental Association. 1982 November; 105(5): 821-9. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=6757302&dopt=Abstract

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The effectiveness of Mint Snuff as an oral substitute in smokeless tobacco cessation. Author(s): Zavela KJ, Harrison LR, Smith CA, Smith MR, Manske KA. Source: J Colo Dent Assoc. 1995 January; 73(3): 26-7. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=9470590&dopt=Abstract

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The patterns and predictors of smokeless tobacco onset among urban public school teenagers. Author(s): Hu FB, Hedeker D, Flay BR, Sussman S, Day LE, Siddiqui O.

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Source: American Journal of Preventive Medicine. 1996 January-February; 12(1): 22-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=8776291&dopt=Abstract •

What have we learned from 20 years of research on smokeless tobacco cessation? Author(s): Severson HH. Source: The American Journal of the Medical Sciences. 2003 October; 326(4): 206-11. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=14557736&dopt=Abstract

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Who enrolls in a self-help cessation program for smokeless tobacco? Author(s): Andrews JA, Severson HH, Akers L, Lichtenstein E, Barckley M. Source: Addictive Behaviors. 2001 September-October; 26(5): 757-64. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_ uids=11676385&dopt=Abstract

Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: •

Alternative Medicine Foundation, Inc.: http://www.herbmed.org/

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AOL: http://search.aol.com/cat.adp?id=169&layer=&from=subcats

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Chinese Medicine: http://www.newcenturynutrition.com/

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drkoop.com: http://www.drkoop.com/InteractiveMedicine/IndexC.html

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Family Village: http://www.familyvillage.wisc.edu/med_altn.htm

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Google: http://directory.google.com/Top/Health/Alternative/

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Healthnotes: http://www.healthnotes.com/

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MedWebPlus: http://medwebplus.com/subject/Alternative_and_Complementary_Medicine

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Open Directory Project: http://dmoz.org/Health/Alternative/

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HealthGate: http://www.tnp.com/

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WebMDHealth: http://my.webmd.com/drugs_and_herbs

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

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Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/

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The following is a specific Web list relating to smokeless tobacco; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •

General Overview Leukoplakia Source: Healthnotes, Inc.; www.healthnotes.com Lung Cancer Source: Integrative Medicine Communications; www.drkoop.com

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Herbs and Supplements Licorice Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525,801,00.html

General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at http://www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources.

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CHAPTER 4. DISSERTATIONS ON SMOKELESS TOBACCO Overview In this chapter, we will give you a bibliography on recent dissertations relating to smokeless tobacco. We will also provide you with information on how to use the Internet to stay current on dissertations. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical dissertations that use the generic term “smokeless tobacco” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on smokeless tobacco, we have not necessarily excluded non-medical dissertations in this bibliography.

Dissertations on Smokeless Tobacco ProQuest Digital Dissertations, the largest archive of academic dissertations available, is located at the following Web address: http://wwwlib.umi.com/dissertations. From this archive, we have compiled the following list covering dissertations devoted to smokeless tobacco. You will see that the information provided includes the dissertation’s title, its author, and the institution with which the author is associated. The following covers recent dissertations found when using this search procedure: •

A Smokeless Tobacco Cessation Program for Postsecondary Students (Oral Disease Prevention) by Williams, Nancy Johnson, EDD from Memphis State University, 1992, 99 pages http://wwwlib.umi.com/dissertations/fullcit/9224292

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An Investigation of the Utility of the Precede Model in Identifying Factors Associated with Patterns of Smokeless Tobacco Use among Male Adolescents (Tobacco) by Polcyn, M. Marguerite, PhD from The University of Toledo, 1990, 154 pages http://wwwlib.umi.com/dissertations/fullcit/9033412

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Effects of Restricted Environmental Stimulation Therapy on Smokeless Tobacco Use (Tobacco) by Cammack, Michael Guy, PhD from Washington State University, 1993, 123 pages http://wwwlib.umi.com/dissertations/fullcit/9402883

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Patterns and Prevalence of Smokeless Tobacco Use by High School Seniors in the State of New York by Olds, Robert Scott, HSD from Indiana University, 1987, 324 pages http://wwwlib.umi.com/dissertations/fullcit/8812479

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Smokeless Tobacco Behaviors among Rural High School Students in Arkansas by Williams, Thomas Kent, EDD from University of Arkansas, 1985, 92 pages http://wwwlib.umi.com/dissertations/fullcit/8528967

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Smokeless Tobacco Cessation with Nicotine Replacement: a Randomized Clinical Trial (Tobacco Cessation) by Boyle, Raymond Gerrard, PhD from University of Oregon, 1992, 104 pages http://wwwlib.umi.com/dissertations/fullcit/9313278

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Smokeless Tobacco Use among Big Ten Wrestlers and Factors Associated with Use (Tobacco) by Hannam, Susan Elizabeth, HSD from Indiana University, 1992, 122 pages http://wwwlib.umi.com/dissertations/fullcit/9314620

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Smokeless Tobacco Use among Native American Indians Enrolled in Tribally Controlled Colleges (Tobacco Use) by Flannery, Diana, PhD from The Pennsylvania State University, 1991, 170 pages http://wwwlib.umi.com/dissertations/fullcit/9204198

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The Chronic Health Effects of Smokeless Tobacco Use by Accortt, Neil Allen, PhD from The University of Alabama at Birmingham, 2003, 168 pages http://wwwlib.umi.com/dissertations/fullcit/3101473

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The Demographic and Psychosocial Characteristics Associated with the Use of Cigarettes and Smokeless Tobacco by Students in Grades 6-12 by Conrad, Timothy Lee, PhD from The Ohio State University, 1995, 138 pages http://wwwlib.umi.com/dissertations/fullcit/9533955

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The Effect of Oral Smokeless Tobacco on the Cardiovascular and Metabolic Responses in Humans during Rest and Exercise (Cardiovascular Responses, Nicotine) by Van Duser, Bruce Lynn, PhD from Texas A&M University, 1991, 118 pages http://wwwlib.umi.com/dissertations/fullcit/9134016

Keeping Current Ask the medical librarian at your library if it has full and unlimited access to the ProQuest Digital Dissertations database. From the library, you should be able to do more complete searches via http://wwwlib.umi.com/dissertations.

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CHAPTER 5. PATENTS ON SMOKELESS TOBACCO Overview Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.8 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information. IMPORTANT NOTE: When following the search strategy described below, you may discover non-medical patents that use the generic term “smokeless tobacco” (or a synonym) in their titles. To accurately reflect the results that you might find while conducting research on smokeless tobacco, we have not necessarily excluded non-medical patents in this bibliography.

Patents on Smokeless Tobacco By performing a patent search focusing on smokeless tobacco, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We will tell you how to obtain this information later in the chapter. 8Adapted

from the United States Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.

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The following is an example of the type of information that you can expect to obtain from a patent search on smokeless tobacco: •

Belt buckle for holding a can of smokeless tobacco Inventor(s): Oliver, Jr.; W. Wayne (Rte. 13, Box 394A, Maryville, TN 37801) Assignee(s): None Reported Patent Number: 4,562,620 Date filed: August 2, 1983 Abstract: The specification discloses a belt buckle for holding a can of smokeless tobacco which includes a plate for attachment to a belt and a clasp to join the ends of the belt. A cylindrically-shaped recess is formed in the plate which has a diameter slightly larger than the can of smokeless tobacco, and three lugs are mounted on the plate adjacent to the recess adjacent the lower 180.degree. portion of the recess. The can is inserted in a downward direction into the recess between the recess and the lugs. The recess and the lugs act cooperatively to compress and flex the can of smokeless tobacco during insertion and a locking action is effected on the can of smokeless tobacco when the can returns to its original configuration when disposed within the recess. Excerpt(s): The present invention relates to belt buckles for holding objects and particularly relates to a belt buckle for holding a can of smokeless tobacco. Consumers of smokeless tobacco may purchase supplies of that product in cylindrical containers (referred to as "cans") which are generally constructed of cardboard or plastic having a lid made from plastic or thin metal. In this construction, the cans have a slight resilient flexibility and the various brands of smokeless tobacco are typically sold in cans of the same size. Also, the manufacturers usually stamp the brand names of the product and a decorative design into the lid. Many consumers of smokeless tobacco like to enjoy their tobacco during activities or employment which requires them to move about. Often the consumers wish to have a supply of smokeless tobacco close at hand while they move from place to place, but the smokeless tobacco can may be burdensome and uncomfortable when carried in a pants or shirt pocket. Therefore, a need has arisen for an article or device that may be used by the consumer to conveniently and comfortably carry a can of smokeless tobacco. Web site: http://www.delphion.com/details?pn=US04562620__

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Belt buckle with a compartment Inventor(s): Wanner; Randy Lee (Box 106, Paradise, UT 84328) Assignee(s): None Reported Patent Number: 5,687,890 Date filed: July 27, 1995 Abstract: A belt buckle with a compartment includes a receptacle having an open end. The receptacle is generally cylindrical, thereby allowing a standard-sized container of smokeless tobacco to be placed in the receptacle. A spring attached within the receptacle pushes the tobacco out of the receptacle. The receptacle has a lid which has at least two grooves that engage corresponding pins attached to the receptacle. A flange is secured about the receptacle. The flange has an inner arcuate surface. A retaining hook

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and retaining structure are secured at opposite ends of the inner surface to permit attachment of the belt buckle to a belt. Excerpt(s): Belt buckles, which come in a variety of shapes and sizes, are mainly used to fasten belts. Although the material and specific workings of each belt buckle varies, the buckle's location in relation to the person wearing the buckle is almost always waisthigh and in front of the user. This location offers convenient access by the user. Additionally, belt buckles, by virtue of their function, are almost always with the user. Unlike wallets, which can be set aside and misplaced, belt buckles are an integral part of the user's clothing. These two features may have led to the use of the belt buckle for other purposes such as storing various items. Combinations of storage devices and belt buckles are useful for storing or hiding items that the user of the buckle wishes to keep secret. Combination belt buckles also offer an alternative to pant pockets when storing sharp objects or objects that may damage the pocket material. The combination belt buckles existing today, however, have several drawbacks. Other belt buckles provide no way to displace an item lodged within the storage compartment of the belt buckle. The close fit of some items within the storage compartment reduces rattle, but also makes these items difficult to remove. For example, if the perimeter of a stored item closely matches the perimeter of the storage compartment, it can be difficult for the user to grasp the stored item with his or her fingers. In this situation, the user often has to remove the entire belt to coax out the contents of the buckle. This limitation hinders the belt buckle's utility for storing items. Web site: http://www.delphion.com/details?pn=US05687890__ •

Chewing tobacco composition and process for producing same Inventor(s): Townend; John (Lancaster, PA) Assignee(s): Helme Tobacco Company (helmetta, Nj) Patent Number: 4,987,907 Date filed: June 29, 1988 Abstract: The chewing tobacco composition contains 25 to 40% by weight cut tobacco, 0.1 to 10% by weight powdered cellulose pulp and 60 to 75% by weight casing solids. The use of powdered cellulose pulp in the composition provides for an increase in the amount of casing solids in the composition. The method entails dipping the cut tobacco into a casing solution composition containing 40% by weight water and 0.5 to 4.0% by weight powdered cellulose pulp. Excerpt(s): The present invention relates to chewing tobacco and more particularly to a sweet chewing tobacco composition that contains powdered cellulose pulp. Chewing tobacco is a category of smokeless tobacco and is generally sold in one of three forms: a plug where the tobacco is compressed into any one of a number of shapes; twists where the leaves are intertwined into a shaped product; and loose where the tobacco is neither pressed nor shaped but presented to the consumer loose in a pouch. Plugs typically come in two forms, soft plugs and hard plugs. Sweet chewing tobaccos are a category of chewing tobaccos that are perceived by the consumer to be very sweet. Generally, chewing tobacco is made by cutting tobacco into strips of suitable size; dipping the tobacco into a casing solution; partially drying the cased tobacco; holding the tobacco in a container for a bulking period; and finally packaging it. The tobacco used in chewing tobacco is typically fermented and aged prior to the cutting step. Most manufacturers

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remove the stem either prior to or during the cutting step and may or may not add back the crushed stem later on as a filler to the chewing tobacco. Web site: http://www.delphion.com/details?pn=US04987907__ •

Chewing tobacco composition and process for producing the same Inventor(s): Townend; John (Lancaster, PA) Assignee(s): Helme Tobacco Company (helmetta, Nj) Patent Number: 4,917,161 Date filed: October 6, 1987 Abstract: A miniature plug of chewing tobacco made from 25 to 80% by weight tobacco on a dry basis and 75 to 20% casing solids and having a tensile strength of greater than 150 g/cm is disclosed. The high tensile strength allows for the miniature plug to be satisfactorily processed. Such a plug can be made with the use of gelatin in the casing solution. The casing includes as an essential element gelatin. Excerpt(s): The present invention relates to smokeless tobacco and more particularly to chewing tobacco and a process for making a miniature soft plug without the use of a masticatory. Smokeless tobacco products can be classified into three main types: moist snuff, dry snuff and chewing tobacco. Generally, chewing tobacco is sold in one of three forms: a "plug" where the tobacco is compressed into any one of a number of shapes; twists where leaves are entwined into a shaped product; and "loose leaf" where the tobacco is not compressed or shaped but presented to the consumer loose in a pouch. Plugs are generally divided into two categories, soft plugs and hard plugs. The hard plugs typically have a moisture content generally 15% or less while the soft plugs have a higher moisture content. Typically, chewing tobacco is made by cutting tobacco into strips of suitable size; dipping the cut tobacco in a casing solution; partially drying the cased tobacco; holding the tobacco in containers for a bulking period; and finally packaging it. Generally the tobacco has been fermented and aged prior to the cutting step. Web site: http://www.delphion.com/details?pn=US04917161__

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Chewing tobacco product Inventor(s): Glock; Eugene (Richmond, VA), Sprinkle, III; Robert S. (Richmond, VA) Assignee(s): American Brands, Inc. (new York, Ny) Patent Number: 5,092,352 Date filed: December 14, 1983 Abstract: A chewing tobacco product that does not disintegrate during mastication characterized by a uniform flavor and a smooth chew that consists of a blend of 10 to 70% of particulate tobacco in a chewing gum base present in the amount of 20 to 75% of the product, together with a glycerine humectant in the amount of 2 to 12% of the product, and sweetening and flavoring agents. Excerpt(s): The invention relates to a chewing tobacco product that does not disintegrate during mastication and has a uniform flavor, a more pleasant appearance and provides a smooth chew. The chewing tobacco products on the market consist of

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plugs or packages of chewing tobacco. Both products include a mixture of tobacco leaf and tobacco casing, which may be comprised of a mixture of flavors, sweeteners and humectants. Tobacco casing is frequently used in chewing tobacco products. In the preparation of tobacco in the form of plugs, tobacco casing is mixed with the tobacco leaf and formed into a plug of the desired size. The loose tobacco product is a mixture of the tobacco leaf and tobacco casing usually sold in a package designed to retain flavor and moisture. U.S. Pat. Nos. 865,026 and 904,521, both to Carleton Ellis, relate to tobacco preparations adapted for chewing purposes wherein the included tobacco is thoroughly sealed with a waterproofing masticable waxy body. The Ellis patents disclose, as their primary aspect, a tobacco substitute for weening and curing the habit of tobacco chewing. Use of the Ellis tobacco substitute is indicated to provide the user with the familiar taste of tobacco and its physiological effects, but to a lesser degree. U.S. Pat. No. 1,376,586 to Francis Schwartz describes a tablet of chewing tobacco completely covered with chicle. U.S. Pat. No. 4,317,837 to Gary Kehoe et al describes a tobacco flavored chewing gum containing a high level of inert fillers. The chewing gum, further, includes at least 10% air voids entrapped in the matrix which become filled with moisture on chewing, causing an increase in the volume. U.S. Pat. No. 3,845,217 to Ove Birger Ferno et al relates to a chewable smoking substitute containing nicotine in a gum base and a water-soluble buffering agent to maintain the pH of the saliva at about 7.4. Web site: http://www.delphion.com/details?pn=US05092352__ •

Loose leaf chewing tobacco Inventor(s): Dean; William G. (Germantown, TN), Rosson; William M. (Memphis, TN) Assignee(s): Conwood Corporation (memphis, Tn) Patent Number: 4,620,556 Date filed: April 12, 1983 Abstract: A loose leaf chewing tobacco product is prepared from leaf tobacco by removing the stems and major veins, then cutting the leaves across the grain of the remaining veins in a uniform manner with the cuts being spaced no greater than 1/4 inch apart, then casing the leaves with a casing mixture and finally drying the cased leaves. Excerpt(s): This invention relates to a chewing tobacco product, and more particularly to a product and a method for making the same in which the tobacco is a loose leaf product having small, uniform leaf size with virtually no objectionable stem parts. Chewing tobacco has been manufactured in various forms for many years, such as pressed plugs, rolled twists, and loose leaf tobacco, formerly called "scrap tobacco". The name "scrap" probably evolved from the origin of the tobacco used in the manufacture of the end product. Originally, some of the tobacco was obtained from other tobacco manufacturing processes such as cigar trimmings. With the advent of homogenized wrapper leaf, cigar trimmings became unsuitable for use in loose leaf chewing tobacco. Therefore, it became necessary to manufacture "scrap" tobacco from virgin air-cured cigar tobacco. Eventually, the term "scrap tobacco" fell into disuse and was replaced by the term "loose leaf" tobacco. Traditionally, loose leaf tobacco has been made from nonuniform pieces of tobacco, including not only leaf parts, but also stems and veins in various forms. Web site: http://www.delphion.com/details?pn=US04620556__

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Methods, agents and devices for removing nucleophilic toxins from tobacco and tobacco smoke Inventor(s): Cerami; Anthony (New York, NY), Cerami; Carla (New York, NY), Ulrich; Peter (Old Tappan, NJ) Assignee(s): Cerami Consulting Corp. (tarrytown, Ny) Patent Number: 6,119,701 Date filed: February 13, 1998 Abstract: This invention provides methods, devices and agents for the removal of nucleophilic toxins present in tobacco and tobacco smoke, without the removal of nicotine. The filter element of a tobacco smoking device or an air filtration device used in conjunction with a tobacco smoking device may comprise chemical moieties reactive with nucleophilic compounds, or agents that trap nucleophilic compounds may be incorporated into the filter element of tobacco smoking device such as a cigarette, cigar, pipe, or in a separate filter through which tobacco smoke passes before entering the mouth. The agents may also be incorporated into air filters for removing tobacco combustion product toxins from room air. The agents may also be incorporated into smoking or smokeless tobacco to remove toxins. Excerpt(s): This invention relates generally to methods, devices and agents for the removal of nucleophilic toxins present in tobacco and tobacco smoke, without affecting nicotine delivery. Nucleophilic toxins are removed by the passage of tobacco smoke or air containing tobacco smoke through a nucleophilic toxin-removing filter device. Agents may also be incorporated into smoking and smokeless tobacco to prevent volatilization and absorption, respectively, of nucleophilic toxins. Dosimetry of nucleophilic tobacco combustion products is used to monitor toxin exposure. Tobacco smoke is a complex mixture which includes numerous chemical compounds and particulates which to a major extent are responsible for both the enjoyment of smoking and the dangers to health in so doing. Use of tobacco products, especially smoking, is associated with increased incidence of lung and other types of cancer, emphysema, and cardiovascular disease. Less lethal adverse effects such as tooth discoloration and facial wrinkling also occur. Among the many compounds present in tobacco smoke are the purported addictive component nicotine, compounds responsible for flavor, and those either proven harmful or believed to be harmful to human health. Tobacco smoke contains chemical toxins such as carbon monoxide and hydrogen cyanide, and known carcinogens such as formaldehyde and hydrazine. Specific compounds in tobacco smoke may fall into more than one of these categories, such as those responsible for flavor. Methods for reducing the exposure of smokers to these toxic compounds without affecting the flavor of smoke while maintaining nicotine delivery has been sought for many decades. Nicotine is an alkaloid present in tobacco and tobacco smoke and is believed to provide the addictive component. Its long-term effects on health are uncertain; nevertheless, one trend in reducing exposure to the harmful effects of tobacco is to provide smokers with alternative nicotine delivery systems, by inhalation, oral absorption, and transdermally, among other routes of administration. Web site: http://www.delphion.com/details?pn=US06119701__

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Precise portion packaging machine Inventor(s): Nastro; Frank S. (Pawling, NY), Paules; Eugene H. (Huntington, CT) Assignee(s): United States Tobacco Company (greenwich, Ct) Patent Number: 4,703,765 Date filed: September 9, 1983 Abstract: A machine for forming, continuously, distinct portions of smokeless tobacco in a pouch or pocket form, and continuously forming a chain of individual pouches containing the distinct portions of smokeless tobacco, cutting each pouch from a string of pouches, counting out a pre-set number of pouches for filling a container with the pre-set number of pouches with a set moisture content; further indexing each container relative to its production cycle, including means for rejecting improperly filled containers based on improperly filled individual or a plurality of pouches, closing each container with a lid, and pneumatic and other control means for controlling the production cycle of the machine. Excerpt(s): This invention pertains to a machine for forming individual packets or pouches of smokeless tobacco, namely snuff. More particularly, this invention pertains to a machine by which, in a continuous operation at a high production rate and with great reliability, packets are formed with great reliability as to the content of each of the packets upon filling, sealing, and the packaging. With the ever-increasing use of smokeless tobacco and the advantages of having individual portions prepackaged in a suitable permeable pouch or packet, the individual packaging of these rather small pouches has become extremely difficult on a large scale, rapid production basis. The basic problem has been the inability to form with assured reliability individual packages in a continuous manner at rates of production which would be acceptable based on the demanded quality control and product specifications. As a consequence, prior art machines which have formed individual packets on a step and index basis have had production rates which have been unsatisfactory. Individual packages have varied in quality and content. Unpredictable products and their slow production have been very unacceptable. In part this has been due to the agglomerative nature of snuff tobacco, all resulting in the production of unacceptable products with a number of quality control problems found to be unmanageable in prior art machines, even at their low rates of production. A machine has now been invented in which a combination of elements are cooperating in a novel manner, employing means heretofore not employed for forming individual portions of the tobacco-containing packets. In this machine, portions of premeasured amounts are injected, from a continuously moving feed wheel, in a continuously formed, permeable non-woven, e.g. paper, tube. While individual filling of the packets takes place, these packets are formed continuously in a string of packets. These packets are appropriately sealed, quality-controlled, and these packets are cut, while in a continuous motion, in individual packets or pouches from a formed string or chain of packets. Thereafter, there are packaged in a pre-set count in packages, i.e. cans, which, in a step and index manner, are filled, moisturized, and closed at high production rates. Web site: http://www.delphion.com/details?pn=US04703765__

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Process of making tobacco pellets Inventor(s): Agner; Jennings M. (Owensboro, KY), Hunt; George F. (Owensboro, KY), Pittman; Luther B. (Owensboro, KY) Assignee(s): The Pinkerton Tobacco Company (owensboro, Ky) Patent Number: 4,513,756 Date filed: April 28, 1983 Abstract: A blend of dark-fired and one-sucker tobacco and a cased cigar type tobacco are cut to obtain a shredded product. After the addition of water and a binder, the resultant mixture is heated, dried and then pelletized into individual discrete pellets. Various additives can be added prior to or during pelletizing. The pellets are sized to give the user the desired taste and flavor of a conventional smokeless tobacco. Excerpt(s): This invention relates to a process of making tobacco pellets and particularly smokeless tobacco pellets. Heretofore, various techniques have been known for fabricating tobacco into shapes and sizes suitable for chewing or placement in the mouth. For chewing purposes, the tobacco has been fabricated in plugs from which bitesize pieces can be taken or as pellets. Where the chewing tobacco has been formed into plugs, the known processes have generally treated a plurality of superimposed filler leaves with a suitable binder and compressed the leaves into a rectangular bar. In some cases, the bar has been covered with a wrapper leaf and further compressed into a relatively dense bar varying from substantially one inch to one quarter of an inch in thickness. The portions desired for use are then removed by biting or cutting. In order to improve on such a bar, it has been known to fabricate the bar with grooves so that individual pieces of the plug can be broken off manually for chewing purposes. Web site: http://www.delphion.com/details?pn=US04513756__

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Smokeless tobacco can holder Inventor(s): Veltman; Stephen J. (3773 Timberglen, #1313, Dallas, TX 75287) Assignee(s): Veltman; Stephen J. (richardson, Tx) Patent Number: 5,752,599 Date filed: February 10, 1996 Abstract: A can holder for use with a can of smokeless tobacco is disclosed. The apparatus comprises a threaded container for receiving and securing a can of smokeless tobacco. A mirror is connected to the underside of the container to assist a smokeless tobacco user in determining whether or not tobacco particles have become lodged or are adhering to their teeth. A toothpick removably retained within a toothpick housing assists a smokeless tobacco user in removing any detected tobacco particles. Excerpt(s): The present invention relates to smokeless tobacco accessories, and more particularly to smokeless tobacco can holders. The widespread use of smokeless tobacco products has become prevalent around the world. Most smokeless tobacco products are sold in circular cardboard and metal or molded plastic cans having a paper seal enclosing them. This particular form of tobacco is normally referred to as snuff or finecut moist smokeless tobacco. When a user desires to use the product, the paper seal is broken, the top of the can removed, and the desired amount of smokeless tobacco removed for enjoyment. The lid is then replaced on the can until further use is desired. Normally a pinch or dip of smokeless tobacco is placed between the lip and gum of a

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user. However, upon placement or removal of the smokeless tobacco between the lip and gums, tobacco particles may become lodged or located on the teeth and gums of the user. This creates an unattractive appearance which the smokeless tobacco user does not desire. Thus, the user is required to use any handy means for removing granules from the teeth, such as a tongue, traditional toothpick, or any other article that might be handy. Furthermore, the user will have difficulty determining whether or not the tobacco particles have been completely removed from their teeth since they are not able to see directly into their own mouth. Thus, they must consult another individual or search for the mirror to look for stray tobacco particles. Therefore, a need has arisen for a smokeless tobacco can holder that assists the user in maintaining a high level oral hygiene but is easy to use and carry in conjunction with a can of smokeless tobacco. Web site: http://www.delphion.com/details?pn=US05752599__ •

Smokeless tobacco pipe Inventor(s): Cabaniss, III; Weldon B. (2118 NW. Military Hwy., San Antonio, TX 78213) Assignee(s): None Reported Patent Number: 4,328,795 Date filed: May 5, 1980 Abstract: A tobacco pipe which directs all of the smoke it produces through the person smoking the pipe prior to release of the smoke to the atmosphere. Storage chambers within the pipe may contain different types of burning material and may be repeatedly accessed for burning the materials in any order desired. The pipe stores its own ashes and has a lighter. Excerpt(s): This invention relates to devices for smoking combustible materials and, more particularly, to a device having a multiplicity of chambers for storage of combustible materials or ash waste materials. The chambers are not in gaseous communication with the smoke passage. The device when constructed with the proper dimensions will enable the smoker to draw the smoke created by burning of the combustible materials through the smoke passage without any substantial amounts of smoke escaping into the atmosphere which has not passed through the smoke passage. Prior to the present invention, many types of smoking devices have been designed and built. Some of the devices would have a multiplicity of chambers for storing additional combustible materials. When the smoker wanted to smoke the "reserve" chamber, all he had to do was orientate a given chamber such that the chamber would become the burning bowl and there would be gaseous communication between the smoke passage and the chamber. Such a device can be seen in U.S. Pat. No. 1,302,047. Another example of a smoking device that uses the principle of alternatively bringing storage chambers in operative relationship with the smoke passage can be found in U.S. Pat. No. 682,278. While not employing the principle of rotating the storage chamber, U.S. Pat. No. 2,216,087 shows that a storage chamber can be alternatively utilized as the burning bowl by rotating a cover plate over one of the several chambers. Web site: http://www.delphion.com/details?pn=US04328795__

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Smokeless tobacco products containing antioxidants Inventor(s): Hersh; Rebecca (Atlanta, GA), Hersh; Ted (Atlanta, GA) Assignee(s): Thione International, Inc. (atlanta, Ga) Patent Number: 6,138,683 Date filed: November 3, 1998 Abstract: A composition for inclusion within a quantity of smokeless tobacco. The composition of antioxidants is capable of reducing free radical damage to the oropharyngeal cavity of a user resulting from consumption of smokeless tobacco. The composition includes L-glutathione and a source of selenium. Excerpt(s): The present invention deals with the combination of various synergistic antioxidants, enzymatic co-factors, such as selenium-containing compounds and amino acids in appropriate delivery vehicles employed in what is commonly referred to as "smokeless tobacco" as a means of preventing or ameliorating signs and symptoms and complications to the oro-pharyngeal cavity from damage by such products. Tobacco is a substance consisting of the dried leaves and stems of the plant Nicotiana tabacum which contains the addictive drug nicotine. The plant is native to North America but is now grown worldwide. Tobacco abuse has been identified as the single most preventable cause of disease, morbidity and mortality. Tobacco contains and produces many toxic chemicals and free radical species. There are three principal ways to consume tobacco: smoking, chewing and dipping and snuffing. Fifty million Americans smoke, and countless others are affected by tobacco smoke, the so-called secondary or passive smokers. Children of smokers breathe this second-hand smoke and have more respiratory problems than children of non-smokers. Non-smoking spouses and coworkers of smokers have a greater frequency of heart disease than true non-smoker controls. Smokeless tobacco is used by as many as fourteen million individuals and has a detrimental effect on the oral cavity plus systemic effects from buccal mucosal absorption of nicotine and other injurious chemicals. There is a growing use of smokeless tobacco in adolescents and young adults. Chewing loose leaf tobacco and "dipping" moist, ground snuff tobacco are common uses of tobacco without smoking. "Snuffing" that is "snorting" dry powdered tobacco into the nasal passageways is rarely used in this country. Health risks from smokeless tobacco are still very significant and it is not a substitute for smoking. The alarming growth of use of smokeless tobacco by 1012 year old users has brought on a massive educational campaign by the National Cancer Institute. Web site: http://www.delphion.com/details?pn=US06138683__

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Smokeless tobacco retrieval device Inventor(s): Calhoun; Timothy W. (331 Company Farm Rd., Baskin, LA 71219) Assignee(s): None Reported Patent Number: 6,129,398 Date filed: October 18, 1999 Abstract: A loose tobacco retrieval device 10 for removing a portion of a quantity of loose tobacco 101 from a conventional loose tobacco receptacle 100. The retrieval device 10 includes an elongated handle member 20 having a flexible hinge 21 and a pair of handle arms 22 each provided with a tab element 23. The outboard ends of each handle

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arm 22 are provided with scoop members 30 adapted to captively engage a portion of the quantity of loose tobacco 101 from the conventional loose tobacco receptacle 100. Excerpt(s): The present invention relates to the field of tong style grasping devices in general, and in particular to a specialized smokeless tobacco retrieval device based on the tong principles. As can be seen by reference to the following U.S. Pat. Nos. 3,934,915; 3,977,410; 4,728,139; 5,649,728; and 5,795,002, the prior art is replete with myriad and diverse hinged handle devices used for a variety of purposes. While all of the aforementioned prior art constructions are more than adequate for the basic purpose and function for which they have been specifically designed, they are uniformly deficient with respect to their failure to provide a simple, efficient, and practical device that can be employed to remove smokeless tobacco from pouches and tins in a relatively hygienic fashion. Web site: http://www.delphion.com/details?pn=US06129398__ •

Substitute for oral smokeless tobacco and method of making the same Inventor(s): Davis; Lori J. (256 SW. Tualatin Loop, West Linn, OR 97068) Assignee(s): None Reported Patent Number: 4,811,746 Date filed: May 14, 1987 Abstract: A method of making a substitute for oral smokeless tobacco comprises the steps of applying a coating of binding agent on fragments of tea to form a cohesive material and moistening the fragments of the tea sufficiently to form a compact mass which is dissociable into portions of selectable size by hand-pinching the mass. The resulting composition resembles genuine smokeless tobacco in appearance, texture, tactile response, and mode of use. One uses the composition by taking a pinch of the composition and placing it in his mouth between the cheek and gum. The composition produces brown juices which provide an expectorate resembling that of genuine smokeless tobacco. The composition is packageable in a low profile cylindrical container of the type used to package snuff. Excerpt(s): This invention relates to chewing substances, and in particular, a tobacco-free composition and a method of making the same which simulates the texture, appearance, tactile sensation, and mode of use of oral smokeless tobacco but which mitigates the deleterious health risks posed by the use of such tobacco products. There has been a resurgence in the United States in the use of all forms of smokeless tobacco, including chewing tobacco and snuff. The use of smokeless tobacco of any type in general parlance is loosely referred to as "chewing," although the term "dipping" is particularly associated with the use of snuff. The use of smokeless tobacco entails the placing of a golf ball size wad of leaf tobacco or a pinch of powdered tobacco in the gingival buccal area of the mouth cavity and sucking on the quid. The term "quid" is given to a portion of smokeless tobacco which is held in the mouth for chewing or dipping. Many persons chew or dip during most waking hours, and some persons keep a quid in place for 24 hours a day. Sales of smokeless tobacco have increased about 11% each year since 1974 with an estimated 22 million users in this country. An influx of youthful chewers and dippers, primarily young male athletes and students in high school and college, has helped sustain the increase in sales of smokeless tobacco products each year since 1974. Surveys have shown that it is not uncommon for a young boy to start habitual chewing, dipping, or both at the age of 10 to 12 in imitation of his elders and peers.

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Web site: http://www.delphion.com/details?pn=US04811746__ •

System and method for protecting oral tissues from smokeless tobacco Inventor(s): Derr; Dedric M. (2420 Bismarck Ave., Loveland, CO 80538) Assignee(s): None Reported Patent Number: 6,162,516 Date filed: April 10, 1998 Abstract: The present invention involves a system and method for a user of smokeless tobacco to reduce the deleterious effects to oral tissues from the chemicals generated from using smokeless tobacco. A protective shield encloses a quantity of tobacco while resting in a mouth of a user, generally between the cheek and gum surfaces. The protective shield may be impermeable, sanitary, and disposable or biodegradable. It may assist in reducing leukoplakia and other oral diseases related to the use of smokeless tobacco. It attempts to allow the normal use of smokeless tobacco without interfering with speech, drinking, and other activities while providing some protection from the chemicals. The present invention involves a system and includes a container for holding the shields, having an opening for removing the shields for convenience and to encourage use, typically in the vicinity to a quantity of smokeless tobacco for easy access. It can be integrated into a lid of a smokeless tobacco container or other locations as well as sold as separate packets. Excerpt(s): This invention relates to smokeless tobacco protective devices and methods. Specifically, it seeks to address the problems of leukoplakia and other oral diseases related to the use of smokeless tobacco. People have used smokeless tobacco for decades and even centuries. Today, an estimated 20 million Americans use smokeless tobacco products. Many believe that they avoid the dangers of smoking tobacco. They believe that by not inhaling the tar of cigarettes, they avoid the lung cancer so prevalent among smokers. But smokeless tobacco has its own problems. Smokeless tobacco irritates the gums, causes them to recede, and ultimately may cause the teeth to loosen. It also irritates the inside lips, cheeks, and at times the throat. Additionally, smokeless tobacco causes sores inside the cheeks. These sores are known as leukoplakia. These sores appear as white patches, typically between the cheeks and gums. Web site: http://www.delphion.com/details?pn=US06162516__

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Tobacco composition Inventor(s): Dusek; Russell L. (3 Middle Patent Rd., Armonk, NY 10504), Posten; Robert J. (236 Glen Ave., Glen Rock, NJ 07452) Assignee(s): None Reported Patent Number: 4,606,357 Date filed: November 19, 1984 Abstract: A chewable resilient tobacco flavor containing composition having a threedimensional network is disclosed. The tobacco flavor impregnated composition is intended for use as a smokeless tobacco and composed of a reaction product of a nontoxic hydrophilic polyurethane prepolymer, an aqueous reactant and tobacco flavor and/or natural tobacco.

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Excerpt(s): The present invention relates to a tobacco-flavor containing composition and particularly to a resilient composition for use as a smokeless tobacco containing a foamed hydrophilic polyurethane and tobacco. Snuff and chewing tobacco as an effective alternative to the smoking of cigarettes, cigars or pipes have been known for more than a century. However, due to an ever increasing aversion by the general public against smoking, chewing tobacco has recently gained new interest. To render chewing tobacco more acceptable to the user in terms of cleanliness and aesthetics, the need to confine loose cut tobacco in packages or otherwise has been recognized. Thus, for reasons such as to prevent crumbs of tobacco from being scattered about the mouth of the user, tobacco has been manufactured in cartridges or charges of defined proportions. To prevent the loose tobacco from coming into contact with the lips, gums and/or tongue of the user, chewing tobacco has been covered with a porous and elastic substance as disclosed in U.S. Pat. Nos. 805,806 or 1,376,586. Also, to preserve the moisture content and natural aroma of tobacco, it is known from U.S. Patent No. 189,604 to cover the individual tobacco plugs with a gelatinous covering layer. It has also been proposed to enclose tobacco into fabric or paper pouches. Finally, U.S. Pat. No. 4,317,837 discloses a product made from chewing gum and tobacco. Web site: http://www.delphion.com/details?pn=US04606357__ •

Tobacco product Inventor(s): Crepps; Dewitt C. (Winston-Salem, NC), Fearrington, Jr.; George W. (Pfafftown, NC), Rice, Jr.; William Y. (Winston-Salem, NC), Sensabaugh, Jr.; Andrew J. (Winston-Salem, NC) Assignee(s): R. J. Reynolds Tobacco Co. (winston-salem, Nc) Patent Number: 4,545,392 Date filed: July 25, 1983 Abstract: A smokeless tobacco product is disclosed which contains cut or otherwise comminuted tobacco treated with a particulated gum composition that adheres as a discontinuous coating to the surface of the tobacco. The gum composition provides improved "gathering" characteristics and other benefits when the treated smokeless tobacco product is placed in the mouth of the consumer of such products. Excerpt(s): This invention relates to a novel smokeless tobacco product such as chewing tobacco or snuff and to a method for preparing same. Snuff and chewing tobacco are frequently referred to as smokeless tobacco products because they are designed for use by the consumer without subjecting the product to a combustion process. Snuff and chewing tobacco products are manufactured in a variety of forms in order to appeal to different consumers. Chewing tobacco, for example, is produced as a firm plug, moist plug, twist, loose leaf and fine cut tobacco. Snuff is marketed in both dry and moist forms with the latter form being basically similar to the fine cut chewing tobacco. At the present time loose leaf chewing tobacco is the most popular form of smokeless tobacco product while the fine cut/moist snuff category is the second most popular form. In spite of this wide popularity these product forms have a characteristic that is perceived as objectionable by consumers who continue to prefer plug chewing tobacco. The objectionable characteristic is the "float" associated with use of the product. In other words, the individual particles of tobacco tend to remain dispersed in the mouth of the consumer rather than to collect into a single aggregate that can be chewed like a portion of plug tobacco. Some consumers overcome the objectionable "float" characteristic by using chewing gum in conjunction with their use of smokeless tobacco products

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containing loose tobacco particles. Surprisingly, this practice has not yet led to the development of a satisfactory smokeless tobacco product which contains chewing gum as an integral part of the product. This failure to develop an acceptable chewing gum/smokeless tobacco combination is due to a variety of factors not the least of which is the consumer psychology involved. Thus, the fact that chewing gum is closely associated with candies and similar comestibles tends to detract from the masculine image portrayed by many smokeless tobacco products if they are offered in combination with chewing gum. Web site: http://www.delphion.com/details?pn=US04545392__ •

Tobacco products with stabilized additives having vitamin E activity Inventor(s): Russo; Joseph D. (Palo Alto, CA) Assignee(s): Rousseau Research, Institute (palo Alto, Ca) Patent Number: 6,584,980 Date filed: May 26, 2000 Abstract: A substantially pure stabilized compound having Vitamin E activity is added to smokable or smokeless tobacco or non-tobacco products to achieve less irritation and antioxidant benefits. In a preferred embodiment, a substantially pure "dry" powdered ester analog of Vitamin E, such as Vitamin E acid succinate, Vitamin E acetate or dalpha-tocopheryl polyethylene glycol 1000 succinate is mixed directly with the tobacco during the curing or manufacturing process. For cigarette applications, these Vitamin E compounds can also be inserted into a cigarette filter, holder and/or paper, either in powdered form or in microencapsulated form. Although not preferred, a common oily form of Vitamin E can be used in the present invention so long as it is stabilized and does not ruin the appearance and function of the tobacco or non-tobacco products. Excerpt(s): The present invention relates to smoking tobacco products, such as cigarettes, cigars, pipe tobacco (bulk), roll your own tobacco and smokeless tobacco products, also known as "snuff" or "chewing tobacco" and non-tobacco smokable or mouthable products. More particularly, a novel form of smokable cigarette, cigar and bulk tobacco, including cured and uncured leaves, non-tobacco smokables or mouthables and smokeless tobacco is disclosed which includes as additives one or more stabilized health enhancing compounds that exhibit Vitamin E activity. Health problems associated with cigarette smoking, cigar smoking, pipe smoking and smokeless tobacco have been well publicized. In various scientific studies, cigarette smoking, cigar smoking, pipe smoking and use of smokeless tobacco have been causally linked to diseases such as lung, throat, mouth and other cancers as well as emphysema, smoker's cough and heart disease. Various attempts have been made to address cigarette health problems through reformulation of cigarettes. For example, special blends of tobacco have been formulated for cigarettes with reduced levels of tar and nicotine. Unfortunately, each reduction of the tar and nicotine level has been accompanied by a corresponding reduced level of smoker satisfaction requiring unhealthy longer, stronger puffs to increase smoker's satisfaction. As such, sales of lowered tar and nicotine cigarettes, particularly those commercially classified as "ultra low tar and nicotine", have not lived up to expectations. More recently, efforts have been made to altogether remove additives from cigarettes. While such "additive free" cigarettes may provide a purer tobacco smoke, it is unclear whether they provide any corresponding health benefits. In fact, in some cases, they have been shown to be

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stronger in tar and nicotine since they contain relatively more tobacco than non-additive containing cigarettes. Web site: http://www.delphion.com/details?pn=US06584980__ •

Tool for opening smokeless tobacco containers Inventor(s): Jacobs; David C. (Veneta, OR) Assignee(s): Hart; Gordon G. (junction City, Or) Patent Number: 4,567,655 Date filed: October 22, 1984 Abstract: A lightweight, hand-held portable tool for opening a smokeless tobacco container uses a rotatable cutting wheel to slit an adhesive coated paper wrapper extending around the rim of the lid and cylindrical body of the container. The tool has a top member which rests on the circular lid to fix the position of the cutting wheel at a distance therebelow. The cutting wheel is recessed in a body member perpendicularly disposed to the top member to restrict the cutting depth to the combined thickness of the rim and wrapper. The tool includes grasping surfaces for the user and a guide member shaped to conform to the side surface of the container so that the opening operation can be accomplished by revolving the tool about the body of the container as the top member rests on the lid. Excerpt(s): This invention relates to means for opening smokeless tobacco containers, and more particularly, to a hand-held portable tool having a rotatable circular cutting means to slit the adhesive coated paper wrapper securing the lid to the outer side surface of the container. The use of the thumbnail as a cutting device not only requires long thumbnails, which are then susceptible to breakage, but also is a laborious means for opening the container. The use of a pocketknife is equally undesirable because of both the potential injury to the user from slippage of the knife from underneath the rim and the destruction of the smokeless tobacco container caused by the exertion of excessive radial pressure which induces a slit in the side of the container together with the paper wrapper. The prior art has not provided an acceptable tool for this purpose. A hand tool designed to open watch cases is disclosed by Southworth U.S. Pat. No. 451,982. This tool embodies a circular plate having thin, beveled edges around the periphery thereof with a support means on either surface to ensure a firm grasping of the tool by its user. The tool is designed to pry open containers by inserting the edge of the tool in the groove between the lid and the body of the container. Successful operation of the tool requires that the container have firm sides to support the forces created while the user pries open the lid. Smokeless tobacco containers, however, are cylindrically shaped having paper or thin plastic side and bottom surfaces covered by a lid. The Southworth tool is unsuitable for opening containers of this type because it requires a container with sides sufficiently rigid to support a prying operation. Web site: http://www.delphion.com/details?pn=US04567655__

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Patent Applications on Smokeless Tobacco As of December 2000, U.S. patent applications are open to public viewing.9 Applications are patent requests which have yet to be granted. (The process to achieve a patent can take several years.) The following patent applications have been filed since December 2000 relating to smokeless tobacco: •

Glutathione, green tea, grape seed extract to neutralize tobacco free radicals Inventor(s): Hersh, Rebecca; (Atlanta, GA), Hersh, Theodore; (Atlanta, GA) Correspondence: Malcolm B. Wittenberg; Crosby, Heafey, Roach & May; Suite 2000; Two Embarcadero Center; San Francisco; CA; 94111; US Patent Application Number: 20020117180 Date filed: May 11, 2001 Abstract: A composition for inclusion within a cigarette, cigar, pipe or smokeless tobacco. The composition can be included within the tobacco itself, a filter for filtering tobacco smoke once burned or even within the paper or wrapper surrounding the tobacco product. In the cigarette filter, be it internal or external filters, the antioxidant complex is capable of scavenging and neutralizing the free radicals emanating from the burning or heated tobacco and passing through the filter as the smoker inhales. The composition is also capable of reducing free radical damage to the oro-pharyngeal cavity, respiratory tract and lungs resulting from tobacco smoke. The composition includes glutathione and preferaby L-glutathione and green tea and/or grape seed extract. Excerpt(s): The present application is a continuation-in-part of U.S. application Ser. No. 09/185,172 filed Nov. 3, 1998 which, in turn, is a continuation-in-part of U.S. application Ser. No. 08/933,696, now U.S. Pat. No. 5,829,449. The present invention deals with the combination of various synergistic antioxidants, enzymatic co-factors and amino acids in appropriate delivery vehicles employed in cigarette filters and in external filters such as cigarette and cigar "holders," in "pipe filters" and in tobacco, wrappers and papers and in so-called smokeless tobacco as a means of preventing or ameliorating signs and symptoms and complications to the oro-pharyngeal cavity, respiratory tract and lungs from damage by tobacco smoke and tobacco chewed induced free radical species. The present invention can be employed in filter cigarettes, unfiltered cigarettes, cigars, pipes, and smokeless tobacco products. The deleterious effects of tobacco abuse are well known and regulatory agencies as well as the public constantly react to these scientific and epidemiologic evidences. Tobacco is indeed a worldwide public health hazard accounting for significant morbidity and mortality. Although smoking places an abundant oxidant insult to the oral cavity, respiratory tract and lungs, evidence supports the notion that the oxidant burden is on the entire organism of the smoker. Smoking promotes development or enhancement of atherosclerosis, causing cardiovascular disease, chronic obstructive pulmonary disease, recently labeled "smoker's lung," cutaneous damage, especially to the face, called "smoker's face," and various forms of cancer, including carcinomas of the mouth, pharynx, esophagus and lung. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

9

This has been a common practice outside the United States prior to December 2000.

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Nitrite scavenging formulation to reduce formation of nitrosamines during chewing of food items such as chewing tobacco and betel nuts Inventor(s): Mao, Hsiang-Kuen; (San Jose, CA) Correspondence: Hsiang-kuen Mao; 2800 West Pintail Way; Elk Grove; CA; 95758-8201; US Patent Application Number: 20030175367 Date filed: January 31, 2003 Abstract: This invention describes a formulation that removes or reduces the formation of nitrosamines when chewing food items such as chewing tobacco, betel nuts, and fruits that contain secondary amines or imines, or other manufactured food items containing sources of amines and imines that could form chemically stable nitrosamines with nitrites in saliva. Nitrosamines are known carcinogens. Excerpt(s): Case first filed in Taiwan, Republic of China, Feb. 5, 2002, number 91102034. Also see accompanied case, Table Salt, Table Sugar, And Table Vinegar Formulations with Nitrite Scavengers. Not applicable. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Smokeless tobacco container with display surfaces for advertising indicia Inventor(s): Cole, Stephen W.; (Edmond, OK) Correspondence: Mary M Lee, P.C.; 3441 W. Memorial Road; Suite 8; Oklahoma City; OK; 73134 Patent Application Number: 20020175195 Date filed: May 20, 2002 Abstract: A holder for a container of smokeless tobacco. The holder provides a vehicle for advertising and can be removably attached to a automobile visor, belt or waistband, golf cart or the like. In its preferred form, the holder is a semi-cylindrical frame with an open top and side. In this way, the inner and outer surfaces of the side wall, as well as the inner surface of the back wall, are visible when the container is not in the holder. When the container is in the holder, the outer side wall is still visible. These visible surfaces are ideal as display surfaces for advertising indicia, which can relate to the brand of smokeless tobacco or to any other advertising subject matter. The holder is inexpensive and can be provided as an advertising "give-away" or sold with the smokeless tobacco as a promotional item. Excerpt(s): This application claims the benefit of the filing date of provisional application No. 60/293,583, filed May 24, 2001, entitled "Smokeless Tobacco Container Holder with Display Surfaces for Advertising Indicia," the content of which is incorporated herein by reference. The present invention relates generally to holders for smokeless tobacco containers. Advertising is critical to most businesses for promoting the sale of products or services. Advertisers and marketing directors constantly are searching for news ways to communicate information about their products to potential customers. Tobacco companies, in particular, are disadvantaged in the realm of advertising, as state and federal laws severely restrict their advertising to certain types of media and locations. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Smokeless tobacco product Inventor(s): Williams, Jonnie R.; (Manakin-Sabot, VA) Correspondence: Banner & Witcoff, LTD.; 1001 G Street, N.W.; Washington; DC; 200014597; US Patent Application Number: 20020162562 Date filed: May 1, 2001 Abstract: A smokeless tobacco product suitable for human consumption can be prepared from an aqueous extract of cured tobacco. In one embodiment, the smokeless tobacco product comprises a solid tablet having at least 50 wt % powdered tobacco. The powdered tobacco preferably consists essentially of Virginia flue tobacco stems. The smokeless tobacco product optionally includes eucalyptus and/or propolis in an amount effective to remove bitterness from said powdered tobacco. The smokeless tobacco product preferably contains powdered tobacco having a collective content of N'nitrosonornicotine (NNN), 4-(N-nitrosomethylamino)-1-(3 -pyridyl)-1-butanone (NNK), N'-nitrosoanatabine (NAT) and N'-nitrosoanabasine (NAB) which is 0.1.mu.g/g or less, preferably 0.05.mu.g/g or less, more preferably 0.03.mu.g/g or less. The powdered tobacco preferably has a content of 4-(N-nitrosomethylamino)-1-(3-pyridyl- )-1-butanone (NNK) which is 0.002.mu.g/g or less, preferably 0.001.mu.g/g or less. Excerpt(s): The invention relates to an oral smokeless tobacco product and, more particularly, a smokeless tobacco product prepared from a tobacco extract. There are many oral delivery forms of tobacco. Such forms include chewing tobacco, chewing gum, lozenges, capsules, and tablets. Chewing tobacco utilizes chopped or shredded tobacco, which is placed in the mouth and ultimately removed from the mouth. Lozenges, tablets, and the like, are often designed to dissolve slowly in order to administer nicotine over a period of time. Such products are often obtained by chopping the tobacco plant or leaf and then extracting soluble components from the tobacco using a solvent. The resulting extract is dried and combined with other ingredients to form the products. U.S. Pat. No. 3,368,567 describes a tablet having a tobacco concentrate and which is intended to be located in the mouth of the user. In preparing the tablet, nicotine and other active ingredients are extracted from cured tobacco that has been ground into fine particles. The tobacco is steeped in water and then concentrated mineral acid is added. The resulting liquid is applied to an absorbent, inert, edible base, to the extent that it constitutes less than 10% of the base. After the liquid is dried, the resultant material is compressed into a tablet. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

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Tobacco dipping cup with saliva reservoir Inventor(s): Wilson, Christopher A.; (Tallahassee, FL) Correspondence: John Wiley Horton; Pennington, Moore, Wilkinson, Bell & Dunbar, P.A.; 215 S. Monroe ST., 2nd Floor; Tallahassee; FL; 32301; US Patent Application Number: 20030052018 Date filed: September 14, 2001 Abstract: A beverage cup having a detachable saliva reservoir so that a user may enjoy a beverage and smokeless tobacco products simultaneously. The cup has a saliva conduit running from its upper extremity down to a saliva reservoir which screws on the

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bottom. The upper portion of the conduit is formed into a mouthpiece which allows the user to easily deposit the saliva without the risk of it contaminating the contents of the cup. The beverage within the cup and the saliva reservoir are separated by an internal bulkhead. Cleaning is facilitated by the fact that the reservoir screws off the bottom. Both the cup and the reservoir can then be placed in a dishwasher or washed by hand. Excerpt(s): This invention relates to the field of drinking vessels. More specifically, the invention comprises a drinking cup with an integral saliva conduit and reservoir, so that a user who is dipping tobacco (snuff) may use a single vessel to hold a liquid drink and hold the saliva which must be spit out of the user's mouth. Many persons enjoy the use of smokeless tobacco products. One method of using such a product is to place a small portion of tobacco between the teeth and gums--commonly referred to as "dipping." The presence of the tobacco causes the user to salivate. This saliva intermingles with the tobacco and can cause sickness if swallowed. Thus, the smokeless tobacco user commonly spits out the induced saliva. In some circumstances - such as when playing baseball--the user can simply spit the saliva onto the ground. This option is impractical when driving a car or generally when indoors. In these cases, the user must employ a can or cup to hold the saliva. As the can or cup is not really designed for this purpose, its use can be difficult. As one example, empty soda cans do not have a sufficiently large opening to receive the saliva. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html •

Tobacco mint plant material product Inventor(s): Atchley, Frank S.; (Nashville, TN), Due, Vernie A.; (Nashville, TN), Gray, Thomas R.; (Murfreesboro, TN) Correspondence: Fitch Even Tabin And Flannery; 120 South LA Salle Street; Suite 1600; Chicago; IL; 60603-3406; US Patent Application Number: 20030094182 Date filed: September 26, 2002 Abstract: The present invention is directed to smokeless tobacco compositions, such as a chewing tobacco and/or snuff composition comprising tobacco and mint plant material, where the mint plant material is mint leaf with or without endogenous mint oil, mint stems, and the like. Excerpt(s): The present invention relates to tobacco compositions, more specifically smokeless tobacco compositions that are comprised of tobacco and mint plant material. More particularly, the composition is comprised of a mixture of tobacco and mint plant material including mint leaves, said leaves being with or without their endogenous mint oil, mint stems with or without their endogenous mint oil, and the like. Mixtures of mint plant material and tobacco are blended in amounts effective for minimizing the negative flavor attributes sometimes found in tobacco. Smokeless tobaccos are products that are orally consumed without subjecting the product to combustion. These products are manufactured in a variety of forms including chewing tobacco, dry snuff and moist snuff. Generally, these types of products are made as follows with the steps being in no particular order: cutting or grinding the tobacco into a suitable size; dipping or spraying the tobacco with a casing solution; partially drying the cased tobacco; holding the tobacco in containers for a period of time; and packaging it. Chewing tobacco is typically sold in one of three forms: a "plug" where the tobacco is compressed into one of any number of shapes; "twists", where leaves are entwined into a rope-shaped

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product; and loose, leafy chewing tobacco where it is presented in an envelop-like container. Plugs typically have a moisture content around 15% or less by volume for "hard" plugs and greater than 15% for "soft" plugs. Twists and loose, leafy material are typically lower in moisture. Web site: http://appft1.uspto.gov/netahtml/PTO/search-bool.html

Keeping Current In order to stay informed about patents and patent applications dealing with smokeless tobacco, you can access the U.S. Patent Office archive via the Internet at the following Web address: http://www.uspto.gov/patft/index.html. You will see two broad options: (1) Issued Patent, and (2) Published Applications. To see a list of issued patents, perform the following steps: Under “Issued Patents,” click “Quick Search.” Then, type “smokeless tobacco” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on smokeless tobacco. You can also use this procedure to view pending patent applications concerning smokeless tobacco. Simply go back to http://www.uspto.gov/patft/index.html. Select “Quick Search” under “Published Applications.” Then proceed with the steps listed above.

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CHAPTER 6. BOOKS ON SMOKELESS TOBACCO Overview This chapter provides bibliographic addition to online booksellers such sources for book titles on smokeless Database and the National Library of these titles available for loan.

book references relating to smokeless tobacco. In as www.amazon.com and www.bn.com, excellent tobacco include the Combined Health Information Medicine. Your local medical library also may have

Book Summaries: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer. For the format option, select “Monograph/Book.” Now type “smokeless tobacco” (or synonyms) into the “For these words:” box. You should check back periodically with this database which is updated every three months. The following is a typical result when searching for books on smokeless tobacco: •

Smokeless Tobacco: A Deadly Addiction Source: Waco, TX: HEALTH EDCO. 1997. 48 p. Contact: Available from HEALTH EDCO. P.O. Box 21207, Waco, TX 76702-1207. (800) 299-3366 or (817) 776-6461. Fax (888) 977-7653. E-mail: [email protected]. Website: www.healthedco.com. PRICE: $5.95; bulk copies available. Order number JG42010. Summary: Americans have become very aware of the health risks of smoking cigarettes, but less is known about the dangers of their popular substitute: snuff and chewing tobacco. This booklet is designed to teach adolescents about the hazards of smokeless tobacco. The booklet defines and describes the different types of smokeless tobacco, including snuff and chewing tobacco, and discusses the drug involved, nicotine. Other topics include the symptoms of nicotine addiction, the history of tobacco use, the users of smokeless tobacco, the ingredients in smokeless tobacco (including carcinogens,

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nitrosamines, sugar, flavoring agents, nicotine), the health effects of smokeless tobacco (bad breath, dental problems, cancer, cardiovascular diseases), the advertising of smokeless tobacco, how tobacco companies control nicotine, legal factors related to smokeless tobacco, why people use snuff and chew, prevention programs in school, the history of smokeless tobacco and baseball (and current efforts to change that relationship), and how to quit the use of smokeless tobacco. The booklet also tells the story of Sean Marsee, a young man who died from oral cancer caused by his regular use of smokeless tobacco. The booklet concludes with a list of 9 reasons for quitting the use of smokeless tobacco. The booklet is illustrated with colorful photographs and graphics. •

Enough Snuff: A Guide for Quitting Smokeless Tobacco. 3rd ed Source: Eugene, OR: Rainbow Productions. 1994. 50 p. Contact: Available from Tobacco Education Clearinghouse of California/ETR Associates. P.O. Box 1830, Santa Cruz, CA 95061-1830. (831) 438-4822. TDD (831) 4610205. Fax (831) 438-3618. PRICE: $3.00 plus shipping and handling. Item number J210. Also available from Rainbow Productions. 4080 Hilyard Street, Eugene, OR 97405. (503) 345-0404. PRICE: $9.95 plus shipping and handling; bulk copies available. Summary: This manual is designed to help readers who wish to quit using snuff or chewing tobacco (smokeless tobacco, or ST). The steps described in the manual have been used by people of all ages who used ST and wanted to quit. First, readers will review their reasons for quitting, next they evaluate their pattern of using snuff or chew, then they choose a plan and quit. The manual is designed to both help readers to quit and to stay off smokeless tobacco. The nine chapters present information in outline or bulleted format, for ease of reading. Six appendices cover the proper use of nicotine gum, nicotine skin patches, a withdrawal scale, smokeless cessation resources, the nicotine content of ST products, and a smokeless self monitoring form.

Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes&Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index all published books (e.g. Books in Print). IMPORTANT NOTE: Online booksellers typically produce search results for medical and non-medical books. When searching for “smokeless tobacco” at online booksellers’ Web sites, you may discover non-medical books that use the generic term “smokeless tobacco” (or a synonym) in their titles. The following is indicative of the results you might find when searching for “smokeless tobacco” (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): •

A Guide for Smokeless Tobacco Users by Roy D. Kindrick; ISBN: 0964804409; http://www.amazon.com/exec/obidos/ASIN/0964804409/icongroupinterna

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Department of Health and Human Services, Food and Drug Administration regulations restricting the sale and distribution of cigarettes and smokeless tobacco to protect children and adolescents (SuDoc GA 1.13:OGC-96-38) by U.S. General Accounting Office; ISBN: B00010VSM8; http://www.amazon.com/exec/obidos/ASIN/B00010VSM8/icongroupinterna

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Fast Facts: Smokeless Tobacco by Jim Parker; ISBN: 089230264X; http://www.amazon.com/exec/obidos/ASIN/089230264X/icongroupinterna

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For Smokers Only: How Smokeless Tobacco Can Save Your Life by Brad Rodu; ISBN: 0945819773; http://www.amazon.com/exec/obidos/ASIN/0945819773/icongroupinterna

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Health effects of smokeless tobacco : hearing before the Subcommittee on Health and the Environment of the Committee on Energy and Commerce, House of Representatives, One Hundred Third Congress, second session, november 29, 1994 (SuDoc Y 4.EN 2/3:103-163); ISBN: 0160469554; http://www.amazon.com/exec/obidos/ASIN/0160469554/icongroupinterna

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Nicotine in cigarettes and smokeless tobacco products is a drug and these products are nicotine delivery devices under the Federal Food, Drug, and Cosmetic Act : appendices (SuDoc HE 20.4002:N 54/APP.) by U.S. Dept of Health and Human Services; ISBN: B00010P4L4; http://www.amazon.com/exec/obidos/ASIN/B00010P4L4/icongroupinterna

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Regulation of cigarettes and smokeless tobacco under the federal Food, Drug, and Cosmetic Act; ISBN: 0160487382; http://www.amazon.com/exec/obidos/ASIN/0160487382/icongroupinterna

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Smokeless Tobacco (Pamphlet); ISBN: 9993933198; http://www.amazon.com/exec/obidos/ASIN/9993933198/icongroupinterna

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Smokeless Tobacco in the Western World: 1550-1950 by Jan Rogozinski (Author); ISBN: 0275936007; http://www.amazon.com/exec/obidos/ASIN/0275936007/icongroupinterna

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Smokeless tobacco or health an international perspective (SuDoc HE 20.3184/2:2) by U.S. Dept of Health and Human Services; ISBN: B00010L8QE; http://www.amazon.com/exec/obidos/ASIN/B00010L8QE/icongroupinterna

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Smokeless Tobacco: A Deadly Addiction by Herbert H. Severson; ISBN: 1567961851; http://www.amazon.com/exec/obidos/ASIN/1567961851/icongroupinterna

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Spit tobacco : a guide for quitting (SuDoc HE 20:3408:SP 4) by U.S. Dept of Health and Human Services; ISBN: B0001141DA; http://www.amazon.com/exec/obidos/ASIN/B0001141DA/icongroupinterna

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Spit tobacco and youth (SuDoc HE 1.2:T 55) by U.S. Dept of Health and Human Services; ISBN: B0001131AE; http://www.amazon.com/exec/obidos/ASIN/B0001131AE/icongroupinterna

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The 2000 Import and Export Market for Manufactured, Smoking, and Chewing Tobacco in Vietnam (World Trade Report) by Smoking, The Manufactured, Chewing Tobacco Research Group; ISBN: 059756356X; http://www.amazon.com/exec/obidos/ASIN/059756356X/icongroupinterna

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The 2000 World Market Forecasts for Imported Manufactured, Smoking, and Chewing Tobacco by The Research Group, Smoking The Manufactured; ISBN: 0741829711; http://www.amazon.com/exec/obidos/ASIN/0741829711/icongroupinterna

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The Health Consequences of Using Smokeless Tobacco by 1742001927; ISBN: 999738833X; http://www.amazon.com/exec/obidos/ASIN/999738833X/icongroupinterna

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Tobacco legislation and the Food and Drug Administration and smokeless tobacco issues in the proposed settlement : hearing before the Committee on Commerce, Science, and Transportation, United States Senate, One Hundred Fifth Congress,

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second session, March 17, 1998 (SuDoc Y 4.C 73/7:S.HRG.105-887); ISBN: 0160581850; http://www.amazon.com/exec/obidos/ASIN/0160581850/icongroupinterna

The National Library of Medicine Book Index The National Library of Medicine at the National Institutes of Health has a massive database of books published on healthcare and biomedicine. Go to the following Internet site, http://locatorplus.gov/, and then select “Search LOCATORplus.” Once you are in the search area, simply type “smokeless tobacco” (or synonyms) into the search box, and select “books only.” From there, results can be sorted by publication date, author, or relevance. The following was recently catalogued by the National Library of Medicine:10 •

Health consequences of using smokeless tobacco: a report of the Advisory Committee to the Surgeon General, 1986. Author: Kenton, Charlotte; Year: 1986

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Health effects of smokeless tobacco use: January 1966 through December 1985. Author: prepared by Charlotte Kenton and William J. Blot; Year: 1995

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Smokeless tobacco use in the United States: a compilation of papers on recent research and discussion of directions for future research. Author: scientific editors: Gayle M. Boyd, Charles A. Darby; Year: 1989

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Tobacco legislation and the Food and Drug Administration and smokeless tobacco issues in the proposed settlement [microform]: hearing before the Committee on Commerce, Science, and Transportation, United States Senate, One Hundred Fifth Congress, second. Author: United States. Congress. Senate. Committee on Commerce, Science, and Transportation; Year: 1999

Chapters on Smokeless Tobacco In order to find chapters that specifically relate to smokeless tobacco, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and smokeless tobacco using the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” Type “smokeless tobacco” (or synonyms) into the “For these words:” box. The following is a typical result when searching for book chapters on smokeless tobacco: •

Premalignant Lesions Source: in Ord, R.A. and Blanchaert, R.H., eds. Oral Cancer: The Dentist's Role in Diagnosis, Management, Rehabilitation, and Prevention. Chicago, IL: Quintessence Publishing Co, Inc. 1999. p. 49-63.

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In addition to LOCATORPlus, in collaboration with authors and publishers, the National Center for Biotechnology Information (NCBI) is currently adapting biomedical books for the Web. The books may be accessed in two ways: (1) by searching directly using any search term or phrase (in the same way as the bibliographic database PubMed), or (2) by following the links to PubMed abstracts. Each PubMed abstract has a "Books" button that displays a facsimile of the abstract in which some phrases are hypertext links. These phrases are also found in the books available at NCBI. Click on hyperlinked results in the list of books in which the phrase is found. Currently, the majority of the links are between the books and PubMed. In the future, more links will be created between the books and other types of information, such as gene and protein sequences and macromolecular structures. See http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Books.

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Contact: Available from Quintessence Publishing Co, Inc. 551 Kimberly Drive, Carol Stream, IL 60188-9981. (800) 621-0387. Fax (630) 682-3288. E-mail: [email protected]. Website: www.quintpub.com. PRICE: $79.00 plus shipping and handling. ISBN: 0867153571. Summary: Dentists are involved in the diagnosis, treatment, rehabilitation, reconstruction, and prevention of oral cancer. This chapter on premalignant oral lesions is from a book written specifically for dental health care providers, including dental students, general dentists, dental specialists, and hygienists. The author discusses leukoplakia (white patches), erythroleukoplakia, erythroplakia (red patches), actinic keratosis (a premalignant skin condition), oral lichen planus, problems associated with smokeless tobacco use, proliferative verrucous leukoplakia (PVL), human papillomavirus, and lesions associated with AIDS. The bulk of the chapter consists of full color photographs of the lesions under discussion. 12 figures. 26 references. •

Herbal Medications, Nutraceuticals, and Hypertension Source: in Miller, L.G. and Murray, W.J., eds. Herbal Medicinals: A Clinician's Guide. New York, NY: Pharmaceutical Products Press. 1998. p. 135-162. Contact: Available from Haworth Herbal Press. 10 Alice Street, Binghamton, NY 139041580. (800) HAWORTH. Fax (800) 895-0582. E-mail: [email protected]. Website: www.haworthpressinc.com. PRICE: $39.95 plus shipping and handling. ISBN: 0789004666. Summary: Hypertension (high blood pressure) is a common problem, for which numerous drug therapies and lifestyle changes are often prescribed. Many patients have elected to augment or substitute their allopathic therapies with herbal remedies, primarily to avoid the many known side effects of antihypertensive drugs. This chapter on herbal medicinals, nutraceuticals, and hypertension is from a clinician's guide to the use of herbal medicinals that uses a case based approach to lead readers through clinical considerations and the potential use of alternative medicines. The authors first briefly review some of the standard antihypertensive treatments, including their potential impact on quality of life. The case studies in this chapter describe licorice induced hypertension (licorice is found in smokeless tobacco); yohimbine to address erectile dysfunction (impotence); the use of garlic to treat hypertension; herbal diuretics (drugs that increase the rate of urine flow and the excretion of sodium); the negative impact of grapefruit juice and ginseng on blood pressure control; Chinese herbs for hypertension; and fish oil supplementation. One table lists herbs that may have an effect on blood pressure; another table summarizes information about herbs reviewed in this chapter. 7 tables. 117 references.

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Benign, Premalignant, and Malignant Lesions Source: in Eisen, D. and Lynch, D.P. Mouth: Diagnosis and Treatment. St. Louis, MO: Mosby, Inc. 1998. p. 58-91. Contact: Available from Harcourt Health Sciences. Book Order Fulfillment Department, 11830 Westline Industrial Drive, St. Louis, MO 63146-9988. Website: www.mosby.com. PRICE: $79.95 plus shipping and handling. ISBN: 0815131054. Summary: The oral mucosal surfaces are subjected to daily irritation through normal masticatory (chewing) functions and hygiene measures. The oral mucosa can also be irritated by lack of oral health (which allows plaque and calculus to build up), and by various oral habits such as lip and cheek biting. The majority of masses noted in the oral

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cavity (mouth) actually represent reactions to these forms of trauma rather than true neoplastic (new tissue) lesions. This chapter on benign, premalignant, and malignant lesions is from a textbook on the mouth that offers information to primary care physicians and to many specialists in medicine and dentistry. The authors help readers undertake and interpret a careful history and physical examination to reveal the underlying source of the injury. Benign lesions covered include pyogenic granuloma, peripheral giant cell granuloma, keratoacanthoma, amputation neuroma, verruciform xanthoma, fibrous histiocytoma, lipoma, granular cell tumor, neurilemoma (schwannoma), neurofibroma, fibrous hyperplasia, pulp polyp, and melanotic neuroectodermal tumor of infancy. Premalignant lesions include leukoplakia, erythroplakia, smokeless tobacco lesions, oral submucous fibrosis, and actinic cheilitis. And the malignant neoplasms covered are squamous cell carcinoma, verrucous carcinoma, oral malignant melanoma, Hodgkin's disease (Hodgkin's lymphoma), nonHodgkin's lymphoma, cutaneous T cell lymphoma, Burkitt's lymphoma, Kaposi's sarcoma, and metastatic neoplasms. The chapter is illustrated with numerous full color photographs of the conditions under discussion. 32 figures. 1 table. 172 references. •

Tobacco Use and Its Relation to Periodontal Diseases Source: in Wilson, T.G., Jr.; Kornman, K.S. Fundamentals of Periodontics. 2nd ed. Chicago, IL: Quintessence Publishing Co., Inc. 2003. p. 185-194. Contact: Available from Quintessence Publishing Co, Inc. 551 Kimberly Drive, Carol Stream, IL 60188-9981. (800) 621-0387 or (630) 682-3223. Fax (630) 682-3288. E-mail: [email protected]. Website: www.quintpub.com. PRICE: $82.00 plus shipping and handling. ISBN: 0867154055. Summary: There is an increasing awareness of the role of tobacco use in the prevalence and severity of periodontal diseases and subsequent tooth loss. Cigarette smoking is one of the most important risk factors in the development of a variety of periodontal diseases, including various forms of chronic periodontitis, aggressive periodontitis, and necrotizing periodontal disease. This chapter on tobacco use is from a periodontics textbook that focuses on diagnosis and clinical management. The author discusses the effect of tobacco smoking on the prevalence and severity of periodontal diseases, alterations to periodontal treatment response in smokers, the underlying mechanisms of tobacco smoking in periodontal diseases, cigar smoking, pipe smoking, and smokeless tobacco products, and applications to clinical practice. The author concludes that cigarette smoking may play a harmful role in almost all forms of periodontal disease and adversely affect the outcomes of almost all forms of periodontal treatment. 4 figures. 126 references.

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Examination, Diagnosis, and Treatment Planning for General and Orthodontic Problems Source: in Pinkham, J.R., et al., eds. Pediatric Dentistry: Infancy Through Adolescence. 3rd ed. Philadelphia, PA: W.B. Saunders Company. 1999. p. 594-617. Contact: Available from W.B. Saunders Company. Book Orders Fulfillment Department, Harcourt Health Sciences, 11830 Westline Industrial Drive, Saint Louis, MO 63146-9988. (800) 545-2522. Website: www.wbsaunders.com. PRICE: $69.00 plus shipping and handling. ISBN: 0721682383. Summary: This chapter on examination, diagnosis, and treatment planning of general and orthodontic problems in the adolescent patient (age 12 to 18 years) is from a textbook on pediatric dentistry. The authors identify three areas that may impact the

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dental care of this patient population: rapid, unpredictable, and irregular skeletal and dental growth; environmental challenges such as drugs, smoking, sexually transmitted diseases, peer pressure, competitive education, career decisions, and family pressures; and the need to learn to cope, make decisions, and become independent. Topics include the patient history (particularly the need to keep the ever changing health history of the adolescent up to date); the patient examination, including behavioral assessment, general appraisal, head and neck examination, facial examination, and radiographic evaluation; treatment planning for nonorthodontic problems; treatment planning and treatment for orthodontic problems, including skeletal and dental problems; and temporomandibular joint disorders (TMD) in children and adolescents, including diagnostic, imaging, and treatment considerations. One sidebar reviews the oral dangers of smokeless tobacco. 16 figures. 3 tables. 20 references. •

Premalignant and Malignant Epithelial Tumors of Mucosa and Skin Source: in Marx, R.E.; Stern, D. Oral and Maxillofacial Pathology: A Rationale for Diagnosis and Treatment. Chicago, IL: Quintessence Publishing Co, Inc. 2003. p.283-373. Contact: Available from Quintessence Publishing Co, Inc. 551 Kimberly Drive, Carol Stream, IL 60188-9981. (800) 621-0387 or (630) 682-3223. Fax (630) 682-3288. E-mail: [email protected]. Website: www.quintpub.com. PRICE: $ 399.00 plus shipping and handling. ISBN: 0867153903. Summary: This chapter on premalignant and malignant epithelial tumors of mucosa and skin is from a clinically oriented guide for oral and maxillofacial surgeons and other advanced dental and medical specialists who deal with pathologies in the oral cavity, midface, and neck. Introductory sections review the biology of cancer, including the causes of cancer, cancer progression, oncogenes, tumor suppressor genes, biology of metastasis, and how cancer kills; and principles of cancer treatment, including surgical treatment, radiotherapy, chemotherapy, and management of the terminal cancer patient. The authors then discuss premalignant and nonpremalignant conditions, including erythroplakia and leukoplakia, nicotinic stomatitis, smokeless tobacco keratosis, submucous fibrosis, verrucous carcinoma, and proliferative verrucous leukoplakia; mucosal squamous cell carcinomas, including diagnostic considerations, and squamous cell carcinoma of the lips, oral tongue, pharyngeal tongue, floor of the mouth, buccal (cheek) mucosa, retromolar trigone, gingival, alveolar ridge, palate, and maxillary sinus, and undifferentiated nasopharyngeal carcinoma; premalignant conditions and malignancies of skin, including actinic keratosis, keratoacanthoma, basal cell carcinoma, squamous cell carcinoma of skin, and Merkel cell tumor; and malignant tumors of adnexal structures, including malignant syringoma (microcystic adnexal carcinoma), ductal eccrine carcinoma, mucinous eccrine carcinoma, pilomatrix carcinoma, and sebaceous carcinoma. For each condition, the authors discuss clinical presentation and pathogenesis, differential diagnosis, diagnostic work-up, histopathology, treatment, and prognosis. Full-color photographs illustrate the chapter. 111 figures. 5 tables.

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White Lesions Source: in Regezi, J.A. and Sciubba, J.J. Oral Pathology: Clinical Pathologic Correlations. 3rd ed. Philadelphia, PA: W.B. Saunders Company. 1999. p. 83-121. Contact: Available from W.B. Saunders Company. Book Order Fulfillment Department, 6277 Sea Harbor Drive, Orlando, FL 32821-9854. (800) 545-2522. Fax (800) 874-6418. Website: www.wbsaunders.com. PRICE: $63.95. ISBN: 0721677312.

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Summary: White-appearing lesions of the oral mucosa obtain their characteristic appearance from the scattering of light through an altered mucosal surface. This chapter on white lesions is from a pathology textbook that presents current concepts of oral and maxillofacial pathology in order to enhance the reader's diagnostic skills through the use of differential diagnosis strategies. The text offers readers detailed guidance of etiology, pathogenesis, clinical features, histopathology, differential diagnosis, and treatment of oral diseases of the mucosa, submucosa, and bone. This chapter covers hereditary conditions, including leukoedema, white sponge nevus, hereditary benign intraepithelial dyskeratosis, and follicular keratosis; reactive lesions, including focal (frictional) hyperkeratosis, white lesions associated with smokeless tobacco, nicotine stomatitis, and solar cheilitis; other white lesions, including idiopathic leukoplakia, hairy leukoplakia, hairy tongue, geographic tongue, lichen planus, and dentifrice associated slough; and nonepithelial white yellow lesions, including candidiasis, mucosal burns, submucous fibrosis, Fordyce's granules, ectopic lymphoid tissue, gingival cysts, parulis, and lipoma. 46 figures. 5 tables. 99 references.

Directories In addition to the references and resources discussed earlier in this chapter, a number of directories relating to smokeless tobacco have been published that consolidate information across various sources. The Combined Health Information Database lists the following, which you may wish to consult in your local medical library:11 •

S.T.O.P. Guide: The Smokeless Tobacco Outreach and Prevention Guide. A Comprehensive Directory of Smokeless Tobacco Prevention and Cessation Resources Source: Point Richmond, CA: Applied Behavior Science Press. 1997. 252 p. Contact: Available from Applied Behavior Science Press. 114 Washington Avenue, Point Richmond, CA 94801. (888) 222-7347 or (510) 236-9400. Fax (510) 236-1979. E-mail: [email protected]. PRICE: $89.00 plus $10.00 for shipping and handling. ISBN: 0963955780. Summary: This directory provides a broad array of information regarding smokeless or spit tobacco use, focusing on cessation and prevention programs. Although titled a directory, the looseleaf notebook contains a variety of information materials, including published articles, essays, and statistics. Topics include the prevalence of snuff and chewing tobacco use in the U.S.; legislation and litigation issues; tobacco industry marketing, sales and promotion; ingredients in smokeless tobacco products; health problems associated with spit tobacco use, including dental caries, periodontal effects, soft tissue alterations, leukoplakia, cancer of the oral cavity and pharynx, and cardiovascular effects; school-based prevention of spit tobacco use; spit tobacco cessation; and resources, including Internet resources and resource organizations. The directory concludes with an extensive bibliography of materials on prevalence, health effects and physiology, use patterns, attitudes and perceptions, prevention, assessment, addiction and withdrawal, cessation, marketing, production and content, and public

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You will need to limit your search to “Directory” and “smokeless tobacco” using the "Detailed Search" option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find directories, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Select your preferred language and the format option “Directory.” Type “smokeless tobacco” (or synonyms) into the “For these words:” box. You should check back periodically with this database as it is updated every three months.

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policy. The directory also includes a glossary of terms, a list of recommended alternatives to spit tobacco, and a series of article reprints.

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CHAPTER 7. MULTIMEDIA ON SMOKELESS TOBACCO Overview In this chapter, we show you how to keep current on multimedia sources of information on smokeless tobacco. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine.

Video Recordings An excellent source of multimedia information on smokeless tobacco is the Combined Health Information Database. You will need to limit your search to “Videorecording” and “smokeless tobacco” using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find video productions, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Videorecording (videotape, videocassette, etc.).” Type “smokeless tobacco” (or synonyms) into the “For these words:” box. The following is a typical result when searching for video recordings on smokeless tobacco: •

Smokeless Tobacco: Breaking Free Source: Princeton, NJ: Films for the Humanities and Sciences. 1997. (videocassette). Contact: Available from Films for the Humanities and Sciences. P.O. Box 2053, Princeton, NJ 08543-2053. (800) 257-5126 or (609) 275-1400. Fax (609) 275-3767. E-mail: [email protected]. Website: www.films.com. PRICE: $129.00 plus shipping and handling. Item number VCS 6934. Summary: This health promotion videotape emphasizes that the best advice concerning smokeless tobacco is 'Don't start.' The program encourages children and teenagers who chew tobacco to stop immediately. Using graphic illustrations of cancerous lesions, mouth cankers, and gum disease, a medical expert sternly discusses the health hazards, while offering step by step advice on how to quit. Baseball star Rod Carew talks about his own addiction to the substance and advises young ballplayers against using it.

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Interviews with teenage users provide the basis for a classroom discussion of the issues. (AA-M). •

Spit Tobacco Kills: Extreme Danger of Chewing and Dipping Tobacco Source: Minneapolis, MN: Community Intervention. 199x. (videocassette, teacher's guide). Contact: Available from Community Intervention. 5295 Seventh Street, Suite 570, Minneapolis, MN 55415. (800) 328-0417. PRICE: $189.00 plus shipping and handling. Summary: This instructional kit contains a videotape program and a teacher's guide on the hazards of smokeless tobacco (spit tobacco). Topics include the health dangers of all tobacco products, the warning signs of diseases caused by using spit tobacco, how the media shapes the views of teenagers concerning spit tobacco, the comparative hazards of spit tobacco and cigarettes, and different forms of spit tobacco. The videotape program features rodeo riders and baseball players discussing the problems associated with spit tobacco and the misleading media images relating sports to spit tobacco. The video then interviews ordinary people who have used or still use spit tobacco, including adolescents, and talks with a panel of teenage girls who exclaim how disgusting they think spit tobacco is. Next, Richard Bender, a former spit tobacco user and cancer survivor, tells the story of his addiction and the subsequent cancer that almost took his life at age 27. One other vignette shows a police department operation in which the police and the school district are working together to stop tobacco sales to minors. The curriculum materials include goals and learning objectives, a summary of the videotape program, review questions and answers, and student project sheets, including class debate ideas, research topics, role plays, and fact sheets. The kit concludes with a glossary of terms and a bibliography. 10 references. (AA-M).

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Smokeless Tobacco: A Spittin' Image Source: Washington, DC: Durrin Productions, Inc. 1994. (videocassette). Contact: Available from Durrin Productions, Inc. 1748 Kalorama Road, NW, Washington, DC 20009. (800) 536-6843 or (202) 387-6700. Fax (202) 265-6079. PRICE: $149.00 plus shipping and handling; rentals $52.00 for 3 days. Also available from Health Edco. P.O. Box 21207, Waco, TX 76702-1207. (800) 299-3366. Fax (817) 751-0221. PRICE: $99.00 plus shipping and handling. Order Number JG46421. Summary: This videotape program refutes the messages presented by industry advertising that smokeless or spit tobacco is a harmless alternative to smoking. At a baseball game, a rodeo, a fast-food drive-in, and in the classroom, the videotape depicts the real image tobacco users project. The program is designed for children in grades 6 through 12. (AA-M).

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Smokeless Tobacco: Is It Worth the Risk? Source: Alexandria, VA: American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS). 199x. (videocassette). Contact: Available from American Academy of Otolaryngology: Head and Neck Surgery (AAO-HNS). Order Fulfillment, One Prince Street, Alexandria, VA 22314-3357. (703) 836-4444. Fax (703) 683-5100. PRICE: $15.00 each (members); $20.00 (nonmembers); plus shipping and handling. Item Number 4763355.

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Summary: This videotape program, targeted at adolescent males, reminds viewers of the dangers of smokeless tobacco. The program opens with footage of various major league baseball games, accompanied by upbeat music, as the narrator, Mel Adams, describes baseball as a great American tradition. The narration continues to describe the use of tobacco as another not-so-great American tradition and the evolution from smoking to smokeless tobacco. The program interviews Dr. Byron Bailey, who shows slides of the oral and dental complications of spit tobacco use. The program describes how young players may be influenced by major league players, by advertising, and by peer pressure to use spit tobacco. Pitcher, Nolan Ryan, is interviewed about how he tries to influence young players not to use smokeless tobacco. Dr. Bailey discusses the addictive properties of nicotine, how spit tobacco hurts the teeth and gums, what to do if symptoms arise, diagnostic tests for oral cancer, and the importance of early diagnosis. Dr. Bailey also discusses surgical intervention often necessary to treat oral cancer, and shows postoperative slides of head and neck cancer patients. The program concludes with a section on how to quit using spit tobacco. After footage of another lively baseball game, the program ends with pictures of Sean Marsee, a young man who died of oral cancer related to smokeless tobacco use. •

Dangerous Game: Major League Baseball Players Tell Teens Why Smokeless Tobacco Users Are Playing a Dangerous Game Source: Bethesda, MD: National Cancer Institute (NCI), National Institute of Dental and Craniofacial Research (NIDCR), National Institutes of Health (NIH). August 1995. (videocassette). Contact: Available from National Cancer Institute (NCI). Publications Ordering Service, P.O. Box 24128, Baltimore, MD 21227. Voice (800) 422-6237. TTY (800) 332-8615. Fax (301) 330-7968. Website: rex.nci.nih.gov/. PRICE: Single copy free. Item Number K371. Summary: This videotape, targeted to teens, focuses on the dangers of using smokeless or spit tobacco. The videotape features Major League baseball players such as Nolan Ryan, Joe Carter, Jim Eisenreich, and Mike Timlin. The players speak out against the use of smokeless tobacco in professional baseball. They describe how they developed their habits, how smokeless tobacco affected them, and how addicting smokeless tobacco can be. A former amateur baseball player, Rick Bender, talks about his oral cancer and the surgery that removed parts of his jaw, mouth, and tongue. The videotape gives compelling reasons to avoid or quit using spit tobacco, corrects widely held myths and misconceptions about spit tobacco, and refutes the image of spit tobacco as integral to the success of Major League baseball players. The videotape concludes by giving the number for the National Cancer Institute hotline, 1-800-4-CANCER. (AA-M).

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CHAPTER 8. PERIODICALS AND NEWS ON SMOKELESS TOBACCO Overview In this chapter, we suggest a number of news sources and present various periodicals that cover smokeless tobacco.

News Services and Press Releases One of the simplest ways of tracking press releases on smokeless tobacco is to search the news wires. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing. PR Newswire To access the PR Newswire archive, simply go to http://www.prnewswire.com/. Select your country. Type “smokeless tobacco” (or synonyms) into the search box. You will automatically receive information on relevant news releases posted within the last 30 days. The search results are shown by order of relevance. Reuters Health The Reuters’ Medical News and Health eLine databases can be very useful in exploring news archives relating to smokeless tobacco. While some of the listed articles are free to view, others are available for purchase for a nominal fee. To access this archive, go to http://www.reutershealth.com/en/index.html and search by “smokeless tobacco” (or synonyms). The following was recently listed in this archive for smokeless tobacco: •

Smokeless tobacco leads to smoking in young me Source: Reuters Medical News Date: March 30, 2001

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Kids unaware of dangers of chewing tobacco Source: Reuters Health eLine Date: December 19, 2000

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Native women's use of smokeless tobacco may increase risk of breast cancer Source: Reuters Medical News Date: May 09, 2000

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Nicotine varies widely in chewing tobacco Source: Reuters Health eLine Date: May 20, 1999

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Smokeless Tobacco May Be Listed As Carcinogen Source: Reuters Medical News Date: April 28, 1998

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Smokeless Tobacco Use Not On The Decline Source: Reuters Medical News Date: September 25, 1996 The NIH

Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at the following Web page: http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within its search engine. Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com/. You can scan the news by industry category or company name. Market Wire Market Wire is more focused on technology than the other wires. To browse the latest press releases by topic, such as alternative medicine, biotechnology, fitness, healthcare, legal, nutrition, and pharmaceuticals, access Market Wire’s Medical/Health channel at http://www.marketwire.com/mw/release_index?channel=MedicalHealth. Or simply go to Market Wire’s home page at http://www.marketwire.com/mw/home, type “smokeless tobacco” (or synonyms) into the search box, and click on “Search News.” As this service is technology oriented, you may wish to use it when searching for press releases covering diagnostic procedures or tests. Search Engines Medical news is also available in the news sections of commercial Internet search engines. See the health news page at Yahoo (http://dir.yahoo.com/Health/News_and_Media/), or

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you can use this Web site’s general news search page at http://news.yahoo.com/. Type in “smokeless tobacco” (or synonyms). If you know the name of a company that is relevant to smokeless tobacco, you can go to any stock trading Web site (such as http://www.etrade.com/) and search for the company name there. News items across various news sources are reported on indicated hyperlinks. Google offers a similar service at http://news.google.com/. BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “smokeless tobacco” (or synonyms).

Newsletters on Smokeless Tobacco Find newsletters on smokeless tobacco using the Combined Health Information Database (CHID). You will need to use the “Detailed Search” option. To access CHID, go to the following hyperlink: http://chid.nih.gov/detail/detail.html. Limit your search to “Newsletter” and “smokeless tobacco.” Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter.” Type “smokeless tobacco” (or synonyms) into the “For these words:” box. The following list was generated using the options described above: •

Oral Health Practitioner Guide: NSTEP Source: Chicago, IL: National Spit Tobacco Education Program (NSTEP), Oral Health America. 1997. 4 p. Contact: Available from National Spit Tobacco Education Program (NSTEP). Oral Health America, 410 North Michigan Avenue, Suite 352, Chicago, IL 60611-4211. (312) 836-9900. PRICE: Single copy free. Summary: This newsletter provides oral health practitioners with information about NSTEP (National Spit Tobacco Education Program), a tobacco prevention and cessation program. The newsletter contains articles describing the program and its activities thus far. The newsletter emphasizes the important 'front line' role of dentists, hygienists, dental assistants, and others on the dental team in this education effort about the dangerous effects of using spit tobacco (smokeless tobacco, snuff, chew). The newsletter describes the NSTEP Practitioner Kits that are available, funding of the program, current statistics and trends in tobacco use in the United States (particularly among adolescents), recommendations for counseling patients to quit tobacco, spit tobacco quit tips for patients, and recommended community outreach activities. The newsletter concludes with a list of common questions and answers about spit tobacco, its accompanying risks, and NSTEP. Also included is a note from the national chairman of the program, Joe Garagiola.

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Newsletter Articles Use the Combined Health Information Database, and limit your search criteria to “newsletter articles.” Again, you will need to use the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter Article.” Type “smokeless tobacco” (or synonyms) into the “For these words:” box. You should check back periodically with this database as it is updated every three months. The following is a typical result when searching for newsletter articles on smokeless tobacco: •

Cancer Registry Shows Increased Incidence and Survival Improvement in Tongue Cancer Among Young Adults Source: News from SPOHNC. News from Support for People with Oral and Head and Neck Cancer, Inc. 11(3): 3, 6. November 2001. Contact: Available from Support for People with Oral and Head and Neck Cancer, Inc. (SPOHNC). P.O. Box 53, Locust Valley, NY 11560-0053. (516) 759-5333. E-mail: [email protected]. Website: www.spohnc.org. Summary: This newsletter article reports on a study of tongue cancer among young adults. Younger patients consistently make up less than 5 percent of all squamous cell carcinoma of the tongue in reported series. It is therefore difficult to accumulate sufficiently large numbers of young patients to make any statistically significant conclusions. On the other hand, mortality data and hospital based statistics can not confirm a real increase of this disease due to therapeutic influences or a lack of population denominator. The authors report on their research using a large cancer surveillance database in the United States to conduct statistical analysis. Results showed that tongue cancer incidence trends for young and old Americans changed at very different rates. In young Americans (below age 40), there was a significantly upward trend from 1973 through 1997 and a sharp acceleration of tongue cancer incidence was found from 1973 until 1985. After 1985, the incidence stopped rising but remained steadily high. The authors review possible risk factors for tongue cancer, including cigarette smoking, alcohol use, use of smokeless tobacco, marijuana use, and human papillomavirus (HPC) infection.

Academic Periodicals covering Smokeless Tobacco Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to smokeless tobacco. In addition to these sources, you can search for articles covering smokeless tobacco that have been published by any of the periodicals listed in previous chapters. To find the latest studies published, go to http://www.ncbi.nlm.nih.gov/pubmed, type the name of the periodical into the search box, and click “Go.” If you want complete details about the historical contents of a journal, you can also visit the following Web site: http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/, you can retrieve more indexing information on medical

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periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.”

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CHAPTER 9. RESEARCHING MEDICATIONS Overview While a number of hard copy or CD-ROM resources are available for researching medications, a more flexible method is to use Internet-based databases. Broadly speaking, there are two sources of information on approved medications: public sources and private sources. We will emphasize free-to-use public sources.

U.S. Pharmacopeia Because of historical investments by various organizations and the emergence of the Internet, it has become rather simple to learn about the medications recommended for smokeless tobacco. One such source is the United States Pharmacopeia. In 1820, eleven physicians met in Washington, D.C. to establish the first compendium of standard drugs for the United States. They called this compendium the U.S. Pharmacopeia (USP). Today, the USP is a non-profit organization consisting of 800 volunteer scientists, eleven elected officials, and 400 representatives of state associations and colleges of medicine and pharmacy. The USP is located in Rockville, Maryland, and its home page is located at http://www.usp.org/. The USP currently provides standards for over 3,700 medications. The resulting USP DI Advice for the Patient can be accessed through the National Library of Medicine of the National Institutes of Health. The database is partially derived from lists of federally approved medications in the Food and Drug Administration’s (FDA) Drug Approvals database, located at http://www.fda.gov/cder/da/da.htm. While the FDA database is rather large and difficult to navigate, the Phamacopeia is both user-friendly and free to use. It covers more than 9,000 prescription and over-the-counter medications. To access this database, simply type the following hyperlink into your Web browser: http://www.nlm.nih.gov/medlineplus/druginformation.html. To view examples of a given medication (brand names, category, description, preparation, proper use, precautions, side effects, etc.), simply follow the hyperlinks indicated within the United States Pharmacopeia (USP). Below, we have compiled a list of medications associated with smokeless tobacco. If you would like more information on a particular medication, the provided hyperlinks will direct you to ample documentation (e.g. typical dosage, side effects, drug-interaction risks, etc.).

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The following drugs have been mentioned in the Pharmacopeia and other sources as being potentially applicable to smokeless tobacco: Nitrates Sublingual, Chewable, or Buccal •

Systemic - U.S. Brands: Isordil; Nitrogard; Nitrostat; Sorbitrate http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202412.html

Commercial Databases In addition to the medications listed in the USP above, a number of commercial sites are available by subscription to physicians and their institutions. Or, you may be able to access these sources from your local medical library.

Mosby’s Drug Consult Mosby’s Drug Consult database (also available on CD-ROM and book format) covers 45,000 drug products including generics and international brands. It provides prescribing information, drug interactions, and patient information. Subscription information is available at the following hyperlink: http://www.mosbysdrugconsult.com/. PDRhealth The PDRhealth database is a free-to-use, drug information search engine that has been written for the public in layman’s terms. It contains FDA-approved drug information adapted from the Physicians’ Desk Reference (PDR) database. PDRhealth can be searched by brand name, generic name, or indication. It features multiple drug interactions reports. Search PDRhealth at http://www.pdrhealth.com/drug_info/index.html. Other Web Sites Drugs.com (www.drugs.com) reproduces the information in the Pharmacopeia as well as commercial information. You may also want to consider the Web site of the Medical Letter, Inc. (http://www.medletter.com/) which allows users to download articles on various drugs and therapeutics for a nominal fee. If you have any questions about a medical treatment, the FDA may have an office near you. Look for their number in the blue pages of the phone book. You can also contact the FDA through its toll-free number, 1-888-INFO-FDA (1-888-463-6332), or on the World Wide Web at www.fda.gov.

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APPENDIX A. PHYSICIAN RESOURCES Overview In this chapter, we focus on databases and Internet-based guidelines and information resources created or written for a professional audience.

NIH Guidelines Commonly referred to as “clinical” or “professional” guidelines, the National Institutes of Health publish physician guidelines for the most common diseases. Publications are available at the following by relevant Institute12: •

Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm

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National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/

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National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html

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National Cancer Institute (NCI); guidelines available at http://www.cancer.gov/cancerinfo/list.aspx?viewid=5f35036e-5497-4d86-8c2c714a9f7c8d25

•

National Eye Institute (NEI); guidelines available at http://www.nei.nih.gov/order/index.htm

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National Heart, Lung, and Blood Institute (NHLBI); guidelines available at http://www.nhlbi.nih.gov/guidelines/index.htm

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National Human Genome Research Institute (NHGRI); research available at http://www.genome.gov/page.cfm?pageID=10000375

•

National Institute on Aging (NIA); guidelines available at http://www.nia.nih.gov/health/

12

These publications are typically written by one or more of the various NIH Institutes.

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National Institute on Alcohol Abuse and Alcoholism (NIAAA); guidelines available at http://www.niaaa.nih.gov/publications/publications.htm

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National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/

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National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); fact sheets and guidelines available at http://www.niams.nih.gov/hi/index.htm

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National Institute of Child Health and Human Development (NICHD); guidelines available at http://www.nichd.nih.gov/publications/pubskey.cfm

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National Institute on Deafness and Other Communication Disorders (NIDCD); fact sheets and guidelines at http://www.nidcd.nih.gov/health/

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National Institute of Dental and Craniofacial Research (NIDCR); guidelines available at http://www.nidr.nih.gov/health/

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National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm

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National Institute on Drug Abuse (NIDA); guidelines available at http://www.nida.nih.gov/DrugAbuse.html

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National Institute of Environmental Health Sciences (NIEHS); environmental health information available at http://www.niehs.nih.gov/external/facts.htm

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National Institute of Mental Health (NIMH); guidelines available at http://www.nimh.nih.gov/practitioners/index.cfm

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National Institute of Neurological Disorders and Stroke (NINDS); neurological disorder information pages available at http://www.ninds.nih.gov/health_and_medical/disorder_index.htm

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National Institute of Nursing Research (NINR); publications on selected illnesses at http://www.nih.gov/ninr/news-info/publications.html

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National Institute of Biomedical Imaging and Bioengineering; general information at http://grants.nih.gov/grants/becon/becon_info.htm

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Center for Information Technology (CIT); referrals to other agencies based on keyword searches available at http://kb.nih.gov/www_query_main.asp

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National Center for Complementary and Alternative Medicine (NCCAM); health information available at http://nccam.nih.gov/health/

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National Center for Research Resources (NCRR); various information directories available at http://www.ncrr.nih.gov/publications.asp

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Office of Rare Diseases; various fact sheets available at http://rarediseases.info.nih.gov/html/resources/rep_pubs.html

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Centers for Disease Control and Prevention; various fact sheets on infectious diseases available at http://www.cdc.gov/publications.htm

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NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.13 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full-text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:14 •

Bioethics: Access to published literature on the ethical, legal, and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html

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HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html

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NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html

•

Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/

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Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html

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Cancer Information: Access to cancer-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html

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Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/

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Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html

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Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html

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Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html

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MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html

13

Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 14 See http://www.nlm.nih.gov/databases/databases.html.

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Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html

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Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html

The NLM Gateway15 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing one-stop searching for many of NLM’s information resources or databases.16 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “smokeless tobacco” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Journal Articles Books / Periodicals / Audio Visual Consumer Health Meeting Abstracts Other Collections Total

Items Found 1760 35 37 5 38 1875

HSTAT17 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.18 These documents include clinical practice guidelines, quickreference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.19 Simply search by “smokeless tobacco” (or synonyms) at the following Web site: http://text.nlm.nih.gov.

15

Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x.

16

The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 17 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 18 19

The HSTAT URL is http://hstat.nlm.nih.gov/.

Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force's Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services’ Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations.

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Coffee Break: Tutorials for Biologists20 Coffee Break is a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. Here you will find a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.21 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.22 This site has new articles every few weeks, so it can be considered an online magazine of sorts. It is intended for general background information. You can access the Coffee Break Web site at the following hyperlink: http://www.ncbi.nlm.nih.gov/Coffeebreak/.

Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are some examples that may interest you: •

CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.

•

Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.

20 Adapted 21

from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html.

The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 22 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process.

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APPENDIX B. PATIENT RESOURCES Overview Official agencies, as well as federally funded institutions supported by national grants, frequently publish a variety of guidelines written with the patient in mind. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. Since new guidelines on smokeless tobacco can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internetbased services that post them.

Patient Guideline Sources The remainder of this chapter directs you to sources which either publish or can help you find additional guidelines on topics related to smokeless tobacco. Due to space limitations, these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly. The National Institutes of Health The NIH gateway to patients is located at http://health.nih.gov/. From this site, you can search across various sources and institutes, a number of which are summarized below. Topic Pages: MEDLINEplus The National Library of Medicine has created a vast and patient-oriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages” which list links to available materials relevant to smokeless tobacco. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. Recently, MEDLINEplus listed the following when searched for “smokeless tobacco”:

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Guides on smokeless tobacco Smokeless Tobacco http://www.nlm.nih.gov/medlineplus/smokelesstobacco.html

•

Other guides Head and Neck Cancer http://www.nlm.nih.gov/medlineplus/headandneckcancer.html Oral Cancer http://www.nlm.nih.gov/medlineplus/oralcancer.html Smoking and Youth http://www.nlm.nih.gov/medlineplus/smokingandyouth.html

Within the health topic page dedicated to smokeless tobacco, the following was listed: •

General/Overviews Spit Tobacco: Does Smokeless Mean Harmless? Source: Mayo Foundation for Medical Education and Research http://www.mayoclinic.com/invoke.cfm?id=CA00019 Spit Tobacco: It's No Game Source: American Academy of Otolaryngology--Head and Neck Surgery http://www.entnet.org/healthinfo/tobacco/spit_tobacco.cfm

•

Specific Conditions/Aspects Smokeless Tobacco and Cancer: Questions and Answers Source: National Cancer Institute http://cis.nci.nih.gov/fact/3_63.htm

•

Children Smokeless Tobacco: Especially for Kids! Source: National Cancer Institute http://dccps.nci.nih.gov/tcrb/less_kids.html Smoking Stinks! Source: Nemours Foundation http://kidshealth.org/kid/watch/house/smoking.html Surgeon General's Report for Kids about Smoking: Is Smokeless Tobacco Safe? Source: Centers for Disease Control and Prevention http://www.cdc.gov/tobacco/sgr/sgr4kids/smokless.htm Talking to Your Child about Smoking and Smokeless Tobacco Source: Nemours Foundation http://kidshealth.org/parent/positive/talk/smoking.html What to Do If Your Kid Smokes or Chews Tobacco Source: Nemours Foundation http://kidshealth.org/parent/emotions/behavior/smokes_chews.html

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From the National Institutes of Health Smokeless Tobacco: Quitting Source: National Cancer Institute http://dccps.nci.nih.gov/tcrb/less_quit.html Smokeless Tobacco: Health and Other Effects Source: National Cancer Institute http://dccps.nci.nih.gov/tcrb/less_effects.html Spit Tobacco: A Guide for Quitting Source: National Institute of Dental and Craniofacial Research http://www.nidcr.nih.gov/health/newsandhealth/spitTobacco/ Spitting into the Wind: The Facts about Dip and Chew Source: National Institute of Dental and Craniofacial Research http://www.nidr.nih.gov/health/pubs/chew/main.htm

•

Organizations American Cancer Society http://www.cancer.org/ American Dental Association http://www.ada.org/ Campaign for Tobacco Free Kids Source: National Center for Tobacco-Free Kids http://tobaccofreekids.org/ CDC's TIPS: Tobacco Information and Prevention Source Source: Centers for Disease Control and Prevention http://www.cdc.gov/tobacco/ National Institute of Dental and Craniofacial Research http://www.nidcr.nih.gov/

•

Research Nicotine Patch Helps Smokeless Tobacco Users Quit, but Maintaining Abstinence May Require Additional Treatment Source: National Institute on Drug Abuse http://www.nida.nih.gov/NIDA_Notes/NNVol16N1/Nicotine.html

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Statistics Healthy People 2010: Tobacco Use Source: Centers for Disease Control and Prevention http://www.healthypeople.gov/document/html/volume2/27tobacco.htm Spit (Smokeless) Tobacco and Kids http://tobaccofreekids.org/research/factsheets/pdf/0003.pdf State-Specific Adult Smoking Prevalence, Smokeless Tobacco Prevalence and State Tax Paid Per Capita Sales of Cigarettes Source: Centers for Disease Control and Prevention http://www.cdc.gov/od/oc/media/fact/smokprev.htm

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Teen Tobacco Use Source: American Cancer Society http://www.cancer.org/docroot/ped/content/ped_10_2x_children_adolescents_a nd_tobacco_use.asp?sitearea=who •

Teenagers I Quit: What to Do When You're Sick of Smoking, Chewing, or Dipping Source: Centers for Disease Control and Prevention http://www.cdc.gov/tobacco/quit/iquit.htm Smokeless Tobacco Source: Nemours Foundation http://kidshealth.org/teen/drug_alcohol/tobacco/smokeless.html

•

Women Women and Smokeless Tobacco Use Source: National Institute on Drug Abuse http://www.nida.nih.gov/NIDA_Notes/NNVol16N1/Women.html

You may also choose to use the search utility provided by MEDLINEplus at the following Web address: http://www.nlm.nih.gov/medlineplus/. Simply type a keyword into the search box and click “Search.” This utility is similar to the NIH search utility, with the exception that it only includes materials that are linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and patient education guidelines on smokeless tobacco. CHID offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: •

Truth About Smokeless Tobacco Source: Waco, TX: HEALTH EDCO. 1996. 8 p. Contact: Available from HEALTH EDCO. P.O. Box 21207, Waco, TX 76702-1207. (800) 299-3366 or (817) 776-6461. Fax (888) 977-7653. E-mail: [email protected]. Website: www.healthedco.com. PRICE: $2.00; bulk copies available. Order number JG42501. Summary: Americans have become very aware of the health risks of smoking cigarettes, but less is known about the dangers of their popular substitute: snuff and chewing tobacco. This booklet is designed to teach readers about the hazards of smokeless tobacco. The booklet likens the use of smokeless tobacco to lighting a fuse on a bomb and then putting the bomb in one's mouth. The brochure first defines and describes the different types of smokeless tobacco, including snuff and chewing tobacco, and

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discusses the drug involved, nicotine. Other topics include the related mouth problems (mouth cancer, leukoplakia, gum disease, bad breath, tooth decay, and worn and stained teeth), heart and blood flow problems (stroke, hypertension, heart disease), the myth that smokeless tobacco enhances athletic performance, the signs of addiction, and the warning signs of cancer. The booklet concludes with a chart comparing the lies and the truths about smokeless tobacco. The booklet is illustrated with colorful line drawings and graphics. •

Dangerous Game: The Truth About Spit Tobacco Source: Bethesda, MD: National Cancer Institute (NCI), National Institutes of Health (NIH). August 1995. [8 p.]. Contact: Available from NCI Publications Department. P.O. Box 24128, Baltimore, MD 21227. (800) 422-6237. PRICE: Single copy free. NIH Publication Number 95-3880. Summary: Spit tobacco (ST or smokeless tobacco) comes in two forms: snuff and chewing tobacco. This brochure from the National Cancer Institute reminds readers of the hazards of ST, including the facts that it is highly addictive, contains nicotine, does not help performance (i.e., in sports), and is not a safe alternative to cigarettes. The brochure uses clean bold graphics in black, white and red to remind readers of the addictiveness of ST and the importance of not starting the habit. The brochure includes full color photographs of some of the hazards of using ST, depicting gums pulling away from the teeth, and white, wrinkled patches inside the mouth that can turn into cancer. The brochure also features before and after photographs of Rick Bender, a young man who underwent major jaw surgery to treat cancer. The brochure concludes by describing the signs and symptoms of oral and head and neck cancer. A brief description is also provided of a guide that can help readers quit the smokeless tobacco habit.

•

Spit Tobacco: A Guide for Quitting Source: Rockville, MD: U.S. Department of Health and Human Services. National Institute of Dental and Craniofacial Research (NIDCR), National Institutes of Health (NIH). 2000. 24 p. Contact: National Oral Health Information Clearinghouse (NOHIC). 1 NOHIC Way, Bethesda, MD 20892-3500. (301) 402-7364. Fax (301) 907-8830. E-mail: [email protected]. Website: www.nohic.nidcr.nih.gov. PRICE: Single copy free. Order Number NR-73. Summary: This booklet is designed to help people who use smokeless tobacco (spit tobacco) quit the habit. The guide is the result of advice from chewers and dippers who have broken their tobacco habit. The booklet uses the term 'spit tobacco' over the term 'smokeless tobacco,' contending that the latter term makes the products sound safe and they are not safe. The booklet reviews the dangers of dip and chew, including tooth decay, gum recession, leukoplakia and red sores, and oral cancer. Other reasons discussed for quitting include cost factors, the esthetic problems (smell on one's breath and clothing), and dental hygiene (stained teeth). Also included is a section for readers to assess how addicted they are to spit tobacco, a section of myths and truths about spit tobacco, an outline of a plan for quitting (including what to expect during nicotine withdrawal, how to avoid triggers to start using again), and additional strategies that are available and may be necessary (nicotine replacement therapy, counseling, medication, support groups). Numerous photographs of and comments from professional athletes about the problems associated with spit tobacco are included. The

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publication concludes with a list of selected resource organizations for more information and a tear-off commentary card for readers to assess the effectiveness of the booklet. The booklet is illustrated with full-color graphics. •

What Everyone Should Know About Spit Tobacco Source: South Deerfield, MA: Channing L. Bete Company, Inc. 1997. 15 p. Contact: Available from Channing L. Bete Company, Inc. Dept. GSA, 200 State Road, South Deerfield, MA 01373-0200. (800) 628-7733; Fax (800) 499-6464; http://www.channing.bete.com. PRICE: $1.326 each for 1-24 copies; bulk pricing available. Item Number 19455D-8-93. Summary: This booklet provides basic information about smokeless tobacco or spit tobacco in an easy-to-read format. Topics covered in the booklet include a definition of spit tobacco; how spit tobacco can contribute to serious health problems; a brief history of tobacco; why spit tobacco has become popular again; basic facts about spit tobacco and its effects on the body; oral health complications of using spit tobacco; cancers related to spit tobacco, including mouth, larynx, and esophagus cancers; other health risks associated with spit tobacco, including high blood pressure, nicotine poisoning, and reduced senses of taste and smell; and some alternatives to spit tobacco. The booklet is illustrated with simple, cartoon line drawings and is aimed at an adolescent reading audience.

•

Smokeless Tobacco: A Medical Perspective Source: Atlanta, GA: American Cancer Society. 1997. [2 p.]. Contact: Available from American Cancer Society (ACS). 1599 Clifton Road, NE, Atlanta, GA 30329. (800) ACS-2345; http://www.cancer.org. Also available from your local American Cancer Society chapter. PRICE: Single copy free; bulk orders available at cost. Summary: This brief brochure reminds health care professionals of the problem of smokeless tobacco use. The author stresses that the medical and dental professions must recognize and educate the public about the serious health risks of smokeless tobacco use. The brochure presents basic facts about smokeless tobacco use and its adverse affects, including carcinogenesis, gingival recession, in utero damage, and long-term nicotine dependence. Full-color photographs illustrate some of the oral health problems, notably oral carcinoma, resulting from smokeless tobacco use. 3 figures.

•

Teens and Tobacco: Spit Tobacco: The Facts are Hard to Swallow, Too Source: Deerfield, MA: Channing Bete Company, Inc. 1999. 4 p. Contact: Channing Bete Company, Inc. One Community Place, South Deerfield, MA 01373-0200. (800) 477-4776. Fax (800) 499-6464. Email: [email protected]. Website: www.channing-bete.com. PRICE: $1.15 for 1-99 copies; $.89 for 100-499 copies; discounts available for large orders. Item number: 31092. Summary: This brightly illustrated brochure helps teenagers understand the real hazards of using spit tobacco (smokeless tobacco). The brochure addresses each of the myths about smokeless tobacco and presents facts about the drug. Topics include nicotine and nicotine addiction, the image cultivated by the tobacco companies, marketing of smokeless tobacco, oral cancer, the differences between smoking and smokeless tobacco, hygiene considerations (bad breath and discolored teeth), and how

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to stop a nicotine habit. The brochure includes drawings of teenagers in various social settings, a full color photograph of a young person with jaw cancer, and the contact information for the National Clearinghouse for Alcohol and Drug Information (www.health.org or 800-729-6686). •

What's Really in Spit Tobacco? Source: Chicago, IL: National Spit Tobacco Education Program (NSTEP), Oral Health America. 199x. [8 p.]. Contact: Available from National Spit Tobacco Education Program (NSTEP). Oral Health America, 410 North Michigan Avenue, Suite 352, Chicago, IL 60611-4211. (312) 836-9900. PRICE: $0.45 each. Summary: This brochure aims to convince readers of the hazards of spit tobacco. Cleverly shaped like a can of smokeless tobacco, the brochure invites readers to discover what is really in smokeless tobacco. The brochure emphasizes that spit tobacco is addictive, contains chemicals (including carcinogenic ones), and causes gum disease, oral cancer, and even death. The brochure features full-color photographs of sports figures with quotations explaining why they do not support the use of spit tobacco. Photographs are also included of gum disease and oral cancer patients (including Sean Marsee, who died at age 19 of oral cancer).

•

50 Things You Should Know About Spit Tobacco: Smokeless Tobacco Source: Santa Cruz, CA: Journeyworks Publishing. 2002. 2 p. Contact: Available from Journeyworks Publishing. PO Box 8466, Santa Cruz, CA 950618466. (800) 775-1998 or (831) 423-1400. Fax (831) 423-8102. Website: www.journeyworks.com. Email: [email protected]. PRICE: $16.00 for 50 copies; discounts available for bulk orders. Title number: 5293. Summary: This brochure alerts readers to the hazards of chewing tobacco (spit tobacco). Written in an accessible form and illustrated with brightly colored graphics, the brochure lists 50 concerns about the habit of using chewing tobacco. Topics include the hazards of smokeless tobacco, cigarette smoking, nicotine addiction, tooth discoloration, bad breath, additives to smokeless tobacco, taste and smell dysfunction, gingiva (gum) bleeding, oral cancer, cardiovascular complications linked to spit tobacco, age factors, sex factors, advertising ploys, and how to deal with peer pressure.

•

Smokeless Tobacco: Think Before You Chew Source: Chicago, IL: American Dental Association (ADA). 1990. [2 p.]. Contact: Available from American Dental Association (ADA). Catalog Sales, P.O. Box 776, St. Charles, IL 60174. (800) 947-4746; Fax (630) 443-9970; http://www.ada.org. PRICE: Single copy free; bulk rates available. Order Number W190. Summary: This brochure describes the oral health hazards associated with snuff dipping and tobacco chewing. Topics include the warning labels on smokeless tobacco; the facts about snuff, smokeless tobacco, and nicotine; the cosmetic effects of using smokeless tobacco; oral cancer caused by smokeless tobacco; and the myths about who really uses smokeless tobacco. The brochure concludes with a glossary of terms and their definitions. The brochure includes full-color pictures of teeth and gums affected by smokeless tobacco, as well as before and after pictures of a young man named Sean Marsee, who died at age 18 of cancer related to smokeless tobacco.

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Quitting Spitting: More Than Enough Reasons to Stop Using Spit Tobacco NOW! Source: Washington, DC: American Cancer Society. 1996. [8 p.]. Contact: Available from American Cancer Society. 1599 Clifton Road, NE, Atlanta, GA 30329. (800) ACS-2345 or (404) 320-3333; http://www.cancer.org. PRICE: Single copy free. Also available from local American Cancer Society offices. Summary: This brochure encourages adolescents to quit the use of spit tobacco (smokeless tobacco). The brochure first lists the consequences of using spit tobacco, including oral cancer, mouth sores, bad breath, stained teeth, and tooth loss. The brochure also reminds readers of the addictive potential of nicotine and how difficult it can be to quit a nicotine habit. The brochure presents the decision to quit using spit tobacco as just one in a series of lifestyle decisions that young adults are making at this point in their lives. The brochure outlines three reasons why this is a good decision: to save money, to save one's looks, and to save lives. A form for determining how much money is spent on spit tobacco (for the individual reader) is provided. The brochure concludes with a section on the difficulties of quitting a spit tobacco habit and how to address those issues. A final section includes a pledge to quit spit tobacco; readers can sign the pledge and send it to the American Cancer Society. The organization will send congratulations in return. The brochure emphasizes the positive feelings that will result in knowing 'you did something on your own for your own good with your own strength and determination.' The brochure is illustrated with line drawings of young adult males.

•

Smokeless Tobacco: Warning: Chewing and Dipping Can be Hazardous to Your Health Source: Austin, TX: Texas Department of Health, Bureau of Dental Health. 199X. 2 p. Contact: Available from Texas Department of Health, Bureau of Dental Health. 1100 West 49th Street, Austin, TX 78756. (512) 458-7525 or (516) 458-7232. PRICE: Single copy free. Item Number 8-28. Summary: This brochure presents basic facts about the dangers of smokeless tobacco. After a few stories and statistics about health problems caused by smokeless tobacco, the brochure discusses how chewing tobacco and the resulting juices can produce leukoplakia; carcinogens in some forms of smokeless tobacco; and other hazards of smokeless tobacco due to nicotine and sugar content. The brochure is written in clear, easy-to-understand language, and is illustrated with simple graphics.

•

Smokeless Tobacco: What's It Going to Cost You? Source: Waco, TX: Health Edco. 1998. [4 p.]. Contact: Available from Health Edco, P.O. Box 21207, Waco, TX 76702-1207. (800) 2993366 or (817) 776-6461. Fax (888) 977-7653. E-mail: [email protected]. Website: www.healthedco.com. PRICE: $2.00; bulk copies available. Order number JG38099. Summary: This brochure provides information and statistics about smokeless tobacco. Aimed at adolescent and young men, the brochure reminds readers of the health risks associated with smokeless tobacco, including oral cancer, bad breath, stained teeth, high blood pressure, leukoplakia, and gum problems. The brochure first reports and then refutes five myths about smokeless tobacco, including: it's safer than cigarettes; if I don't use the strong stuff, I won't get addicted; I won't get cancer because I don't inhale any smoke; I'm young, so my body can take it for awhile; and snuff and chewing tobacco are

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symbols of independence and toughness. The brochure also describes the manipulation tactics of tobacco advertisers, with illustrations from some of the most popular brands. The brochure concludes with the contact information for three resource organizations: the American Cancer Society, the American Heart Association, and the Office on Smoking and Health (of the Centers for Disease Control and Prevention). •

Spit Tobacco: Dangerous and Deadly Source: Chicago, IL: Oral Health America. 1996. 4 p. Contact: Available from Oral Health America. America's Fund for Dental Health, 410 North Michigan Avenue, Suite 352, Chicago, IL 60611-4211. (312) 836-9900. PRICE: $0.35 each. Summary: This brochure provides readers with basic facts about smokeless or spit tobacco and the National Spit Tobacco Education Program (NSTEP). NSTEP is a collaborative effort linking many of baseball's most colorful and popular personalities with the nation's leading oral health experts and government agencies. NSTEP's goal is to educate Americans that spit tobacco is not a safe alternative to cigarettes. The brochure features photographs and quotations from famous baseball players, including two who have struggled with oral cancer. Striking postoperative photographs of the latter are included. The brochure also presents basic facts about spit tobacco and the addictive nature of nicotine. It provides statistics on users of the products and discusses what is being done to address the problems associated with smokeless tobacco. 6 figures.

•

Spit Tobacco Source: Alexandria, VA: American Academy of Otolaryngology. 1995. 2 p. Contact: Available from American Academy of Otolaryngology, Head and Neck Surgery, Inc. One Prince Street, Alexandria, VA 22314-3357. (703) 836-4444. PRICE: Single copy free. Summary: This brochure warns readers of the problems associated with spit tobacco, including chewing tobacco and snuff. Topics covered include how the two forms are used; how the nicotine is absorbed by the body; the ingredients, mostly chemicals, that are in spit tobacco; the process of addiction; the physical and mental effects of using smokeless tobacco, including cancer, leukoplakia, heart disease, gum and tooth disease, and social effects; the early warning signs of oral cancer; and tips to help readers quit using spit tobacco. The brochure concludes with a brief description of the discipline of otolaryngology-head and neck surgery.

•

Smokeless Tobacco: Are You Feeling the Pinch? Source: Indianapolis, IN: Indiana State Department of Health. 199x. 2 p. Contact: Available from Indiana State Department of Health. 1330 West Michigan Street, P.O. Box 1964, Indianapolis, IN 46206-1964. (317) 633-0306. PRICE: Single copy free. Summary: This brochure, designed for adolescents, urges readers to say 'no' to the use of smokeless tobacco. The brochure focuses on the dangers of smokeless tobacco, including bad breath, stained teeth, abrasion, gum recession, sensitive teeth, leukoplakia, oral cancer, and addiction to nicotine. The brochure also includes a fictional letter to Dear Abby and a statement from professional baseball player, Carlton Fisk, against the use of smokeless tobacco.

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Smokeless Tobacco: A Chemical Time Bomb Source: Waco, TX: Health Edco. 1995. 16 p. Contact: Available from Health Edco. P.O. Box 21207, Waco, TX 76702-1207. (800) 2993366 or (817) 776-6461. Fax (817) 751-0221. PRICE: $2.00 each for 1 to 49 copies; bulk orders available. Item Number JG40014. Summary: This brochure, written by a medical doctor, informs readers about the negative health consequences of using smokeless tobacco. Topics include a definition of the types of smokeless tobacco; the ingredients of smokeless or spit tobacco, including nicotine, sweeteners, salts, carcinogens, chemicals, and abrasives; the hazards of each of these ingredients; smokeless tobacco and problems with oral hygiene, including halitosis, stained teeth, calculus deposits, worn-down teeth, gingivitis, and gum ulcers; smokeless tobacco and oral cancer, including leukoplakia, early cancer, mouth cancer, cancer of the roof of the mouth, and cancer of the tongue; the cardiovascular consequences of smokeless tobacco; and the hormonal effects of smokeless tobacco, including on glucose, insulin, cortisol, vasopressin, acetylcholine, and fats. The brochure concludes with a list of ten myths about smokeless tobacco and five cartoons humorously noting the problems associated with smokeless tobacco. The brochure is illustrated with detailed, full color photographs and medical drawings.

•

Chew Sucks! Get the Facts: The Dangers of Smokeless Tobacco Source: Chicago, IL: American Dental Association (ADA). 1995. [2 p.]. Contact: Available from American Dental Association (ADA). Catalog Sales, P.O. Box 776, St. Charles, IL 60174. (800) 947-4746; Fax (630) 443-9970. PRICE: Single copy free; bulk orders available. Order Number W132. Summary: This colorful brochure from the American Dental Association warns young readers about the risks inherent in the use of smokeless or spit tobacco. The brochure lists seven facts about the addictive nature of smokeless tobacco and the adverse effects of using it. Another section profiles the story of Sean Marsee, including photographs before he was ill and just before he died of cancer caused by using snuff. The third section depicts a cartoon figure of an adolescent male, with descriptions of the impact of smokeless tobacco on different parts of his body. The brochure encourages readers not to start using smokeless tobacco, or if already using it, to quit.

•

Smokeless Tobacco: Three Strikes, You're Out Source: Hagerstown, MD: Health Connection. 1992. [4 p.]. Contact: Available from Health Connection. Department 8101, 55 West Oak Ridge Drive, Hagerstown, MD 21740-7390. (800) 548-8700 or (301) 790-9735; Fax (888) 294-8405; E-mail: [email protected]; http://www.healthconnection.org. PRICE: $0.45 each for 1-24 copies; bulk rates available. Item Number 12665. Summary: This colorful brochure uses a baseball metaphor to advise readers of the hazards of spit tobacco (smokeless tobacco). The brochure tells readers the rules of the game: Strike One is risk of nicotine addiction; Strike Two is risk of oral cancer; and Strike Three is other health risks, including oral health problems, heart disease, and birth defects. The section on oral cancer risk lists the warning signs of oral cancer, including a sore that doesn't heal; white or red patches on the gums, tongue, or lining of the mouth; and difficulty chewing, swallowing, or moving the tongue or jaw. One sidebar provides readers with suggestions on how to quit a smokeless tobacco habit.

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The brochure is illustrated with bold graphics of young people and smokeless tobacco products. 3 references. •

Let's Learn About Spit Tobacco: An Information and Activities Book Source: South Deerfield, MA: Channing L. Bete Company, Inc. 1998. 7 p. Contact: Available from Channing L. Bete Company, Inc. Dept. GSA, 200 State Road, South Deerfield, MA 01373-0200. (800) 628-7733. Fax (800) 499-6464. Website: www.channing.bete.com. PRICE: $1.32 each for 1-24 copies; bulk pricing available. Item Number 56598E-4-98. Summary: This coloring and activities book provides children with information about smokeless or spit tobacco. Utilizing cartoons, crossword puzzles, and other word games, the booklet covers the types of spit tobacco; the ingredients of spit tobacco; why some people try spit tobacco; the myths about spit tobacco; the powerful effect of tobacco advertisements; oral health problems due to the use of spit tobacco; other health problems, including nicotine poisoning, dental problems, and reduced sense of smell and taste; and suggestions for what to do if offered spit tobacco.

•

Dental Health Fact Sheet: Smokeless Tobacco Source: Madison, WI: Wisconsin Division of Health, Department of Health and Social Services, Oral Health Consultant, Bureau of Public Health. 1992. 2 p. Contact: Available from Oral Health Consultant, Bureau of Public Health. 1414 East Washington Avenue, Madison, WI 53703. (608) 266-5152 or (608) 267-3824. PRICE: Single copy free. Stock Number POH 4293. Summary: This dental health fact sheet provides information about smokeless tobacco and young people. The fact sheet lists statistical information in four categories: the types of products available; usage patterns; the U.S. Surgeon General's Report; and health facts. The fact sheet stresses that smokeless tobacco can cause cancer and other mouth disorders and that it contains high levels of nicotine and is addicting. Oral health problems covered include periodontal diseases and tooth loss, bad breath and stained teeth, and dental caries from sugar added to these products.

•

Quitting Smokeless Tobacco Fact Sheet Source: Phoenix, AZ: Arizona Department of Health. 199x. 1 p. Contact: Available from Arizona Department of Health Services. Office of Dental Health, Division of Family Health Services, 1740 West Adams, Phoenix, AZ 85007. (602) 542-1866. PRICE: Single copy free. Summary: This fact sheet provides a checklist of suggestions to help the reader who is trying to break the habit of using smokeless tobacco. Five sections provide suggestions on what to do before quitting, when one quits, when facing the urge to use tobacco, if more assistance in quitting is required, and after quitting. The contact information for the American Cancer Society (toll-free telephone number) and the Arizona Lung Association is included.

•

Spit Tobacco Quit Tips Source: Chicago, IL: Oral Health America. 199x. 1 p.

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Contact: Available from Oral Health America. 410 North Michigan Avenue, Suite 352, Chicago, IL 60611-4211. (312) 836-9900; Fax (312) 836-9986. PRICE: Single copy free. Summary: This fact sheet provides suggestions for readers who wish to quit using spit tobacco. The fact sheet is part of a multi-media, multi-year effort by Oral Health America's National Spit Tobacco Education Program (NSTEP) to help teach Americans that spit tobacco is not a safe alternative to cigarettes. The fact sheet lists eight ideas and tips for quitting. It suggests being committed; setting a quit date and sticking to it; enlisting the aid of friends and family; taking it one day at a time; substituting seeds, gum, or water for tobacco use; learning how to cope with stressful situations without resorting to tobacco use; asking a dentist or physician about nicotine replacement products; and don't quit trying to quit. •

Smokeless Tobacco Source: Alexandria, VA: American Academy of Otolaryngology-Head and Neck Surgery, Inc. 1992. 2 p. Contact: Available from American Academy of Otolaryngology-Head and Neck Surgery, Inc. One Prince Street, Alexandria, VA 22314. (703) 836-4444. PRICE: Single copy free (send self-addressed, stamped envelope); $20.00 per 100 copies for members, $25.00 for nonmembers. Virginia orders require sales tax. Summary: This health education brochure describes the problems associated with smokeless or spit tobacco. Topics covered include statistics that document the growing problem with smokeless tobacco, nicotine and related chemicals and their relation to cancer, the effects of smokeless tobacco, and the cost of smoking and using other tobacco products in health care costs and taxes. The brochure includes a list of suggestions to help readers quit. The brochure concludes with a brief description of the specialty of otolaryngology-head and neck surgery.

•

Smokeless Tobacco Resource Kit Source: Chicago, IL: American Dental Association (ADA). 199x. (information packet). Contact: Available from American Dental Association (ADA). Council on Access, Prevention and Interprofessional Relations, 211 East Chicago Avenue, Chicago, IL 60611-2678. (312) 440-2879. PRICE: Single copy free. Summary: This resource kit, from the American Dental Association, provides brochures and journal articles about smokeless tobacco and cessation programs. Brochures are included on the following topics: a general overview of smokeless tobacco and oral health, the hazards of smokeless tobacco (including full-color photographs), a reprint of a 'Reader's Digest' article about Sean Marsee, and two brochures advertising additional information resources. The journal articles are grouped in three categories: clinical and community interventions for smokeless tobacco cessation; general information on the health implications of smokeless tobacco use; and ADA policies, congressional testimonies, and general statistics. Specific topics include an international perspective on the use of smokeless tobacco; the sugar and fluoride content of various forms of tobacco; the reversibility of leukoplakia caused by smokeless tobacco; the prevalence of smokeless tobacco use among adolescent male athletes; smokeless tobacco use, oral lesions and cessation in high school males; oral cancer and its detection; screening recommendations for the dental practitioner; and the COMMIT dental model. Other materials include a list of National Cancer Institute (NCI) publications for health

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professionals and a list of audiovisual materials (posters) promoting smokeless tobacco cessation. •

Don't Chews to Lose: Some Facts on Smokeless Tobacco Source: Phoenix, AZ: Arizona Department of Health. 199x. 3 p. Contact: Available from Arizona Department of Health Services. Office of Dental Health, Division of Family Health Services, 1740 West Adams, Phoenix, AZ 85007. (602) 542-1866. PRICE: Single copy free. Summary: This three-page fact sheet provides readers with current information about smokeless or spit tobacco. Topics covered include a definition of smokeless tobacco and its various shapes and forms, statistics on the use of smokeless tobacco, smokeless tobacco use among children, the health effects of using smokeless tobacco, nicotine and its addictive qualities, risk factors for cancer, and information from the tobacco companies on how smokeless tobacco is advertised and promoted. The fact sheet concludes with a lengthy poem about smokeless tobacco and one user's experience with mouth cancer caused by tobacco. Healthfinder™

Healthfinder™ is sponsored by the U.S. Department of Health and Human Services and offers links to hundreds of other sites that contain healthcare information. This Web site is located at http://www.healthfinder.gov. Again, keyword searches can be used to find guidelines. The following was recently found in this database: •

Smokeless Tobacco: Tips On How To Stop Summary: Advice on how to quit using smokeless tobacco. This document also discusses the health risks associated with smokeless tobacco use and why it is important for the user to quit. Source: American Academy of Family Physicians http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=6057

•

Surgeon General's Report for Kids about Smoking: Is Smokeless Tobacco Safer Than Cigarettes? Summary: Is smokeless tobacco safer than cigarettes? The answer is NO! This page details the problems associated with smokeless tobacco. Source: Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&RecordID=1369 The NIH Search Utility

The NIH search utility allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEB-SPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to smokeless tobacco. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for

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professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html. Additional Web Sources A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats

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Family Village: http://www.familyvillage.wisc.edu/specific.htm

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Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/

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Med Help International: http://www.medhelp.org/HealthTopics/A.html

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Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/

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Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/

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WebMDHealth: http://my.webmd.com/health_topics

Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to smokeless tobacco. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with smokeless tobacco. The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about smokeless tobacco. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797. Directory of Health Organizations The Directory of Health Organizations, provided by the National Library of Medicine Specialized Information Services, is a comprehensive source of information on associations. The Directory of Health Organizations database can be accessed via the Internet at http://www.sis.nlm.nih.gov/Dir/DirMain.html. It is composed of two parts: DIRLINE and Health Hotlines. The DIRLINE database comprises some 10,000 records of organizations, research centers, and government institutes and associations that primarily focus on health and biomedicine. To access DIRLINE directly, go to the following Web site: http://dirline.nlm.nih.gov/.

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Simply type in “smokeless tobacco” (or a synonym), and you will receive information on all relevant organizations listed in the database. Health Hotlines directs you to toll-free numbers to over 300 organizations. You can access this database directly at http://www.sis.nlm.nih.gov/hotlines/. On this page, you are given the option to search by keyword or by browsing the subject list. When you have received your search results, click on the name of the organization for its description and contact information. The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “smokeless tobacco”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” Type “smokeless tobacco” (or synonyms) into the “For these words:” box. You should check back periodically with this database since it is updated every three months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by health topic. You can access this database at the following Web site: http://www.rarediseases.org/search/orgsearch.html. Type “smokeless tobacco” (or a synonym) into the search box, and click “Submit Query.”

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APPENDIX C. FINDING MEDICAL LIBRARIES Overview In this Appendix, we show you how to quickly find a medical library in your area.

Preparation Your local public library and medical libraries have interlibrary loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.23

Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.

Medical Libraries in the U.S. and Canada In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries with reference facilities that are open to the public. The following is the NLM’s list and includes hyperlinks to each library’s Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of

23

Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.

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libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located)24: •

Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/

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Alabama: Richard M. Scrushy Library (American Sports Medicine Institute)

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Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm

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California: Kris Kelly Health Information Center (St. Joseph Health System, Humboldt), http://www.humboldt1.com/~kkhic/index.html

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California: Community Health Library of Los Gatos, http://www.healthlib.org/orgresources.html

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California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html

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California: Gateway Health Library (Sutter Gould Medical Foundation)

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California: Health Library (Stanford University Medical Center), http://wwwmed.stanford.edu/healthlibrary/

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California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp

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California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html

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California: Los Gatos PlaneTree Health Library, http://planetreesanjose.org/

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California: Sutter Resource Library (Sutter Hospitals Foundation, Sacramento), http://suttermedicalcenter.org/library/

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California: Health Sciences Libraries (University of California, Davis), http://www.lib.ucdavis.edu/healthsci/

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California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System, Pleasanton), http://gaelnet.stmarysca.edu/other.libs/gbal/east/vchl.html

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California: Washington Community Health Resource Library (Fremont), http://www.healthlibrary.org/

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Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.saintjosephdenver.org/yourhealth/libraries/

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Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/

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Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/

24

Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.

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•

Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital, Waterbury), http://www.waterburyhospital.com/library/consumer.shtml

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Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute, Wilmington), http://www.christianacare.org/health_guide/health_guide_pmri_health_info.cfm

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Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine, Wilmington), http://www.delamed.org/chls.html

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Georgia: Family Resource Library (Medical College of Georgia, Augusta), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm

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Georgia: Health Resource Center (Medical Center of Central Georgia, Macon), http://www.mccg.org/hrc/hrchome.asp

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Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library, Honolulu), http://hml.org/CHIS/

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Idaho: DeArmond Consumer Health Library (Kootenai Medical Center, Coeur d’Alene), http://www.nicon.org/DeArmond/index.htm

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Illinois: Health Learning Center of Northwestern Memorial Hospital (Chicago), http://www.nmh.org/health_info/hlc.html

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Illinois: Medical Library (OSF Saint Francis Medical Center, Peoria), http://www.osfsaintfrancis.org/general/library/

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Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital, Lexington), http://www.centralbap.com/education/community/library.cfm

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Kentucky: University of Kentucky - Health Information Library (Chandler Medical Center, Lexington), http://www.mc.uky.edu/PatientEd/

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Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation, New Orleans), http://www.ochsner.org/library/

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Louisiana: Louisiana State University Health Sciences Center Medical LibraryShreveport, http://lib-sh.lsuhsc.edu/

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Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital, Farmington), http://www.fchn.org/fmh/lib.htm

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Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center, Lewiston), http://www.cmmc.org/library/library.html

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Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare, Bangor), http://www.emh.org/hll/hpl/guide.htm

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Maine: Maine Medical Center Library (Maine Medical Center, Portland), http://www.mmc.org/library/

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Maine: Parkview Hospital (Brunswick), http://www.parkviewhospital.org/

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Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center, Biddeford), http://www.smmc.org/services/service.php3?choice=10

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Maine: Stephens Memorial Hospital’s Health Information Library (Western Maine Health, Norway), http://www.wmhcc.org/Library/

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Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html

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Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre, Winnipeg), http://www.deerlodge.mb.ca/crane_library/about.asp

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Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp

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Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/

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Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://med-libwww.bu.edu/library/lib.html

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Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital, Lowell), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm

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Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital, Boston), http://www.nebh.org/health_lib.asp

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Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital, Southcoast Health System, New Bedford), http://www.southcoast.org/library/

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Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html

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Massachusetts: UMass HealthNet (University of Massachusetts Medical School, Worchester), http://healthnet.umassmed.edu/

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Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm

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Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/

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Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html

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Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center, Ann Arbor), http://www.cancer.med.umich.edu/learn/leares.htm

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Michigan: Sladen Library & Center for Health Information Resources - Consumer Health Information (Detroit), http://www.henryford.com/body.cfm?id=39330

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Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center, Missoula)

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National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html

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National: National Network of Libraries of Medicine (National Library of Medicine) provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/

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National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/

Finding Medical Libraries

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Nevada: Health Science Library, West Charleston Library (Las Vegas-Clark County Library District, Las Vegas), http://www.lvccld.org/special_collections/medical/index.htm

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New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library, Hanover), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/

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New Jersey: Consumer Health Library (Rahway Hospital, Rahway), http://www.rahwayhospital.com/library.htm

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New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center, Englewood), http://www.englewoodhospital.com/links/index.htm

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New Jersey: Meland Foundation (Englewood Hospital and Medical Center, Englewood), http://www.geocities.com/ResearchTriangle/9360/

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New York: Choices in Health Information (New York Public Library) - NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html

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New York: Health Information Center (Upstate Medical University, State University of New York, Syracuse), http://www.upstate.edu/library/hic/

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New York: Health Sciences Library (Long Island Jewish Medical Center, New Hyde Park), http://www.lij.edu/library/library.html

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New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/

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Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm

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Oklahoma: The Health Information Center at Saint Francis Hospital (Saint Francis Health System, Tulsa), http://www.sfh-tulsa.com/services/healthinfo.asp

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Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center, The Dalles), http://www.mcmc.net/phrc/

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Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center, Hershey), http://www.hmc.psu.edu/commhealth/

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Pennsylvania: Community Health Resource Library (Geisinger Medical Center, Danville), http://www.geisinger.edu/education/commlib.shtml

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Pennsylvania: HealthInfo Library (Moses Taylor Hospital, Scranton), http://www.mth.org/healthwellness.html

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Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System, Pittsburgh), http://www.hsls.pitt.edu/guides/chi/hopwood/index_html

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Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml

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Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System, Williamsport), http://www.shscares.org/services/lrc/index.asp

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Pennsylvania: Medical Library (UPMC Health System, Pittsburgh), http://www.upmc.edu/passavant/library.htm

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Quebec, Canada: Medical Library (Montreal General Hospital), http://www.mghlib.mcgill.ca/

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South Dakota: Rapid City Regional Hospital Medical Library (Rapid City Regional Hospital), http://www.rcrh.org/Services/Library/Default.asp

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Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/

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Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/

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Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center, Vancouver), http://www.swmedicalcenter.com/body.cfm?id=72

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ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries. The National Library of Medicine has compiled the following list of online dictionaries: •

ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html

•

MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp

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Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/

•

Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html

•

On-line Medical Dictionary (CancerWEB): http://cancerweb.ncl.ac.uk/omd/

•

Rare Diseases Terms (Office of Rare Diseases): http://ord.aspensys.com/asp/diseases/diseases.asp

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Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm

Beyond these, MEDLINEplus contains a very patient-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia can be accessed at http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a).

Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries: •

Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical

•

MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html

•

Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/

•

Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine

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SMOKELESS TOBACCO DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. Abdomen: That portion of the body that lies between the thorax and the pelvis. [NIH] Abdominal: Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs. [NIH] Aberrant: Wandering or deviating from the usual or normal course. [EU] Abrasion: 1. The wearing away of a substance or structure (such as the skin or the teeth) through some unusual or abnormal mechanical process. 2. An area of body surface denuded of skin or mucous membrane by some unusual or abnormal mechanical process. [EU] Acceptor: A substance which, while normally not oxidized by oxygen or reduced by hydrogen, can be oxidized or reduced in presence of a substance which is itself undergoing oxidation or reduction. [NIH] Acetylcholine: A neurotransmitter. Acetylcholine in vertebrates is the major transmitter at neuromuscular junctions, autonomic ganglia, parasympathetic effector junctions, a subset of sympathetic effector junctions, and at many sites in the central nervous system. It is generally not used as an administered drug because it is broken down very rapidly by cholinesterases, but it is useful in some ophthalmological applications. [NIH] Acetylcholinesterase: An enzyme that catalyzes the hydrolysis of acetylcholine to choline and acetate. In the CNS, this enzyme plays a role in the function of peripheral neuromuscular junctions. EC 3.1.1.7. [NIH] Acoustic: Having to do with sound or hearing. [NIH] Actinic keratosis: A precancerous condition of thick, scaly patches of skin. Also called solar or senile keratosis. [NIH] Adaptability: Ability to develop some form of tolerance to conditions extremely different from those under which a living organism evolved. [NIH] Adaptation: 1. The adjustment of an organism to its environment, or the process by which it enhances such fitness. 2. The normal ability of the eye to adjust itself to variations in the intensity of light; the adjustment to such variations. 3. The decline in the frequency of firing of a neuron, particularly of a receptor, under conditions of constant stimulation. 4. In dentistry, (a) the proper fitting of a denture, (b) the degree of proximity and interlocking of restorative material to a tooth preparation, (c) the exact adjustment of bands to teeth. 5. In microbiology, the adjustment of bacterial physiology to a new environment. [EU] Adduct: Complex formed when a carcinogen combines with DNA or a protein. [NIH] Adenosine: A nucleoside that is composed of adenine and d-ribose. Adenosine or adenosine derivatives play many important biological roles in addition to being components of DNA and RNA. Adenosine itself is a neurotransmitter. [NIH] Adjustment: The dynamic process wherein the thoughts, feelings, behavior, and biophysiological mechanisms of the individual continually change to adjust to the environment. [NIH] Adjuvant: A substance which aids another, such as an auxiliary remedy; in immunology, nonspecific stimulator (e.g., BCG vaccine) of the immune response. [EU]

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Adrenal Cortex: The outer layer of the adrenal gland. It secretes mineralocorticoids, androgens, and glucocorticoids. [NIH] Adrenal Medulla: The inner part of the adrenal gland; it synthesizes, stores and releases catecholamines. [NIH] Adrenergic: Activated by, characteristic of, or secreting epinephrine or substances with similar activity; the term is applied to those nerve fibres that liberate norepinephrine at a synapse when a nerve impulse passes, i.e., the sympathetic fibres. [EU] Adverse Effect: An unwanted side effect of treatment. [NIH] Aerobic: In biochemistry, reactions that need oxygen to happen or happen when oxygen is present. [NIH] Affinity: 1. Inherent likeness or relationship. 2. A special attraction for a specific element, organ, or structure. 3. Chemical affinity; the force that binds atoms in molecules; the tendency of substances to combine by chemical reaction. 4. The strength of noncovalent chemical binding between two substances as measured by the dissociation constant of the complex. 5. In immunology, a thermodynamic expression of the strength of interaction between a single antigen-binding site and a single antigenic determinant (and thus of the stereochemical compatibility between them), most accurately applied to interactions among simple, uniform antigenic determinants such as haptens. Expressed as the association constant (K litres mole -1), which, owing to the heterogeneity of affinities in a population of antibody molecules of a given specificity, actually represents an average value (mean intrinsic association constant). 6. The reciprocal of the dissociation constant. [EU] Agar: A complex sulfated polymer of galactose units, extracted from Gelidium cartilagineum, Gracilaria confervoides, and related red algae. It is used as a gel in the preparation of solid culture media for microorganisms, as a bulk laxative, in making emulsions, and as a supporting medium for immunodiffusion and immunoelectrophoresis. [NIH]

Age Distribution: The frequency of different ages or age groups in a given population. The distribution may refer to either how many or what proportion of the group. The population is usually patients with a specific disease but the concept is not restricted to humans and is not restricted to medicine. [NIH] Age Factors: Age as a constituent element or influence contributing to the production of a result. It may be applicable to the cause or the effect of a circumstance. It is used with human or animal concepts but should be differentiated from aging, a physiological process, and time factors which refers only to the passage of time. [NIH] Age Groups: Persons classified by age from birth (infant, newborn) to octogenarians and older (aged, 80 and over). [NIH] Age of Onset: The age or period of life at which a disease or the initial symptoms or manifestations of a disease appear in an individual. [NIH] Agonist: In anatomy, a prime mover. In pharmacology, a drug that has affinity for and stimulates physiologic activity at cell receptors normally stimulated by naturally occurring substances. [EU] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alkaloid: A member of a large group of chemicals that are made by plants and have nitrogen in them. Some alkaloids have been shown to work against cancer. [NIH] Alpha Particles: Positively charged particles composed of two protons and two neutrons, i.e., helium nuclei, emitted during disintegration of very heavy isotopes; a beam of alpha

Dictionary 165

particles or an alpha ray has very strong ionizing power, but weak penetrability. [NIH] Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments. Alternative medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Ameliorating: A changeable condition which prevents the consequence of a failure or accident from becoming as bad as it otherwise would. [NIH] Amino Acid Sequence: The order of amino acids as they occur in a polypeptide chain. This is referred to as the primary structure of proteins. It is of fundamental importance in determining protein conformation. [NIH] Amino Acids: Organic compounds that generally contain an amino (-NH2) and a carboxyl (COOH) group. Twenty alpha-amino acids are the subunits which are polymerized to form proteins. [NIH] Amino Acids: Organic compounds that generally contain an amino (-NH2) and a carboxyl (COOH) group. Twenty alpha-amino acids are the subunits which are polymerized to form proteins. [NIH] Amputation: Surgery to remove part or all of a limb or appendage. [NIH] Anabasine: A botanical insecticide. [NIH] Anaesthesia: Loss of feeling or sensation. Although the term is used for loss of tactile sensibility, or of any of the other senses, it is applied especially to loss of the sensation of pain, as it is induced to permit performance of surgery or other painful procedures. [EU] Anal: Having to do with the anus, which is the posterior opening of the large bowel. [NIH] Analog: In chemistry, a substance that is similar, but not identical, to another. [NIH] Anaphylatoxins: The family of peptides C3a, C4a, C5a, and C5a des-arginine produced in the serum during complement activation. They produce smooth muscle contraction, mast cell histamine release, affect platelet aggregation, and act as mediators of the local inflammatory process. The order of anaphylatoxin activity from strongest to weakest is C5a, C3a, C4a, and C5a des-arginine. The latter is the so-called "classical" anaphylatoxin but shows no spasmogenic activity though it contains some chemotactic ability. [NIH] Anaplasia: Loss of structural differentiation and useful function of neoplastic cells. [NIH] Anatomical: Pertaining to anatomy, or to the structure of the organism. [EU] Anoikis: Apoptosis triggered by loss of contact with the extracellular matrix. [NIH] Antagonism: Interference with, or inhibition of, the growth of a living organism by another living organism, due either to creation of unfavorable conditions (e. g. exhaustion of food supplies) or to production of a specific antibiotic substance (e. g. penicillin). [NIH] Antibodies: Immunoglobulin molecules having a specific amino acid sequence by virtue of which they interact only with the antigen that induced their synthesis in cells of the lymphoid series (especially plasma cells), or with an antigen closely related to it. [NIH] Antibody: A type of protein made by certain white blood cells in response to a foreign substance (antigen). Each antibody can bind to only a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on the nature of the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen. [NIH] Antidepressant: A drug used to treat depression. [NIH] Antigen: Any substance which is capable, under appropriate conditions, of inducing a

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specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Antigen-Antibody Complex: The complex formed by the binding of antigen and antibody molecules. The deposition of large antigen-antibody complexes leading to tissue damage causes immune complex diseases. [NIH] Antihypertensive: An agent that reduces high blood pressure. [EU] Anti-inflammatory: Having to do with reducing inflammation. [NIH] Antimicrobial: Killing microorganisms, or suppressing their multiplication or growth. [EU] Antimycotic: Suppressing the growth of fungi. [EU] Antioxidant: A substance that prevents damage caused by free radicals. Free radicals are highly reactive chemicals that often contain oxygen. They are produced when molecules are split to give products that have unpaired electrons. This process is called oxidation. [NIH] Apoptosis: One of the two mechanisms by which cell death occurs (the other being the pathological process of necrosis). Apoptosis is the mechanism responsible for the physiological deletion of cells and appears to be intrinsically programmed. It is characterized by distinctive morphologic changes in the nucleus and cytoplasm, chromatin cleavage at regularly spaced sites, and the endonucleolytic cleavage of genomic DNA (DNA fragmentation) at internucleosomal sites. This mode of cell death serves as a balance to mitosis in regulating the size of animal tissues and in mediating pathologic processes associated with tumor growth. [NIH] Aqueous: Having to do with water. [NIH] Arachidonic Acid: An unsaturated, essential fatty acid. It is found in animal and human fat as well as in the liver, brain, and glandular organs, and is a constituent of animal phosphatides. It is formed by the synthesis from dietary linoleic acid and is a precursor in the biosynthesis of prostaglandins, thromboxanes, and leukotrienes. [NIH] Areca: A small genus of East Indian palms (Palmae) whose leaves and nuts yield arecoline. Its leaves and nuts have been used as masticatories, stimulants, and astringents in traditional medicine. [NIH] Arecoline: An alkaloid obtained from the betel nut (Areca catechu), fruit of a palm tree. It is an agonist at both muscarinic and nicotinic acetycholine receptors. It is used in the form of various salts as a ganglionic stimulant, a parasympathomimetic, and a vermifuge, especially in veterinary practice. It has been used as a euphoriant in the Pacific Islands. [NIH] Arginine: An essential amino acid that is physiologically active in the L-form. [NIH] Aromatic: Having a spicy odour. [EU] Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Astringents: Agents, usually topical, that cause the contraction of tissues for the control of bleeding or secretions. [NIH] Autonomic: Self-controlling; functionally independent. [EU] Autopsy: Postmortem examination of the body. [NIH] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or

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bacillary, and spiral or spirochetal. [NIH] Bacterial Physiology: Physiological processes and activities of bacteria. [NIH] Bacteriophage: A virus whose host is a bacterial cell; A virus that exclusively infects bacteria. It generally has a protein coat surrounding the genome (DNA or RNA). One of the coliphages most extensively studied is the lambda phage, which is also one of the most important. [NIH] Basal cell carcinoma: A type of skin cancer that arises from the basal cells, small round cells found in the lower part (or base) of the epidermis, the outer layer of the skin. [NIH] Basal cells: Small, round cells found in the lower part (or base) of the epidermis, the outer layer of the skin. [NIH] Base: In chemistry, the nonacid part of a salt; a substance that combines with acids to form salts; a substance that dissociates to give hydroxide ions in aqueous solutions; a substance whose molecule or ion can combine with a proton (hydrogen ion); a substance capable of donating a pair of electrons (to an acid) for the formation of a coordinate covalent bond. [EU] Benign: Not cancerous; does not invade nearby tissue or spread to other parts of the body. [NIH]

Benign tumor: A noncancerous growth that does not invade nearby tissue or spread to other parts of the body. [NIH] Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH] Binding agent: A substance that makes a loose mixture stick together. For example, binding agents can be used to make solid pills from loose powders. [NIH] Bioassay: Determination of the relative effective strength of a substance (as a vitamin, hormone, or drug) by comparing its effect on a test organism with that of a standard preparation. [NIH] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biological Assay: A method of measuring the effects of a biologically active substance using an intermediate in vivo or in vitro tissue or cell model under controlled conditions. It includes virulence studies in animal fetuses in utero, mouse convulsion bioassay of insulin, quantitation of tumor-initiator systems in mouse skin, calculation of potentiating effects of a hormonal factor in an isolated strip of contracting stomach muscle, etc. [NIH] Biomarkers: Substances sometimes found in an increased amount in the blood, other body fluids, or tissues and that may suggest the presence of some types of cancer. Biomarkers include CA 125 (ovarian cancer), CA 15-3 (breast cancer), CEA (ovarian, lung, breast, pancreas, and GI tract cancers), and PSA (prostate cancer). Also called tumor markers. [NIH] Biopsy: Removal and pathologic examination of specimens in the form of small pieces of tissue from the living body. [NIH] Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction. [NIH] Biotransformation: The chemical alteration of an exogenous substance by or in a biological system. The alteration may inactivate the compound or it may result in the production of an

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active metabolite of an inactive parent compound. The alteration may be either nonsynthetic (oxidation-reduction, hydrolysis) or synthetic (glucuronide formation, sulfate conjugation, acetylation, methylation). This also includes metabolic detoxication and clearance. [NIH] Bladder: The organ that stores urine. [NIH] Blood Glucose: Glucose in blood. [NIH] Blood pressure: The pressure of blood against the walls of a blood vessel or heart chamber. Unless there is reference to another location, such as the pulmonary artery or one of the heart chambers, it refers to the pressure in the systemic arteries, as measured, for example, in the forearm. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Body Fluids: Liquid components of living organisms. [NIH] Brachial: All the nerves from the arm are ripped from the spinal cord. [NIH] Brachial Plexus: The large network of nerve fibers which distributes the innervation of the upper extremity. The brachial plexus extends from the neck into the axilla. In humans, the nerves of the plexus usually originate from the lower cervical and the first thoracic spinal cord segments (C5-C8 and T1), but variations are not uncommon. [NIH] Brachytherapy: A collective term for interstitial, intracavity, and surface radiotherapy. It uses small sealed or partly-sealed sources that may be placed on or near the body surface or within a natural body cavity or implanted directly into the tissues. [NIH] Bradykinin: A nonapeptide messenger that is enzymatically produced from kallidin in the blood where it is a potent but short-lived agent of arteriolar dilation and increased capillary permeability. Bradykinin is also released from mast cells during asthma attacks, from gut walls as a gastrointestinal vasodilator, from damaged tissues as a pain signal, and may be a neurotransmitter. [NIH] Branch: Most commonly used for branches of nerves, but applied also to other structures. [NIH]

Bronchi: The larger air passages of the lungs arising from the terminal bifurcation of the trachea. [NIH] Bronchial: Pertaining to one or more bronchi. [EU] Bronchitis: Inflammation (swelling and reddening) of the bronchi. [NIH] Buccal: Pertaining to or directed toward the cheek. In dental anatomy, used to refer to the buccal surface of a tooth. [EU] Buccal mucosa: The inner lining of the cheeks and lips. [NIH] Bupropion: A unicyclic, aminoketone antidepressant. The mechanism of its therapeutic actions is not well understood, but it does appear to block dopamine uptake. The hydrochloride is available as an aid to smoking cessation treatment. [NIH] Burns: Injuries to tissues caused by contact with heat, steam, chemicals (burns, chemical), electricity (burns, electric), or the like. [NIH] Burns, Electric: Burns produced by contact with electric current or from a sudden discharge of electricity. [NIH] Calcium: A basic element found in nearly all organized tissues. It is a member of the alkaline earth family of metals with the atomic symbol Ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal

Dictionary 169

functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. [NIH] Callus: A callosity or hard, thick skin; the bone-like reparative substance that is formed round the edges and fragments of broken bone. [NIH] Candidiasis: Infection with a fungus of the genus Candida. It is usually a superficial infection of the moist cutaneous areas of the body, and is generally caused by C. albicans; it most commonly involves the skin (dermatocandidiasis), oral mucous membranes (thrush, def. 1), respiratory tract (bronchocandidiasis), and vagina (vaginitis). Rarely there is a systemic infection or endocarditis. Called also moniliasis, candidosis, oidiomycosis, and formerly blastodendriosis. [EU] Candidosis: An infection caused by an opportunistic yeasts that tends to proliferate and become pathologic when the environment is favorable and the host resistance is weakened. [NIH]

Capsid: The outer protein protective shell of a virus, which protects the viral nucleic acid. [NIH]

Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Carcinogen: Any substance that causes cancer. [NIH] Carcinogenesis: The process by which normal cells are transformed into cancer cells. [NIH] Carcinogenic: Producing carcinoma. [EU] Carcinoma: Cancer that begins in the skin or in tissues that line or cover internal organs. [NIH]

Cardiac: Having to do with the heart. [NIH] Cardiovascular: Having to do with the heart and blood vessels. [NIH] Cardiovascular disease: Any abnormal condition characterized by dysfunction of the heart and blood vessels. CVD includes atherosclerosis (especially coronary heart disease, which can lead to heart attacks), cerebrovascular disease (e.g., stroke), and hypertension (high blood pressure). [NIH] Carotene: The general name for a group of pigments found in green, yellow, and leafy vegetables, and yellow fruits. The pigments are fat-soluble, unsaturated aliphatic hydrocarbons functioning as provitamins and are converted to vitamin A through enzymatic processes in the intestinal wall. [NIH] Catecholamine: A group of chemical substances manufactured by the adrenal medulla and secreted during physiological stress. [NIH] Causal: Pertaining to a cause; directed against a cause. [EU] Cause of Death: Factors which produce cessation of all vital bodily functions. They can be analyzed from an epidemiologic viewpoint. [NIH] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Cell Cycle: The complex series of phenomena, occurring between the end of one cell division and the end of the next, by which cellular material is divided between daughter cells. [NIH] Cell Death: The termination of the cell's ability to carry out vital functions such as metabolism, growth, reproduction, responsiveness, and adaptability. [NIH] Cell Differentiation: Progressive restriction of the developmental potential and increasing specialization of function which takes place during the development of the embryo and leads to the formation of specialized cells, tissues, and organs. [NIH]

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Cell Division: The fission of a cell. [NIH] Cell proliferation: An increase in the number of cells as a result of cell growth and cell division. [NIH] Cell Respiration: The metabolic process of all living cells (animal and plant) in which oxygen is used to provide a source of energy for the cell. [NIH] Cellobiose: A disaccharide consisting of two glucose units in beta (1-4) glycosidic linkage. Obtained from the partial hydrolysis of cellulose. [NIH] Cellulose: A polysaccharide with glucose units linked as in cellobiose. It is the chief constituent of plant fibers, cotton being the purest natural form of the substance. As a raw material, it forms the basis for many derivatives used in chromatography, ion exchange materials, explosives manufacturing, and pharmaceutical preparations. [NIH] Central Nervous System: The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. [NIH] Cerebrovascular: Pertaining to the blood vessels of the cerebrum, or brain. [EU] Cervical: Relating to the neck, or to the neck of any organ or structure. Cervical lymph nodes are located in the neck; cervical cancer refers to cancer of the uterine cervix, which is the lower, narrow end (the "neck") of the uterus. [NIH] Cervix: The lower, narrow end of the uterus that forms a canal between the uterus and vagina. [NIH] Cheilitis: Inflammation of the lips. It is of various etiologies and degrees of pathology. [NIH] Chemotactic Factors: Chemical substances that attract or repel cells or organisms. The concept denotes especially those factors released as a result of tissue injury, invasion, or immunologic activity, that attract leukocytes, macrophages, or other cells to the site of infection or insult. [NIH] Chemotherapy: Treatment with anticancer drugs. [NIH] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Choline: A basic constituent of lecithin that is found in many plants and animal organs. It is important as a precursor of acetylcholine, as a methyl donor in various metabolic processes, and in lipid metabolism. [NIH] Cholinergic: Resembling acetylcholine in pharmacological action; stimulated by or releasing acetylcholine or a related compound. [EU] Chromatin: The material of chromosomes. It is a complex of DNA, histones, and nonhistone proteins (chromosomal proteins, non-histone) found within the nucleus of a cell. [NIH] Chromosomal: Pertaining to chromosomes. [EU] Chromosome: Part of a cell that contains genetic information. Except for sperm and eggs, all human cells contain 46 chromosomes. [NIH] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Chronic Disease: Disease or ailment of long duration. [NIH] Chronic Obstructive Pulmonary Disease: Collective term for chronic bronchitis and emphysema. [NIH] CIS: Cancer Information Service. The CIS is the National Cancer Institute's link to the public, interpreting and explaining research findings in a clear and understandable manner, and providing personalized responses to specific questions about cancer. Access the CIS by calling 1-800-4-CANCER, or by using the Web site at http://cis.nci.nih.gov. [NIH]

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Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH] Cloning: The production of a number of genetically identical individuals; in genetic engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Codons: Any triplet of nucleotides (coding unit) in DNA or RNA (if RNA is the carrier of primary genetic information as in some viruses) that codes for particular amino acid or signals the beginning or end of the message. [NIH] Cofactor: A substance, microorganism or environmental factor that activates or enhances the action of another entity such as a disease-causing agent. [NIH] Cohort Studies: Studies in which subsets of a defined population are identified. These groups may or may not be exposed to factors hypothesized to influence the probability of the occurrence of a particular disease or other outcome. Cohorts are defined populations which, as a whole, are followed in an attempt to determine distinguishing subgroup characteristics. [NIH] Collagen: A polypeptide substance comprising about one third of the total protein in mammalian organisms. It is the main constituent of skin, connective tissue, and the organic substance of bones and teeth. Different forms of collagen are produced in the body but all consist of three alpha-polypeptide chains arranged in a triple helix. Collagen is differentiated from other fibrous proteins, such as elastin, by the content of proline, hydroxyproline, and hydroxylysine; by the absence of tryptophan; and particularly by the high content of polar groups which are responsible for its swelling properties. [NIH] Complement: A term originally used to refer to the heat-labile factor in serum that causes immune cytolysis, the lysis of antibody-coated cells, and now referring to the entire functionally related system comprising at least 20 distinct serum proteins that is the effector not only of immune cytolysis but also of other biologic functions. Complement activation occurs by two different sequences, the classic and alternative pathways. The proteins of the classic pathway are termed 'components of complement' and are designated by the symbols C1 through C9. C1 is a calcium-dependent complex of three distinct proteins C1q, C1r and C1s. The proteins of the alternative pathway (collectively referred to as the properdin system) and complement regulatory proteins are known by semisystematic or trivial names. Fragments resulting from proteolytic cleavage of complement proteins are designated with lower-case letter suffixes, e.g., C3a. Inactivated fragments may be designated with the suffix 'i', e.g. C3bi. Activated components or complexes with biological activity are designated by a bar over the symbol e.g. C1 or C4b,2a. The classic pathway is activated by the binding of C1 to classic pathway activators, primarily antigen-antibody complexes containing IgM, IgG1, IgG3; C1q binds to a single IgM molecule or two adjacent IgG molecules. The alternative pathway can be activated by IgA immune complexes and also by nonimmunologic materials including bacterial endotoxins, microbial polysaccharides, and cell walls. Activation of the classic pathway triggers an enzymatic cascade involving C1, C4, C2 and C3; activation of the alternative pathway triggers a cascade involving C3 and factors B, D and P. Both result in the cleavage of C5 and the formation of the membrane attack complex. Complement activation also results in the formation of many biologically active complement fragments that act as anaphylatoxins, opsonins, or chemotactic factors. [EU] Complementary and alternative medicine: CAM. Forms of treatment that are used in addition to (complementary) or instead of (alternative) standard treatments. These practices are not considered standard medical approaches. CAM includes dietary supplements, megadose vitamins, herbal preparations, special teas, massage therapy, magnet therapy,

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spiritual healing, and meditation. [NIH] Complementary medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used to enhance or complement the standard treatments. Complementary medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Compress: A plug used to occludate an orifice in the control of bleeding, or to mop up secretions; an absorbent pad. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Conception: The onset of pregnancy, marked by implantation of the blastocyst; the formation of a viable zygote. [EU] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Constriction: The act of constricting. [NIH] Consultation: A deliberation between two or more physicians concerning the diagnosis and the proper method of treatment in a case. [NIH] Consumption: Pulmonary tuberculosis. [NIH] Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] Control group: In a clinical trial, the group that does not receive the new treatment being studied. This group is compared to the group that receives the new treatment, to see if the new treatment works. [NIH] Convulsion: A violent involuntary contraction or series of contractions of the voluntary muscles. [EU] Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Coronary heart disease: A type of heart disease caused by narrowing of the coronary arteries that feed the heart, which needs a constant supply of oxygen and nutrients carried by the blood in the coronary arteries. When the coronary arteries become narrowed or clogged by fat and cholesterol deposits and cannot supply enough blood to the heart, CHD results. [NIH] Coronary Thrombosis: Presence of a thrombus in a coronary artery, often causing a myocardial infarction. [NIH] Cortisol: A steroid hormone secreted by the adrenal cortex as part of the body's response to stress. [NIH] Cotinine: 1-Methyl-5-(3-pyridyl)-2-pyrrolidinone antidepressant. Synonym: Scotine. [NIH]

fumarate.

Stimulant

proposed

as

Cross-Sectional Studies: Studies in which the presence or absence of disease or other health-related variables are determined in each member of the study population or in a

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representative sample at one particular time. This contrasts with longitudinal studies which are followed over a period of time. [NIH] Crowns: A prosthetic restoration that reproduces the entire surface anatomy of the visible natural crown of a tooth. It may be partial (covering three or more surfaces of a tooth) or complete (covering all surfaces). It is made of gold or other metal, porcelain, or resin. [NIH] Cues: Signals for an action; that specific portion of a perceptual field or pattern of stimuli to which a subject has learned to respond. [NIH] Curative: Tending to overcome disease and promote recovery. [EU] Cutaneous: Having to do with the skin. [NIH] Cyclic: Pertaining to or occurring in a cycle or cycles; the term is applied to chemical compounds that contain a ring of atoms in the nucleus. [EU] Cytogenetics: A branch of genetics which deals with the cytological and molecular behavior of genes and chromosomes during cell division. [NIH] Cytokine: Small but highly potent protein that modulates the activity of many cell types, including T and B cells. [NIH] Cytoplasm: The protoplasm of a cell exclusive of that of the nucleus; it consists of a continuous aqueous solution (cytosol) and the organelles and inclusions suspended in it (phaneroplasm), and is the site of most of the chemical activities of the cell. [EU] Cytotoxic: Cell-killing. [NIH] Cytotoxicity: Quality of being capable of producing a specific toxic action upon cells of special organs. [NIH] Databases, Bibliographic: Extensive collections, reputedly complete, of references and citations to books, articles, publications, etc., generally on a single subject or specialized subject area. Databases can operate through automated files, libraries, or computer disks. The concept should be differentiated from factual databases which is used for collections of data and facts apart from bibliographic references to them. [NIH] Deception: The act of deceiving or the fact or condition of being deceived. [NIH] Deletion: A genetic rearrangement through loss of segments of DNA (chromosomes), bringing sequences, which are normally separated, into close proximity. [NIH] Delivery of Health Care: The concept concerned with all aspects of providing and distributing health services to a patient population. [NIH] Density: The logarithm to the base 10 of the opacity of an exposed and processed film. [NIH] Dental Abutments: Natural teeth or teeth roots used as anchorage for a fixed or removable denture or other prosthesis (such as an implant) serving the same purpose. [NIH] Dental Assistants: Individuals who assist the dentist or the dental hygienist. [NIH] Dental Care: The total of dental diagnostic, preventive, and restorative services provided to meet the needs of a patient (from Illustrated Dictionary of Dentistry, 1982). [NIH] Dental Caries: Localized destruction of the tooth surface initiated by decalcification of the enamel followed by enzymatic lysis of organic structures and leading to cavity formation. If left unchecked, the cavity may penetrate the enamel and dentin and reach the pulp. The three most prominent theories used to explain the etiology of the disase are that acids produced by bacteria lead to decalcification; that micro-organisms destroy the enamel protein; or that keratolytic micro-organisms produce chelates that lead to decalcification. [NIH]

Dental Hygienists: Persons trained in an accredited school or dental college and licensed by

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the state in which they reside to provide dental prophylaxis under the direction of a licensed dentist. [NIH] Dentists: Individuals licensed to practice dentistry. [NIH] Dentures: An appliance used as an artificial or prosthetic replacement for missing teeth and adjacent tissues. It does not include crowns, dental abutments, nor artificial teeth. [NIH] Depolarization: The process or act of neutralizing polarity. In neurophysiology, the reversal of the resting potential in excitable cell membranes when stimulated, i.e., the tendency of the cell membrane potential to become positive with respect to the potential outside the cell. [EU] Deprivation: Loss or absence of parts, organs, powers, or things that are needed. [EU] Dermal: Pertaining to or coming from the skin. [NIH] Detoxification: Treatment designed to free an addict from his drug habit. [EU] Deuterium: Deuterium. The stable isotope of hydrogen. It has one neutron and one proton in the nucleus. [NIH] Developing Countries: Countries in the process of change directed toward economic growth, that is, an increase in production, per capita consumption, and income. The process of economic growth involves better utilization of natural and human resources, which results in a change in the social, political, and economic structures. [NIH] Diabetes Mellitus: A heterogeneous group of disorders that share glucose intolerance in common. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Diarrhoea: Abnormal frequency and liquidity of faecal discharges. [EU] Diastolic: Of or pertaining to the diastole. [EU] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Digestive tract: The organs through which food passes when food is eaten. These organs are the mouth, esophagus, stomach, small and large intestines, and rectum. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Disposition: A tendency either physical or mental toward certain diseases. [EU] Distal: Remote; farther from any point of reference; opposed to proximal. In dentistry, used to designate a position on the dental arch farther from the median line of the jaw. [EU] Diuresis: Increased excretion of urine. [EU] Dopamine: An endogenous catecholamine and prominent neurotransmitter in several systems of the brain. In the synthesis of catecholamines from tyrosine, it is the immediate precursor to norepinephrine and epinephrine. Dopamine is a major transmitter in the extrapyramidal system of the brain, and important in regulating movement. A family of dopaminergic receptor subtypes mediate its action. Dopamine is used pharmacologically for its direct (beta adrenergic agonist) and indirect (adrenergic releasing) sympathomimetic effects including its actions as an inotropic agent and as a renal vasodilator. [NIH] Drive: A state of internal activity of an organism that is a necessary condition before a given stimulus will elicit a class of responses; e.g., a certain level of hunger (drive) must be present before food will elicit an eating response. [NIH] Dross: Residue remaining in an opium pipe which has been smoked; contains 50 % of the morphine present in the original drug. [NIH]

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Drug Interactions: The action of a drug that may affect the activity, metabolism, or toxicity of another drug. [NIH] Drug Tolerance: Progressive diminution of the susceptibility of a human or animal to the effects of a drug, resulting from its continued administration. It should be differentiated from drug resistance wherein an organism, disease, or tissue fails to respond to the intended effectiveness of a chemical or drug. It should also be differentiated from maximum tolerated dose and no-observed-adverse-effect level. [NIH] Duct: A tube through which body fluids pass. [NIH] Duodenum: The first part of the small intestine. [NIH] Dysplasia: Cells that look abnormal under a microscope but are not cancer. [NIH] Ectopic: Pertaining to or characterized by ectopia. [EU] Effector: It is often an enzyme that converts an inactive precursor molecule into an active second messenger. [NIH] Efficacy: The extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideal conditions. Ideally, the determination of efficacy is based on the results of a randomized control trial. [NIH] Elastin: The protein that gives flexibility to tissues. [NIH] Electrocardiogram: Measurement of electrical activity during heartbeats. [NIH] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU] Electrons: Stable elementary particles having the smallest known negative charge, present in all elements; also called negatrons. Positively charged electrons are called positrons. The numbers, energies and arrangement of electrons around atomic nuclei determine the chemical identities of elements. Beams of electrons are called cathode rays or beta rays, the latter being a high-energy biproduct of nuclear decay. [NIH] Embryo: The prenatal stage of mammalian development characterized by rapid morphological changes and the differentiation of basic structures. [NIH] Emphysema: A pathological accumulation of air in tissues or organs. [NIH] Empirical: A treatment based on an assumed diagnosis, prior to receiving confirmatory laboratory test results. [NIH] Enamel: A very hard whitish substance which covers the dentine of the anatomical crown of a tooth. [NIH] Endocarditis: Exudative and proliferative inflammatory alterations of the endocardium, characterized by the presence of vegetations on the surface of the endocardium or in the endocardium itself, and most commonly involving a heart valve, but sometimes affecting the inner lining of the cardiac chambers or the endocardium elsewhere. It may occur as a primary disorder or as a complication of or in association with another disease. [EU] Endothelial cell: The main type of cell found in the inside lining of blood vessels, lymph vessels, and the heart. [NIH] Endothelium: A layer of epithelium that lines the heart, blood vessels (endothelium, vascular), lymph vessels (endothelium, lymphatic), and the serous cavities of the body. [NIH] Endothelium-derived: Small molecule that diffuses to the adjacent muscle layer and relaxes it. [NIH] Endotoxins: Toxins closely associated with the living cytoplasm or cell wall of certain microorganisms, which do not readily diffuse into the culture medium, but are released

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upon lysis of the cells. [NIH] Environmental Exposure: The exposure to potentially harmful chemical, physical, or biological agents in the environment or to environmental factors that may include ionizing radiation, pathogenic organisms, or toxic chemicals. [NIH] Environmental Health: The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health. [NIH]

Environmental tobacco smoke: ETS. Smoke that comes from the burning of a tobacco product and smoke that is exhaled by smokers (second-hand smoke). Inhaling ETS is called involuntary or passive smoking. [NIH] Enzymatic: Phase where enzyme cuts the precursor protein. [NIH] Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Epidemic: Occurring suddenly in numbers clearly in excess of normal expectancy; said especially of infectious diseases but applied also to any disease, injury, or other healthrelated event occurring in such outbreaks. [EU] Epidemiologic Studies: Studies designed to examine associations, commonly, hypothesized causal relations. They are usually concerned with identifying or measuring the effects of risk factors or exposures. The common types of analytic study are case-control studies, cohort studies, and cross-sectional studies. [NIH] Epidemiological: Relating to, or involving epidemiology. [EU] Epidermal: Pertaining to or resembling epidermis. Called also epidermic or epidermoid. [EU] Epidermis: Nonvascular layer of the skin. It is made up, from within outward, of five layers: 1) basal layer (stratum basale epidermidis); 2) spinous layer (stratum spinosum epidermidis); 3) granular layer (stratum granulosum epidermidis); 4) clear layer (stratum lucidum epidermidis); and 5) horny layer (stratum corneum epidermidis). [NIH] Epidermoid carcinoma: A type of cancer in which the cells are flat and look like fish scales. Also called squamous cell carcinoma. [NIH] Epigastric: Having to do with the upper middle area of the abdomen. [NIH] Epinephrine: The active sympathomimetic hormone from the adrenal medulla in most species. It stimulates both the alpha- and beta- adrenergic systems, causes systemic vasoconstriction and gastrointestinal relaxation, stimulates the heart, and dilates bronchi and cerebral vessels. It is used in asthma and cardiac failure and to delay absorption of local anesthetics. [NIH] Epithelial: Refers to the cells that line the internal and external surfaces of the body. [NIH] Epithelial Cells: Cells that line the inner and outer surfaces of the body. [NIH] Epithelium: One or more layers of epithelial cells, supported by the basal lamina, which covers the inner or outer surfaces of the body. [NIH] Epstein: Failure of the upper eyelid to move downward on downward movement of the eye, occurring in premature and nervous infants. [NIH] Epstein-Barr virus: EBV. A common virus that remains dormant in most people. It has been associated with certain cancers, including Burkitt's lymphoma, immunoblastic lymphoma, and nasopharyngeal carcinoma. [NIH] Erectile: The inability to get or maintain an erection for satisfactory sexual intercourse. Also called impotence. [NIH] Erection: The condition of being made rigid and elevated; as erectile tissue when filled with

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blood. [EU] Erythroplakia: A reddened patch with a velvety surface found in the mouth. [NIH] Esophageal: Having to do with the esophagus, the muscular tube through which food passes from the throat to the stomach. [NIH] Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH]

Eucalyptus: A genus of Australian trees of the Myrtaceae family that yields gums, oils, and resins which are used as flavoring agents, astringents, and aromatics, and formerly to treat diarrhea, asthma, bronchitis, and respiratory tract infections. [NIH] Exocrine: Secreting outwardly, via a duct. [EU] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] External-beam radiation: Radiation therapy that uses a machine to aim high-energy rays at the cancer. Also called external radiation. [NIH] Extracellular: Outside a cell or cells. [EU] Extracellular Matrix: A meshwork-like substance found within the extracellular space and in association with the basement membrane of the cell surface. It promotes cellular proliferation and provides a supporting structure to which cells or cell lysates in culture dishes adhere. [NIH] Extraction: The process or act of pulling or drawing out. [EU] Extrapyramidal: Outside of the pyramidal tracts. [EU] Extremity: A limb; an arm or leg (membrum); sometimes applied specifically to a hand or foot. [EU] Facial: Of or pertaining to the face. [EU] Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH] Family Practice: A medical specialty concerned with the provision of continuing, comprehensive primary health care for the entire family. [NIH] Fat: Total lipids including phospholipids. [NIH] Fathers: Male parents, human or animal. [NIH] Fatty acids: A major component of fats that are used by the body for energy and tissue development. [NIH] Femoral: Pertaining to the femur, or to the thigh. [EU] Femur: The longest and largest bone of the skeleton, it is situated between the hip and the knee. [NIH] Fetus: The developing offspring from 7 to 8 weeks after conception until birth. [NIH] Fibrosis: Any pathological condition where fibrous connective tissue invades any organ, usually as a consequence of inflammation or other injury. [NIH] Filler: An inactive substance used to make a product bigger or easier to handle. For example, fillers are often used to make pills or capsules because the amount of active drug is too small to be handled conveniently. [NIH] Filtration: The passage of a liquid through a filter, accomplished by gravity, pressure, or vacuum (suction). [EU] Flavoring Agents: Substances added to foods and medicine to improve the quality of taste. [NIH]

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Flexor: Muscles which flex a joint. [NIH] Foam Cells: Lipid-laden macrophages originating from monocytes or from smooth muscle cells. [NIH] Forearm: The part between the elbow and the wrist. [NIH] Fungus: A general term used to denote a group of eukaryotic protists, including mushrooms, yeasts, rusts, moulds, smuts, etc., which are characterized by the absence of chlorophyll and by the presence of a rigid cell wall composed of chitin, mannans, and sometimes cellulose. They are usually of simple morphological form or show some reversible cellular specialization, such as the formation of pseudoparenchymatous tissue in the fruiting body of a mushroom. The dimorphic fungi grow, according to environmental conditions, as moulds or yeasts. [EU] Gamma Rays: Very powerful and penetrating, high-energy electromagnetic radiation of shorter wavelength than that of x-rays. They are emitted by a decaying nucleus, usually between 0.01 and 10 MeV. They are also called nuclear x-rays. [NIH] Ganglia: Clusters of multipolar neurons surrounded by a capsule of loosely organized connective tissue located outside the central nervous system. [NIH] Gas: Air that comes from normal breakdown of food. The gases are passed out of the body through the rectum (flatus) or the mouth (burp). [NIH] Gelatin: A product formed from skin, white connective tissue, or bone collagen. It is used as a protein food adjuvant, plasma substitute, hemostatic, suspending agent in pharmaceutical preparations, and in the manufacturing of capsules and suppositories. [NIH] Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]

Gingival Recession: The exposure of root surface by an apical shift in the position of the gingiva. [NIH] Ginseng: An araliaceous genus of plants that contains a number of pharmacologically active agents used as stimulants, sedatives, and tonics, especially in traditional medicine. [NIH] Gland: An organ that produces and releases one or more substances for use in the body. Some glands produce fluids that affect tissues or organs. Others produce hormones or participate in blood production. [NIH] Glucose: D-Glucose. A primary source of energy for living organisms. It is naturally occurring and is found in fruits and other parts of plants in its free state. It is used therapeutically in fluid and nutrient replacement. [NIH] Glutathione Peroxidase: An enzyme catalyzing the oxidation of 2 moles of glutathione in the presence of hydrogen peroxide to yield oxidized glutathione and water. EC 1.11.1.9. [NIH]

Glycoprotein: A protein that has sugar molecules attached to it. [NIH] Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Government Agencies: Administrative units of government responsible for policy making and management of governmental activities in the U.S. and abroad. [NIH] Grade: The grade of a tumor depends on how abnormal the cancer cells look under a microscope and how quickly the tumor is likely to grow and spread. Grading systems are different for each type of cancer. [NIH] Granular Cell Tumor: Unusual tumor affecting any site of the body, but most often

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encountered in the head and neck. Considerable debate has surrounded the histogenesis of this neoplasm; however, it is considered to be a myoblastoma of, usually, a benign nature. It affects women more often than men. When it develops beneath the epidermis or mucous membrane, it can lead to proliferation of the squamous cells and mimic squamous cell carcinoma. [NIH] Granulocytes: Leukocytes with abundant granules in the cytoplasm. They are divided into three groups: neutrophils, eosinophils, and basophils. [NIH] Granuloma: A relatively small nodular inflammatory lesion containing grouped mononuclear phagocytes, caused by infectious and noninfectious agents. [NIH] Growth: The progressive development of a living being or part of an organism from its earliest stage to maturity. [NIH] Guanylate Cyclase: An enzyme that catalyzes the conversion of GTP to 3',5'-cyclic GMP and pyrophosphate. It also acts on ITP and dGTP. (From Enzyme Nomenclature, 1992) EC 4.6.1.2. [NIH] Habitual: Of the nature of a habit; according to habit; established by or repeated by force of habit, customary. [EU] Habituation: Decline in response of an organism to environmental or other stimuli with repeated or maintained exposure. [NIH] Halitosis: An offensive, foul breath odor resulting from a variety of causes such as poor oral hygiene, dental or oral infections, or the ingestion of certain foods. [NIH] Health Care Costs: The actual costs of providing services related to the delivery of health care, including the costs of procedures, therapies, and medications. It is differentiated from health expenditures, which refers to the amount of money paid for the services, and from fees, which refers to the amount charged, regardless of cost. [NIH] Health Education: Education that increases the awareness and favorably influences the attitudes and knowledge relating to the improvement of health on a personal or community basis. [NIH] Health Expenditures: The amounts spent by individuals, groups, nations, or private or public organizations for total health care and/or its various components. These amounts may or may not be equivalent to the actual costs (health care costs) and may or may not be shared among the patient, insurers, and/or employers. [NIH] Health Promotion: Encouraging consumer behaviors most likely to optimize health potentials (physical and psychosocial) through health information, preventive programs, and access to medical care. [NIH] Health Status: The level of health of the individual, group, or population as subjectively assessed by the individual or by more objective measures. [NIH] Heart attack: A seizure of weak or abnormal functioning of the heart. [NIH] Hemoglobin: One of the fractions of glycosylated hemoglobin A1c. Glycosylated hemoglobin is formed when linkages of glucose and related monosaccharides bind to hemoglobin A and its concentration represents the average blood glucose level over the previous several weeks. HbA1c levels are used as a measure of long-term control of plasma glucose (normal, 4 to 6 percent). In controlled diabetes mellitus, the concentration of glycosylated hemoglobin A is within the normal range, but in uncontrolled cases the level may be 3 to 4 times the normal conentration. Generally, complications are substantially lower among patients with Hb levels of 7 percent or less than in patients with HbA1c levels of 9 percent or more. [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH]

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Hepatic: Refers to the liver. [NIH] Hereditary: Of, relating to, or denoting factors that can be transmitted genetically from one generation to another. [NIH] Heredity: 1. The genetic transmission of a particular quality or trait from parent to offspring. 2. The genetic constitution of an individual. [EU] Herpes: Any inflammatory skin disease caused by a herpesvirus and characterized by the formation of clusters of small vesicles. When used alone, the term may refer to herpes simplex or to herpes zoster. [EU] Herpes Zoster: Acute vesicular inflammation. [NIH] Histology: The study of tissues and cells under a microscope. [NIH] Hormonal: Pertaining to or of the nature of a hormone. [EU] Hormone: A substance in the body that regulates certain organs. Hormones such as gastrin help in breaking down food. Some hormones come from cells in the stomach and small intestine. [NIH] Human papillomavirus: HPV. A virus that causes abnormal tissue growth (warts) and is often associated with some types of cancer. [NIH] Hybrid: Cross fertilization between two varieties or, more usually, two species of vines, see also crossing. [NIH] Hybridization: The genetic process of crossbreeding to produce a hybrid. Hybrid nucleic acids can be formed by nucleic acid hybridization of DNA and RNA molecules. Protein hybridization allows for hybrid proteins to be formed from polypeptide chains. [NIH] Hydrogen: The first chemical element in the periodic table. It has the atomic symbol H, atomic number 1, and atomic weight 1. It exists, under normal conditions, as a colorless, odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1 isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive isotope tritium. [NIH] Hydrogen Cyanide: HCN. A toxic liquid or colorless gas. It is found in the smoke of various tobacco products and released by combustion of nitrogen-containing organic materials. [NIH] Hydrogen Peroxide: A strong oxidizing agent used in aqueous solution as a ripening agent, bleach, and topical anti-infective. It is relatively unstable and solutions deteriorate over time unless stabilized by the addition of acetanilide or similar organic materials. [NIH] Hydrolysis: The process of cleaving a chemical compound by the addition of a molecule of water. [NIH] Hydrophilic: Readily absorbing moisture; hygroscopic; having strongly polar groups that readily interact with water. [EU] Hydroxylysine: A hydroxylated derivative of the amino acid lysine that is present in certain collagens. [NIH] Hydroxyproline: A hydroxylated form of the imino acid proline. A deficiency in ascorbic acid can result in impaired hydroxyproline formation. [NIH] Hygienic: Pertaining to hygiene, or conducive to health. [EU] Hypercholesterolemia: Abnormally high levels of cholesterol in the blood. [NIH] Hyperkeratosis: 1. Hypertrophy of the corneous layer of the skin. 2a. Any of various conditions marked by hyperkeratosis. 2b. A disease of cattle marked by thickening and wringling of the hide and formation of papillary outgrowths on the buccal mucous membranes, often accompanied by watery discharge from eyes and nose, diarrhoea, loss of

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condition, and abortion of pregnant animals, and now believed to result from ingestion of the chlorinated naphthalene of various lubricating oils. [EU] Hyperplasia: An increase in the number of cells in a tissue or organ, not due to tumor formation. It differs from hypertrophy, which is an increase in bulk without an increase in the number of cells. [NIH] Hypertension: Persistently high arterial blood pressure. Currently accepted threshold levels are 140 mm Hg systolic and 90 mm Hg diastolic pressure. [NIH] Hypertrophy: General increase in bulk of a part or organ, not due to tumor formation, nor to an increase in the number of cells. [NIH] Id: The part of the personality structure which harbors the unconscious instinctive desires and strivings of the individual. [NIH] Idiopathic: Describes a disease of unknown cause. [NIH] Immune response: The activity of the immune system against foreign substances (antigens). [NIH]

Immune system: The organs, cells, and molecules responsible for the recognition and disposal of foreign ("non-self") material which enters the body. [NIH] Immunization: Deliberate stimulation of the host's immune response. Active immunization involves administration of antigens or immunologic adjuvants. Passive immunization involves administration of immune sera or lymphocytes or their extracts (e.g., transfer factor, immune RNA) or transplantation of immunocompetent cell producing tissue (thymus or bone marrow). [NIH] Immunohistochemistry: Histochemical localization of immunoreactive substances using labeled antibodies as reagents. [NIH] Immunologic: The ability of the antibody-forming system to recall a previous experience with an antigen and to respond to a second exposure with the prompt production of large amounts of antibody. [NIH] Implant radiation: A procedure in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near the tumor. Also called [NIH] Impotence: The inability to perform sexual intercourse. [NIH] In situ: In the natural or normal place; confined to the site of origin without invasion of neighbouring tissues. [EU] In vitro: In the laboratory (outside the body). The opposite of in vivo (in the body). [NIH] In vivo: In the body. The opposite of in vitro (outside the body or in the laboratory). [NIH] Indicative: That indicates; that points out more or less exactly; that reveals fairly clearly. [EU] Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] Infancy: The period of complete dependency prior to the acquisition of competence in walking, talking, and self-feeding. [NIH] Infarction: A pathological process consisting of a sudden insufficient blood supply to an area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus, or a vascular torsion. [NIH] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be clinically unapparent or result in local cellular injury due to competitive metabolism, toxins,

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intracellular replication, or antigen-antibody response. The infection may remain localized, subclinical, and temporary if the body's defensive mechanisms are effective. A local infection may persist and spread by extension to become an acute, subacute, or chronic clinical infection or disease state. A local infection may also become systemic when the microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [EU]

Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Informed Consent: Voluntary authorization, given to the physician by the patient, with full comprehension of the risks involved, for diagnostic or investigative procedures and medical and surgical treatment. [NIH] Ingestion: Taking into the body by mouth [NIH] Inhalation: The drawing of air or other substances into the lungs. [EU] Initiation: Mutation induced by a chemical reactive substance causing cell changes; being a step in a carcinogenic process. [NIH] Initiator: A chemically reactive substance which may cause cell changes if ingested, inhaled or absorbed into the body; the substance may thus initiate a carcinogenic process. [NIH] Innervation: 1. The distribution or supply of nerves to a part. 2. The supply of nervous energy or of nerve stimulus sent to a part. [EU] Inotropic: Affecting the force or energy of muscular contractions. [EU] Insight: The capacity to understand one's own motives, to be aware of one's own psychodynamics, to appreciate the meaning of symbolic behavior. [NIH] Insomnia: Difficulty in going to sleep or getting enough sleep. [NIH] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulin-dependent diabetes mellitus. [NIH] Insulin-dependent diabetes mellitus: A disease characterized by high levels of blood glucose resulting from defects in insulin secretion, insulin action, or both. Autoimmune, genetic, and environmental factors are involved in the development of type I diabetes. [NIH] Interleukin-1: A soluble factor produced by monocytes, macrophages, and other cells which activates T-lymphocytes and potentiates their response to mitogens or antigens. IL-1 consists of two distinct forms, IL-1 alpha and IL-1 beta which perform the same functions but are distinct proteins. The biological effects of IL-1 include the ability to replace macrophage requirements for T-cell activation. The factor is distinct from interleukin-2. [NIH] Interleukin-2: Chemical mediator produced by activated T lymphocytes and which regulates the proliferation of T cells, as well as playing a role in the regulation of NK cell activity. [NIH] Internal radiation: A procedure in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near the tumor. Also called brachytherapy, implant radiation, or interstitial radiation therapy. [NIH] Interstitial: Pertaining to or situated between parts or in the interspaces of a tissue. [EU] Intervention Studies: Epidemiologic investigations designed to test a hypothesized causeeffect relation by modifying the supposed causal factor(s) in the study population. [NIH] Intestinal: Having to do with the intestines. [NIH]

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Intoxication: Poisoning, the state of being poisoned. [EU] Intracellular: Inside a cell. [NIH] Intraepithelial: Within the layer of cells that form the surface or lining of an organ. [NIH] Involuntary: Reaction occurring without intention or volition. [NIH] Ionization: 1. Any process by which a neutral atom gains or loses electrons, thus acquiring a net charge, as the dissociation of a substance in solution into ions or ion production by the passage of radioactive particles. 2. Iontophoresis. [EU] Ionizing: Radiation comprising charged particles, e. g. electrons, protons, alpha-particles, etc., having sufficient kinetic energy to produce ionization by collision. [NIH] Ions: An atom or group of atoms that have a positive or negative electric charge due to a gain (negative charge) or loss (positive charge) of one or more electrons. Atoms with a positive charge are known as cations; those with a negative charge are anions. [NIH] Irradiation: The use of high-energy radiation from x-rays, neutrons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy) or from materials called radioisotopes. Radioisotopes produce radiation and can be placed in or near the tumor or in the area near cancer cells. This type of radiation treatment is called internal radiation therapy, implant radiation, interstitial radiation, or brachytherapy. Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body. Irradiation is also called radiation therapy, radiotherapy, and x-ray therapy. [NIH] Joint: The point of contact between elements of an animal skeleton with the parts that surround and support it. [NIH] Kb: A measure of the length of DNA fragments, 1 Kb = 1000 base pairs. The largest DNA fragments are up to 50 kilobases long. [NIH] Keratin: A class of fibrous proteins or scleroproteins important both as structural proteins and as keys to the study of protein conformation. The family represents the principal constituent of epidermis, hair, nails, horny tissues, and the organic matrix of tooth enamel. Two major conformational groups have been characterized, alpha-keratin, whose peptide backbone forms an alpha-helix, and beta-keratin, whose backbone forms a zigzag or pleated sheet structure. [NIH] Keratinocytes: Epidermal cells which synthesize keratin and undergo characteristic changes as they move upward from the basal layers of the epidermis to the cornified (horny) layer of the skin. Successive stages of differentiation of the keratinocytes forming the epidermal layers are basal cell, spinous or prickle cell, and the granular cell. [NIH] Keratoacanthoma: A benign, non-neoplastic, usually self-limiting epithelial lesion closely resembling squamous cell carcinoma clinically and histopathologically. It occurs in solitary, multiple, and eruptive forms. The solitary and multiple forms occur on sunlight exposed areas and are identical histologically; they affect primarily white males. The eruptive form usually involves both sexes and appears as a generalized papular eruption. [NIH] Keratolytic: An agent that promotes keratolysis. [EU] Keratosis: Any horny growth such as a wart or callus. [NIH] Kinetic: Pertaining to or producing motion. [EU] Labile: 1. Gliding; moving from point to point over the surface; unstable; fluctuating. 2. Chemically unstable. [EU] Large Intestine: The part of the intestine that goes from the cecum to the rectum. The large intestine absorbs water from stool and changes it from a liquid to a solid form. The large

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intestine is 5 feet long and includes the appendix, cecum, colon, and rectum. Also called colon. [NIH] Larynx: An irregularly shaped, musculocartilaginous tubular structure, lined with mucous membrane, located at the top of the trachea and below the root of the tongue and the hyoid bone. It is the essential sphincter guarding the entrance into the trachea and functioning secondarily as the organ of voice. [NIH] Latency: The period of apparent inactivity between the time when a stimulus is presented and the moment a response occurs. [NIH] Latent: Phoria which occurs at one distance or another and which usually has no troublesome effect. [NIH] Lesion: An area of abnormal tissue change. [NIH] Lethal: Deadly, fatal. [EU] Leukoplakia: A white patch that may develop on mucous membranes such as the cheek, gums, or tongue and may become cancerous. [NIH] Leukoplakia, Hairy: Epithelial hyperplasia of the oral mucosa associated with Epstein-Barr virus (human herpesvirus 4) and found almost exclusively in persons with HIV infection. The lesion consists of a white patch that is often corrugated or hairy. [NIH] Library Services: Services offered to the library user. They include reference and circulation. [NIH]

Lichen Planus: An inflammatory, pruritic disease of the skin and mucous membranes, which can be either generalized or localized. It is characterized by distinctive purplish, flattopped papules having a predilection for the trunk and flexor surfaces. The lesions may be discrete or coalesce to form plaques. Histologically, there is a "saw-tooth" pattern of epidermal hyperplasia and vacuolar alteration of the basal layer of the epidermis along with an intense upper dermal inflammatory infiltrate composed predominantly of T-cells. Etiology is unknown. [NIH] Ligament: A band of fibrous tissue that connects bones or cartilages, serving to support and strengthen joints. [EU] Linkage: The tendency of two or more genes in the same chromosome to remain together from one generation to the next more frequently than expected according to the law of independent assortment. [NIH] Lip: Either of the two fleshy, full-blooded margins of the mouth. [NIH] Lipid: Fat. [NIH] Lipid Peroxidation: Peroxidase catalyzed oxidation of lipids using hydrogen peroxide as an electron acceptor. [NIH] Lipoma: A benign tumor composed of fat cells. [NIH] Lipopolysaccharide: Substance consisting of polysaccaride and lipid. [NIH] Liquor: 1. A liquid, especially an aqueous solution containing a medicinal substance. 2. A general term used in anatomical nomenclature for certain fluids of the body. [EU] Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Lobeline: An alkaloid that has actions similar to nicotine on nicotinic cholinergic receptors but is less potent. It has been proposed for a variety of therapeutic uses including in respiratory disorders, peripheral vascular disorders, insomnia, and smoking cessation. [NIH] Local Government: Smallest political subdivisions within a country at which general

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governmental functions are carried-out. [NIH] Localization: The process of determining or marking the location or site of a lesion or disease. May also refer to the process of keeping a lesion or disease in a specific location or site. [NIH] Localized: Cancer which has not metastasized yet. [NIH] Lymph: The almost colorless fluid that travels through the lymphatic system and carries cells that help fight infection and disease. [NIH] Lymph node: A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Also known as a lymph gland. Lymph nodes are spread out along lymphatic vessels and contain many lymphocytes, which filter the lymphatic fluid (lymph). [NIH]

Lymphatic: The tissues and organs, including the bone marrow, spleen, thymus, and lymph nodes, that produce and store cells that fight infection and disease. [NIH] Lymphocyte: A white blood cell. Lymphocytes have a number of roles in the immune system, including the production of antibodies and other substances that fight infection and diseases. [NIH] Lymphoid: Referring to lymphocytes, a type of white blood cell. Also refers to tissue in which lymphocytes develop. [NIH] Lymphokine: A soluble protein produced by some types of white blood cell that stimulates other white blood cells to kill foreign invaders. [NIH] Lymphoma: A general term for various neoplastic diseases of the lymphoid tissue. [NIH] Macrophage: A type of white blood cell that surrounds and kills microorganisms, removes dead cells, and stimulates the action of other immune system cells. [NIH] Malignant: Cancerous; a growth with a tendency to invade and destroy nearby tissue and spread to other parts of the body. [NIH] Malignant tumor: A tumor capable of metastasizing. [NIH] Mastication: The act and process of chewing and grinding food in the mouth. [NIH] Maxillary: Pertaining to the maxilla : the irregularly shaped bone that with its fellow forms the upper jaw. [EU] Maxillary Sinus: One of the paired paranasal sinuses, located in the body of the maxilla, communicating with the middle meatus of the nasal cavity. [NIH] Meatus: A canal running from the internal auditory foramen through the petrous portion of the temporal bone. It gives passage to the facial and auditory nerves together with the auditory branch of the basilar artery and the internal auditory veins. [NIH] Median Nerve: A major nerve of the upper extremity. In humans, the fibers of the median nerve originate in the lower cervical and upper thoracic spinal cord (usually C6 to T1), travel via the brachial plexus, and supply sensory and motor innervation to parts of the forearm and hand. [NIH] Mediate: Indirect; accomplished by the aid of an intervening medium. [EU] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Meiosis: A special method of cell division, occurring in maturation of the germ cells, by means of which each daughter nucleus receives half the number of chromosomes characteristic of the somatic cells of the species. [NIH] Melanocytes: Epidermal dendritic pigment cells which control long-term morphological

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color changes by alteration in their number or in the amount of pigment they produce and store in the pigment containing organelles called melanosomes. Melanophores are larger cells which do not exist in mammals. [NIH] Melanoma: A form of skin cancer that arises in melanocytes, the cells that produce pigment. Melanoma usually begins in a mole. [NIH] Membrane: A very thin layer of tissue that covers a surface. [NIH] Mental Disorders: Psychiatric illness or diseases manifested by breakdowns in the adaptational process expressed primarily as abnormalities of thought, feeling, and behavior producing either distress or impairment of function. [NIH] Mental Health: The state wherein the person is well adjusted. [NIH] Mental Processes: Conceptual functions or thinking in all its forms. [NIH] Metabolite: Any substance produced by metabolism or by a metabolic process. [EU] Metastasis: The spread of cancer from one part of the body to another. Tumors formed from cells that have spread are called "secondary tumors" and contain cells that are like those in the original (primary) tumor. The plural is metastases. [NIH] Metastatic: Having to do with metastasis, which is the spread of cancer from one part of the body to another. [NIH] Methyltransferase: A drug-metabolizing enzyme. [NIH] MI: Myocardial infarction. Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Microbe: An organism which cannot be observed with the naked eye; e. g. unicellular animals, lower algae, lower fungi, bacteria. [NIH] Microbiology: The study of microorganisms such as fungi, bacteria, algae, archaea, and viruses. [NIH] Micronuclei: Nuclei, separate from and additional to the main nucleus of a cell, produced during the telophase of mitosis or meiosis by lagging chromosomes or chromosome fragments derived from spontaneous or experimentally induced chromosomal structural changes. This concept also includes the smaller, reproductive nuclei found in multinucleate protozoans. [NIH] Microorganism: An organism that can be seen only through a microscope. Microorganisms include bacteria, protozoa, algae, and fungi. Although viruses are not considered living organisms, they are sometimes classified as microorganisms. [NIH] Micro-organism: An organism which cannot be observed with the naked eye; e. g. unicellular animals, lower algae, lower fungi, bacteria. [NIH] Migration: The systematic movement of genes between populations of the same species, geographic race, or variety. [NIH] Mitochondria: Parts of a cell where aerobic production (also known as cell respiration) takes place. [NIH] Mitosis: A method of indirect cell division by means of which the two daughter nuclei normally receive identical complements of the number of chromosomes of the somatic cells of the species. [NIH] Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU]

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Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] Monitor: An apparatus which automatically records such physiological signs as respiration, pulse, and blood pressure in an anesthetized patient or one undergoing surgical or other procedures. [NIH] Monoclonal: An antibody produced by culturing a single type of cell. It therefore consists of a single species of immunoglobulin molecules. [NIH] Monocyte: A type of white blood cell. [NIH] Mononuclear: A cell with one nucleus. [NIH] Mucinous: Containing or resembling mucin, the main compound in mucus. [NIH] Mucins: A secretion containing mucopolysaccharides and protein that is the chief constituent of mucus. [NIH] Mucosa: A mucous membrane, or tunica mucosa. [EU] Mucus: The viscous secretion of mucous membranes. It contains mucin, white blood cells, water, inorganic salts, and exfoliated cells. [NIH] Mutagenic: Inducing genetic mutation. [EU] Mydriatic: 1. Dilating the pupil. 2. Any drug that dilates the pupil. [EU] Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] Nasal Cavity: The proximal portion of the respiratory passages on either side of the nasal septum, lined with ciliated mucosa, extending from the nares to the pharynx. [NIH] Nasal Mucosa: The mucous membrane lining the nasal cavity. [NIH] NCI: National Cancer Institute. NCI, part of the National Institutes of Health of the United States Department of Health and Human Services, is the federal government's principal agency for cancer research. NCI conducts, coordinates, and funds cancer research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer. Access the NCI Web site at http://cancer.gov. [NIH] Necrosis: A pathological process caused by the progressive degradative action of enzymes that is generally associated with severe cellular trauma. It is characterized by mitochondrial swelling, nuclear flocculation, uncontrolled cell lysis, and ultimately cell death. [NIH] Need: A state of tension or dissatisfaction felt by an individual that impels him to action toward a goal he believes will satisfy the impulse. [NIH] Neoplasia: Abnormal and uncontrolled cell growth. [NIH] Neoplasm: A new growth of benign or malignant tissue. [NIH] Neoplastic: Pertaining to or like a neoplasm (= any new and abnormal growth); pertaining to neoplasia (= the formation of a neoplasm). [EU] Nerve: A cordlike structure of nervous tissue that connects parts of the nervous system with other tissues of the body and conveys nervous impulses to, or away from, these tissues. [NIH] Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH] Networks: Pertaining to a nerve or to the nerves, a meshlike structure of interlocking fibers or strands. [NIH]

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Neurofibroma: A fibrous tumor, usually benign, arising from the nerve sheath or the endoneurium. [NIH] Neuroma: A tumor that arises in nerve cells. [NIH] Neuromuscular: Pertaining to muscles and nerves. [EU] Neuromuscular Junction: The synapse between a neuron and a muscle. [NIH] Neuronal: Pertaining to a neuron or neurons (= conducting cells of the nervous system). [EU] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH] Neutrons: Electrically neutral elementary particles found in all atomic nuclei except light hydrogen; the mass is equal to that of the proton and electron combined and they are unstable when isolated from the nucleus, undergoing beta decay. Slow, thermal, epithermal, and fast neutrons refer to the energy levels with which the neutrons are ejected from heavier nuclei during their decay. [NIH] Nevus: A benign growth on the skin, such as a mole. A mole is a cluster of melanocytes and surrounding supportive tissue that usually appears as a tan, brown, or flesh-colored spot on the skin. The plural of nevus is nevi (NEE-vye). [NIH] Nicotine: Nicotine is highly toxic alkaloid. It is the prototypical agonist at nicotinic cholinergic receptors where it dramatically stimulates neurons and ultimately blocks synaptic transmission. Nicotine is also important medically because of its presence in tobacco smoke. [NIH] Nitric Oxide: A free radical gas produced endogenously by a variety of mammalian cells. It is synthesized from arginine by a complex reaction, catalyzed by nitric oxide synthase. Nitric oxide is endothelium-derived relaxing factor. It is released by the vascular endothelium and mediates the relaxation induced by some vasodilators such as acetylcholine and bradykinin. It also inhibits platelet aggregation, induces disaggregation of aggregated platelets, and inhibits platelet adhesion to the vascular endothelium. Nitric oxide activates cytosolic guanylate cyclase and thus elevates intracellular levels of cyclic GMP. [NIH]

Nitrogen: An element with the atomic symbol N, atomic number 7, and atomic weight 14. Nitrogen exists as a diatomic gas and makes up about 78% of the earth's atmosphere by volume. It is a constituent of proteins and nucleic acids and found in all living cells. [NIH] Nitrosamines: A class of compounds that contain a -NH2 and a -NO radical. Many members of this group have carcinogenic and mutagenic properties. [NIH] Norepinephrine: Precursor of epinephrine that is secreted by the adrenal medulla and is a widespread central and autonomic neurotransmitter. Norepinephrine is the principal transmitter of most postganglionic sympathetic fibers and of the diffuse projection system in the brain arising from the locus ceruleus. It is also found in plants and is used pharmacologically as a sympathomimetic. [NIH] Nuclear: A test of the structure, blood flow, and function of the kidneys. The doctor injects a mildly radioactive solution into an arm vein and uses x-rays to monitor its progress through the kidneys. [NIH] Nuclei: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Nucleic acid: Either of two types of macromolecule (DNA or RNA) formed by polymerization of nucleotides. Nucleic acids are found in all living cells and contain the information (genetic code) for the transfer of genetic information from one generation to the

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next. [NIH] Nucleic Acid Hybridization: The process whereby two single-stranded polynucleotides form a double-stranded molecule, with hydrogen bonding between the complementary bases in the two strains. [NIH] Nucleus: A body of specialized protoplasm found in nearly all cells and containing the chromosomes. [NIH] Odds Ratio: The ratio of two odds. The exposure-odds ratio for case control data is the ratio of the odds in favor of exposure among cases to the odds in favor of exposure among noncases. The disease-odds ratio for a cohort or cross section is the ratio of the odds in favor of disease among the exposed to the odds in favor of disease among the unexposed. The prevalence-odds ratio refers to an odds ratio derived cross-sectionally from studies of prevalent cases. [NIH] Odour: A volatile emanation that is perceived by the sense of smell. [EU] Office Visits: Visits made by patients to health service providers' offices for diagnosis, treatment, and follow-up. [NIH] Ointments: Semisolid preparations used topically for protective emollient effects or as a vehicle for local administration of medications. Ointment bases are various mixtures of fats, waxes, animal and plant oils and solid and liquid hydrocarbons. [NIH] Oncogene: A gene that normally directs cell growth. If altered, an oncogene can promote or allow the uncontrolled growth of cancer. Alterations can be inherited or caused by an environmental exposure to carcinogens. [NIH] On-line: A sexually-reproducing population derived from a common parentage. [NIH] Oral Health: The optimal state of the mouth and normal functioning of the organs of the mouth without evidence of disease. [NIH] Oral Hygiene: The practice of personal hygiene of the mouth. It includes the maintenance of oral cleanliness, tissue tone, and general preservation of oral health. [NIH] Oropharynx: Oral part of the pharynx. [NIH] Otolaryngology: A surgical specialty concerned with the study and treatment of disorders of the ear, nose, and throat. [NIH] Oxidation: The act of oxidizing or state of being oxidized. Chemically it consists in the increase of positive charges on an atom or the loss of negative charges. Most biological oxidations are accomplished by the removal of a pair of hydrogen atoms (dehydrogenation) from a molecule. Such oxidations must be accompanied by reduction of an acceptor molecule. Univalent o. indicates loss of one electron; divalent o., the loss of two electrons. [EU]

Oxidative Stress: A disturbance in the prooxidant-antioxidant balance in favor of the former, leading to potential damage. Indicators of oxidative stress include damaged DNA bases, protein oxidation products, and lipid peroxidation products (Sies, Oxidative Stress, 1991, pxv-xvi). [NIH] P53 gene: A tumor suppressor gene that normally inhibits the growth of tumors. This gene is altered in many types of cancer. [NIH] Palate: The structure that forms the roof of the mouth. It consists of the anterior hard palate and the posterior soft palate. [NIH] Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is

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comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Papillary: Pertaining to or resembling papilla, or nipple. [EU] Papillomavirus: A genus of Papovaviridae causing proliferation of the epithelium, which may lead to malignancy. A wide range of animals are infected including humans, chimpanzees, cattle, rabbits, dogs, and horses. [NIH] Paraffin: A mixture of solid hydrocarbons obtained from petroleum. It has a wide range of uses including as a stiffening agent in ointments, as a lubricant, and as a topical antiinflammatory. It is also commonly used as an embedding material in histology. [NIH] Paranasal Sinuses: Air-filled extensions of the respiratory part of the nasal cavity into the frontal, ethmoid, sphenoid, and maxillary cranial bones. They vary in size and form in different individuals and are lined by the ciliated mucous membranes of the nasal cavity. [NIH]

Patch: A piece of material used to cover or protect a wound, an injured part, etc.: a patch over the eye. [NIH] Pathogenesis: The cellular events and reactions that occur in the development of disease. [NIH]

Pathologic: 1. Indicative of or caused by a morbid condition. 2. Pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Pathologic Processes: The abnormal mechanisms and forms involved in the dysfunctions of tissues and organs. [NIH] Pathologies: The study of abnormality, especially the study of diseases. [NIH] Patient Education: The teaching or training of patients concerning their own health needs. [NIH]

Pediatric Dentistry: The practice of dentistry concerned with the dental problems of children, proper maintenance, and treatment. The dental care may include the services provided by dental specialists. [NIH] Pelvic: Pertaining to the pelvis. [EU] Periodontal disease: Disease involving the supporting structures of the teeth (as the gums and periodontal membranes). [NIH] Periodontics: A dental specialty concerned with the histology, physiology, and pathology of the tissues that support, attach, and surround the teeth, and of the treatment and prevention of disease affecting these tissues. [NIH] Periodontitis: Inflammation of the periodontal membrane; also called periodontitis simplex. [NIH]

Peripheral blood: Blood circulating throughout the body. [NIH] Peripheral Nervous System: The nervous system outside of the brain and spinal cord. The peripheral nervous system has autonomic and somatic divisions. The autonomic nervous system includes the enteric, parasympathetic, and sympathetic subdivisions. The somatic nervous system includes the cranial and spinal nerves and their ganglia and the peripheral sensory receptors. [NIH] Peritoneal: Having to do with the peritoneum (the tissue that lines the abdominal wall and covers most of the organs in the abdomen). [NIH] Peritoneum: Endothelial lining of the abdominal cavity, the parietal peritoneum covering the inside of the abdominal wall and the visceral peritoneum covering the bowel, the

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mesentery, and certain of the organs. The portion that covers the bowel becomes the serosal layer of the bowel wall. [NIH] Petroleum: Naturally occurring complex liquid hydrocarbons which, after distillation, yield combustible fuels, petrochemicals, and lubricants. [NIH] Pharmaceutical Preparations: Drugs intended for human or veterinary use, presented in their finished dosage form. Included here are materials used in the preparation and/or formulation of the finished dosage form. [NIH] Pharmacist: A person trained to prepare and distribute medicines and to give information about them. [NIH] Pharmacokinetic: The mathematical analysis of the time courses of absorption, distribution, and elimination of drugs. [NIH] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Pharynx: The hollow tube about 5 inches long that starts behind the nose and ends at the top of the trachea (windpipe) and esophagus (the tube that goes to the stomach). [NIH] Phospholipases: A class of enzymes that catalyze the hydrolysis of phosphoglycerides or glycerophosphatidates. EC 3.1.-. [NIH] Physical Examination: Systematic and thorough inspection of the patient for physical signs of disease or abnormality. [NIH] Physical Fitness: A state of well-being in which performance is optimal, often as a result of physical conditioning which may be prescribed for disease therapy. [NIH] Physiologic: Having to do with the functions of the body. When used in the phrase "physiologic age," it refers to an age assigned by general health, as opposed to calendar age. [NIH]

Physiology: The science that deals with the life processes and functions of organismus, their cells, tissues, and organs. [NIH] Pigment: A substance that gives color to tissue. Pigments are responsible for the color of skin, eyes, and hair. [NIH] Pilot study: The initial study examining a new method or treatment. [NIH] Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid and diploid generations. [NIH] Plaque: A clear zone in a bacterial culture grown on an agar plate caused by localized destruction of bacterial cells by a bacteriophage. The concentration of infective virus in a fluid can be estimated by applying the fluid to a culture and counting the number of. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Plasma cells: A type of white blood cell that produces antibodies. [NIH] Platelet Activation: A series of progressive, overlapping events triggered by exposure of the platelets to subendothelial tissue. These events include shape change, adhesiveness, aggregation, and release reactions. When carried through to completion, these events lead to the formation of a stable hemostatic plug. [NIH] Platelet Aggregation: The attachment of platelets to one another. This clumping together can be induced by a number of agents (e.g., thrombin, collagen) and is part of the mechanism leading to the formation of a thrombus. [NIH]

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Platelets: A type of blood cell that helps prevent bleeding by causing blood clots to form. Also called thrombocytes. [NIH] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] Policy Making: The decision process by which individuals, groups or institutions establish policies pertaining to plans, programs or procedures. [NIH] Polyethylene: A vinyl polymer made from ethylene. It can be branched or linear. Branched or low-density polyethylene is tough and pliable but not to the same degree as linear polyethylene. Linear or high-density polyethylene has a greater hardness and tensile strength. Polyethylene is used in a variety of products, including implants and prostheses. [NIH]

Polyp: A growth that protrudes from a mucous membrane. [NIH] Polypeptide: A peptide which on hydrolysis yields more than two amino acids; called tripeptides, tetrapeptides, etc. according to the number of amino acids contained. [EU] Polysaccharide: A type of carbohydrate. It contains sugar molecules that are linked together chemically. [NIH] Population Growth: Increase, over a specific period of time, in the number of individuals living in a country or region. [NIH] Posterior: Situated in back of, or in the back part of, or affecting the back or dorsal surface of the body. In lower animals, it refers to the caudal end of the body. [EU] Postoperative: After surgery. [NIH] Postsynaptic: Nerve potential generated by an inhibitory hyperpolarizing stimulation. [NIH] Potentiates: A degree of synergism which causes the exposure of the organism to a harmful substance to worsen a disease already contracted. [NIH] Potentiating: A degree of synergism which causes the exposure of the organism to a harmful substance to worsen a disease already contracted. [NIH] Potentiation: An overall effect of two drugs taken together which is greater than the sum of the effects of each drug taken alone. [NIH] Practice Guidelines: Directions or principles presenting current or future rules of policy for the health care practitioner to assist him in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. [NIH] Precancerous: A term used to describe a condition that may (or is likely to) become cancer. Also called premalignant. [NIH] Precursor: Something that precedes. In biological processes, a substance from which another, usually more active or mature substance is formed. In clinical medicine, a sign or symptom that heralds another. [EU] Premalignant: A term used to describe a condition that may (or is likely to) become cancer. Also called precancerous. [NIH] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Prickle: Several layers of the epidermis where the individual cells are connected by cell bridges. [NIH]

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Primary Prevention: Prevention of disease or mental disorders in susceptible individuals or populations through promotion of health, including mental health, and specific protection, as in immunization, as distinguished from the prevention of complications or after-effects of existing disease. [NIH] Progression: Increase in the size of a tumor or spread of cancer in the body. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Projection: A defense mechanism, operating unconsciously, whereby that which is emotionally unacceptable in the self is rejected and attributed (projected) to others. [NIH] Proline: A non-essential amino acid that is synthesized from glutamic acid. It is an essential component of collagen and is important for proper functioning of joints and tendons. [NIH] Proneness: Susceptibility to accidents due to human factors. [NIH] Prophylaxis: An attempt to prevent disease. [NIH] Propolis: Resinous substance obtained from beehives; contains many different substances which may have antimicrobial or antimycotic activity topically; its extracts are called propolis resin or balsam. Synonyms: bee bread; hive dross; bee glue. [NIH] Prospective study: An epidemiologic study in which a group of individuals (a cohort), all free of a particular disease and varying in their exposure to a possible risk factor, is followed over a specific amount of time to determine the incidence rates of the disease in the exposed and unexposed groups. [NIH] Prostaglandin: Any of a group of components derived from unsaturated 20-carbon fatty acids, primarily arachidonic acid, via the cyclooxygenase pathway that are extremely potent mediators of a diverse group of physiologic processes. The abbreviation for prostaglandin is PG; specific compounds are designated by adding one of the letters A through I to indicate the type of substituents found on the hydrocarbon skeleton and a subscript (1, 2 or 3) to indicate the number of double bonds in the hydrocarbon skeleton e.g., PGE2. The predominant naturally occurring prostaglandins all have two double bonds and are synthesized from arachidonic acid (5,8,11,14-eicosatetraenoic acid) by the pathway shown in the illustration. The 1 series and 3 series are produced by the same pathway with fatty acids having one fewer double bond (8,11,14-eicosatrienoic acid or one more double bond (5,8,11,14,17-eicosapentaenoic acid) than arachidonic acid. The subscript a or ß indicates the configuration at C-9 (a denotes a substituent below the plane of the ring, ß, above the plane). The naturally occurring PGF's have the a configuration, e.g., PGF2a. All of the prostaglandins act by binding to specific cell-surface receptors causing an increase in the level of the intracellular second messenger cyclic AMP (and in some cases cyclic GMP also). The effect produced by the cyclic AMP increase depends on the specific cell type. In some cases there is also a positive feedback effect. Increased cyclic AMP increases prostaglandin synthesis leading to further increases in cyclic AMP. [EU] Prostaglandins A: (13E,15S)-15-Hydroxy-9-oxoprosta-10,13-dien-1-oic acid (PGA(1)); (5Z,13E,15S)-15-hydroxy-9-oxoprosta-5,10,13-trien-1-oic acid (PGA(2)); (5Z,13E,15S,17Z)-15hydroxy-9-oxoprosta-5,10,13,17-tetraen-1-oic acid (PGA(3)). A group of naturally occurring secondary prostaglandins derived from PGE. PGA(1) and PGA(2) as well as their 19hydroxy derivatives are found in many organs and tissues. [NIH] Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests upon the rectum. [NIH] Protective Devices: Devices designed to provide personal protection against injury to

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individuals exposed to hazards in industry, sports, aviation, or daily activities. [NIH] Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to recurrent venous and arterial thrombosis. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH] Proteolytic: 1. Pertaining to, characterized by, or promoting proteolysis. 2. An enzyme that promotes proteolysis (= the splitting of proteins by hydrolysis of the peptide bonds with formation of smaller polypeptides). [EU] Protocol: The detailed plan for a clinical trial that states the trial's rationale, purpose, drug or vaccine dosages, length of study, routes of administration, who may participate, and other aspects of trial design. [NIH] Protons: Stable elementary particles having the smallest known positive charge, found in the nuclei of all elements. The proton mass is less than that of a neutron. A proton is the nucleus of the light hydrogen atom, i.e., the hydrogen ion. [NIH] Proximal: Nearest; closer to any point of reference; opposed to distal. [EU] Pruritic: Pertaining to or characterized by pruritus. [EU] Psychology: The science dealing with the study of mental processes and behavior in man and animals. [NIH] Public Health: Branch of medicine concerned with the prevention and control of disease and disability, and the promotion of physical and mental health of the population on the international, national, state, or municipal level. [NIH] Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Publishing: "The business or profession of the commercial production and issuance of literature" (Webster's 3d). It includes the publisher, publication processes, editing and editors. Production may be by conventional printing methods or by electronic publishing. [NIH]

Pulmonary: Relating to the lungs. [NIH] Pulmonary Artery: The short wide vessel arising from the conus arteriosus of the right ventricle and conveying unaerated blood to the lungs. [NIH] Pulse: The rhythmical expansion and contraction of an artery produced by waves of pressure caused by the ejection of blood from the left ventricle of the heart as it contracts. [NIH]

Pyogenic: Producing pus; pyopoietic (= liquid inflammation product made up of cells and a thin fluid called liquor puris). [EU] Quality of Life: A generic concept reflecting concern with the modification and enhancement of life attributes, e.g., physical, political, moral and social environment. [NIH] Race: A population within a species which exhibits general similarities within itself, but is both discontinuous and distinct from other populations of that species, though not sufficiently so as to achieve the status of a taxon. [NIH] Radiation: Emission or propagation of electromagnetic energy (waves/rays), or the waves/rays themselves; a stream of electromagnetic particles (electrons, neutrons, protons, alpha particles) or a mixture of these. The most common source is the sun. [NIH] Radiation therapy: The use of high-energy radiation from x-rays, gamma rays, neutrons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a

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machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body in the area near cancer cells (internal radiation therapy, implant radiation, or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body. Also called radiotherapy. [NIH] Radioactive: Giving off radiation. [NIH] Radioimmunotherapy: Radiotherapy where cytotoxic radionuclides are linked to antibodies in order to deliver toxins directly to tumor targets. Therapy with targeted radiation rather than antibody-targeted toxins (immunotoxins) has the advantage that adjacent tumor cells, which lack the appropriate antigenic determinants, can be destroyed by radiation cross-fire. Radioimmunotherapy is sometimes called targeted radiotherapy, but this latter term can also refer to radionuclides linked to non-immune molecules (radiotherapy). [NIH] Radiolabeled: Any compound that has been joined with a radioactive substance. [NIH] Radiotherapy: The use of ionizing radiation to treat malignant neoplasms and other benign conditions. The most common forms of ionizing radiation used as therapy are x-rays, gamma rays, and electrons. A special form of radiotherapy, targeted radiotherapy, links a cytotoxic radionuclide to a molecule that targets the tumor. When this molecule is an antibody or other immunologic molecule, the technique is called radioimmunotherapy. [NIH] Randomized: Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments. [NIH] Reactive Oxygen Species: Reactive intermediate oxygen species including both radicals and non-radicals. These substances are constantly formed in the human body and have been shown to kill bacteria and inactivate proteins, and have been implicated in a number of diseases. Scientific data exist that link the reactive oxygen species produced by inflammatory phagocytes to cancer development. [NIH] Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Reference point: The midpoint of a line connecting the centers of the two end faces of the acoustic test fixture. [NIH] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Relapse: The return of signs and symptoms of cancer after a period of improvement. [NIH] Reliability: Used technically, in a statistical sense, of consistency of a test with itself, i. e. the extent to which we can assume that it will yield the same result if repeated a second time. [NIH]

Respiration: The act of breathing with the lungs, consisting of inspiration, or the taking into the lungs of the ambient air, and of expiration, or the expelling of the modified air which contains more carbon dioxide than the air taken in (Blakiston's Gould Medical Dictionary, 4th ed.). This does not include tissue respiration (= oxygen consumption) or cell respiration (= cell respiration). [NIH] Restoration: Broad term applied to any inlay, crown, bridge or complete denture which restores or replaces loss of teeth or oral tissues. [NIH] Retrospective: Looking back at events that have already taken place. [NIH] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of

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developing a disease. [NIH] Risk-Taking: Undertaking a task involving a challenge for achievement or a desirable goal in which there is a lack of certainty or a fear of failure. It may also include the exhibiting of certain behaviors whose outcomes may present a risk to the individual or to those associated with him or her. [NIH] Role Playing: The adopting or performing the role of another significant individual in order to gain insight into the behavior of that person. [NIH] Root Caries: Dental caries involving the tooth root, cementum, or cervical area of the tooth. [NIH]

Rural Population: The inhabitants of rural areas or of small towns classified as rural. [NIH] Saliva: The clear, viscous fluid secreted by the salivary glands and mucous glands of the mouth. It contains mucins, water, organic salts, and ptylin. [NIH] Salivary: The duct that convey saliva to the mouth. [NIH] Salivary glands: Glands in the mouth that produce saliva. [NIH] Sanitary: Relating or belonging to health and hygiene; conductive to the restoration or maintenance of health. [NIH] Sarcoma: A connective tissue neoplasm formed by proliferation of mesodermal cells; it is usually highly malignant. [NIH] Satellite: Applied to a vein which closely accompanies an artery for some distance; in cytogenetics, a chromosomal agent separated by a secondary constriction from the main body of the chromosome. [NIH] Schizoid: Having qualities resembling those found in greater degree in schizophrenics; a person of schizoid personality. [NIH] Schizophrenia: A mental disorder characterized by a special type of disintegration of the personality. [NIH] Schizotypal Personality Disorder: A personality disorder in which there are oddities of thought (magical thinking, paranoid ideation, suspiciousness), perception (illusions, depersonalization), speech (digressive, vague, overelaborate), and behavior (inappropriate affect in social interactions, frequently social isolation) that are not severe enough to characterize schizophrenia. [NIH] Schwannoma: A tumor of the peripheral nervous system that begins in the nerve sheath (protective covering). It is almost always benign, but rare malignant schwannomas have been reported. [NIH] Screening: Checking for disease when there are no symptoms. [NIH] Sebaceous: Gland that secretes sebum. [NIH] Sebum: The oily substance secreted by sebaceous glands. It is composed of keratin, fat, and cellular debris. [NIH] Secondary tumor: Cancer that has spread from the organ in which it first appeared to another organ. For example, breast cancer cells may spread (metastasize) to the lungs and cause the growth of a new tumor. When this happens, the disease is called metastatic breast cancer, and the tumor in the lungs is called a secondary tumor. Also called secondary cancer. [NIH] Secretion: 1. The process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. Any substance produced by secretion. [EU]

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Secretory: Secreting; relating to or influencing secretion or the secretions. [NIH] Selenium: An element with the atomic symbol Se, atomic number 34, and atomic weight 78.96. It is an essential micronutrient for mammals and other animals but is toxic in large amounts. Selenium protects intracellular structures against oxidative damage. It is an essential component of glutathione peroxidase. [NIH] Semen: The thick, yellowish-white, viscid fluid secretion of male reproductive organs discharged upon ejaculation. In addition to reproductive organ secretions, it contains spermatozoa and their nutrient plasma. [NIH] Senile: Relating or belonging to old age; characteristic of old age; resulting from infirmity of old age. [NIH] Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins have been removed. [NIH] Sex Distribution: The number of males and females in a given population. The distribution may refer to how many men or women or what proportion of either in the group. The population is usually patients with a specific disease but the concept is not restricted to humans and is not restricted to medicine. [NIH] Sex Factors: Maleness or femaleness as a constituent element or influence contributing to the production of a result. It may be applicable to the cause or effect of a circumstance. It is used with human or animal concepts but should be differentiated from sex characteristics, anatomical or physiological manifestations of sex, and from sex distribution, the number of males and females in given circumstances. [NIH] Sexually Transmitted Diseases: Diseases due to or propagated by sexual contact. [NIH] Shock: The general bodily disturbance following a severe injury; an emotional or moral upset occasioned by some disturbing or unexpected experience; disruption of the circulation, which can upset all body functions: sometimes referred to as circulatory shock. [NIH]

Side effect: A consequence other than the one(s) for which an agent or measure is used, as the adverse effects produced by a drug, especially on a tissue or organ system other than the one sought to be benefited by its administration. [EU] Signal Transduction: The intercellular or intracellular transfer of information (biological activation/inhibition) through a signal pathway. In each signal transduction system, an activation/inhibition signal from a biologically active molecule (hormone, neurotransmitter) is mediated via the coupling of a receptor/enzyme to a second messenger system or to an ion channel. Signal transduction plays an important role in activating cellular functions, cell differentiation, and cell proliferation. Examples of signal transduction systems are the GABA-postsynaptic receptor-calcium ion channel system, the receptor-mediated T-cell activation pathway, and the receptor-mediated activation of phospholipases. Those coupled to membrane depolarization or intracellular release of calcium include the receptormediated activation of cytotoxic functions in granulocytes and the synaptic potentiation of protein kinase activation. Some signal transduction pathways may be part of larger signal transduction pathways; for example, protein kinase activation is part of the platelet activation signal pathway. [NIH] Signs and Symptoms: Clinical manifestations that can be either objective when observed by a physician, or subjective when perceived by the patient. [NIH] Skeletal: Having to do with the skeleton (boney part of the body). [NIH] Skeleton: The framework that supports the soft tissues of vertebrate animals and protects many of their internal organs. The skeletons of vertebrates are made of bone and/or cartilage. [NIH]

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Sneezing: Sudden, forceful, involuntary expulsion of air from the nose and mouth caused by irritation to the mucous membranes of the upper respiratory tract. [NIH] Social Environment: The aggregate of social and cultural institutions, forms, patterns, and processes that influence the life of an individual or community. [NIH] Social Support: Support systems that provide assistance and encouragement to individuals with physical or emotional disabilities in order that they may better cope. Informal social support is usually provided by friends, relatives, or peers, while formal assistance is provided by churches, groups, etc. [NIH] Sodium: An element that is a member of the alkali group of metals. It has the atomic symbol Na, atomic number 11, and atomic weight 23. With a valence of 1, it has a strong affinity for oxygen and other nonmetallic elements. Sodium provides the chief cation of the extracellular body fluids. Its salts are the most widely used in medicine. (From Dorland, 27th ed) Physiologically the sodium ion plays a major role in blood pressure regulation, maintenance of fluid volume, and electrolyte balance. [NIH] Soft tissue: Refers to muscle, fat, fibrous tissue, blood vessels, or other supporting tissue of the body. [NIH] Solvent: 1. Dissolving; effecting a solution. 2. A liquid that dissolves or that is capable of dissolving; the component of a solution that is present in greater amount. [EU] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Sphincter: A ringlike band of muscle fibres that constricts a passage or closes a natural orifice; called also musculus sphincter. [EU] Spinal cord: The main trunk or bundle of nerves running down the spine through holes in the spinal bone (the vertebrae) from the brain to the level of the lower back. [NIH] Spinous: Like a spine or thorn in shape; having spines. [NIH] Squamous: Scaly, or platelike. [EU] Squamous cell carcinoma: Cancer that begins in squamous cells, which are thin, flat cells resembling fish scales. Squamous cells are found in the tissue that forms the surface of the skin, the lining of the hollow organs of the body, and the passages of the respiratory and digestive tracts. Also called epidermoid carcinoma. [NIH] Squamous cell carcinoma: Cancer that begins in squamous cells, which are thin, flat cells resembling fish scales. Squamous cells are found in the tissue that forms the surface of the skin, the lining of the hollow organs of the body, and the passages of the respiratory and digestive tracts. Also called epidermoid carcinoma. [NIH] Squamous cells: Flat cells that look like fish scales under a microscope. These cells cover internal and external surfaces of the body. [NIH] Statistically significant: Describes a mathematical measure of difference between groups. The difference is said to be statistically significant if it is greater than what might be expected to happen by chance alone. [NIH] Steroid: A group name for lipids that contain a hydrogenated cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones,

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bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU] Stimulants: Any drug or agent which causes stimulation. [NIH] Stimulus: That which can elicit or evoke action (response) in a muscle, nerve, gland or other excitable issue, or cause an augmenting action upon any function or metabolic process. [NIH] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Stomatitis: Inflammation of the oral mucosa, due to local or systemic factors which may involve the buccal and labial mucosa, palate, tongue, floor of the mouth, and the gingivae. [EU]

Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or tension. Stress may be either physical or psychologic, or both. [NIH] Stroke: Sudden loss of function of part of the brain because of loss of blood flow. Stroke may be caused by a clot (thrombosis) or rupture (hemorrhage) of a blood vessel to the brain. [NIH] Subacute: Somewhat acute; between acute and chronic. [EU] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Submucous: Occurring beneath the mucosa or a mucous membrane. [NIH] Subspecies: A category intermediate in rank between species and variety, based on a smaller number of correlated characters than are used to differentiate species and generally conditioned by geographical and/or ecological occurrence. [NIH] Substance P: An eleven-amino acid neurotransmitter that appears in both the central and peripheral nervous systems. It is involved in transmission of pain, causes rapid contractions of the gastrointestinal smooth muscle, and modulates inflammatory and immune responses. [NIH]

Suction: The removal of secretions, gas or fluid from hollow or tubular organs or cavities by means of a tube and a device that acts on negative pressure. [NIH] Supplementation: Adding nutrients to the diet. [NIH] Support group: A group of people with similar disease who meet to discuss how better to cope with their cancer and treatment. [NIH] Suppositories: A small cone-shaped medicament having cocoa butter or gelatin at its basis and usually intended for the treatment of local conditions in the rectum. [NIH] Sympathomimetic: 1. Mimicking the effects of impulses conveyed by adrenergic postganglionic fibres of the sympathetic nervous system. 2. An agent that produces effects similar to those of impulses conveyed by adrenergic postganglionic fibres of the sympathetic nervous system. Called also adrenergic. [EU] Symphysis: A secondary cartilaginous joint. [NIH] Synaptic: Pertaining to or affecting a synapse (= site of functional apposition between neurons, at which an impulse is transmitted from one neuron to another by electrical or chemical means); pertaining to synapsis (= pairing off in point-for-point association of homologous chromosomes from the male and female pronuclei during the early prophase of meiosis). [EU] Synaptic Transmission: The communication from a neuron to a target (neuron, muscle, or secretory cell) across a synapse. In chemical synaptic transmission, the presynaptic neuron

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releases a neurotransmitter that diffuses across the synaptic cleft and binds to specific synaptic receptors. These activated receptors modulate ion channels and/or secondmessenger systems to influence the postsynaptic cell. Electrical transmission is less common in the nervous system, and, as in other tissues, is mediated by gap junctions. [NIH] Synergistic: Acting together; enhancing the effect of another force or agent. [EU] Systemic: Affecting the entire body. [NIH] Systemic disease: Disease that affects the whole body. [NIH] Systolic: Indicating the maximum arterial pressure during contraction of the left ventricle of the heart. [EU] Technology Transfer: Spread and adoption of inventions and techniques from one geographic area to another, from one discipline to another, or from one sector of the economy to another. For example, improvements in medical equipment may be transferred from industrial countries to developing countries, advances arising from aerospace engineering may be applied to equipment for persons with disabilities, and innovations in science arising from government research are made available to private enterprise. [NIH] Telophase: The final phase of cell division, in which two daughter nuclei are formed, the cytoplasm divides, and the chromosomes lose their distinctness and are transformed into chromatin networks. [NIH] Theophylline: Alkaloid obtained from Thea sinensis (tea) and others. It stimulates the heart and central nervous system, dilates bronchi and blood vessels, and causes diuresis. The drug is used mainly in bronchial asthma and for myocardial stimulation. Among its more prominent cellular effects are inhibition of cyclic nucleotide phosphodiesterases and antagonism of adenosine receptors. [NIH] Therapeutics: The branch of medicine which is concerned with the treatment of diseases, palliative or curative. [NIH] Thigh: A leg; in anatomy, any elongated process or part of a structure more or less comparable to a leg. [NIH] Thoracic: Having to do with the chest. [NIH] Threshold: For a specified sensory modality (e. g. light, sound, vibration), the lowest level (absolute threshold) or smallest difference (difference threshold, difference limen) or intensity of the stimulus discernible in prescribed conditions of stimulation. [NIH] Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Time Factors: Elements of limited time intervals, contributing to particular results or situations. [NIH] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Tobacco, Smokeless: The powdered leaves of Nicotiana tabacum which are either inhaled through the nose, chewed, or stored in cheek pouches. It includes any product of tobacco that is not smoked. [NIH] Tolerance: 1. The ability to endure unusually large doses of a drug or toxin. 2. Acquired drug tolerance; a decreasing response to repeated constant doses of a drug or the need for increasing doses to maintain a constant response. [EU] Tooth Loss: The failure to retain teeth as a result of disease or injury. [NIH] Tooth Preparation: Procedures carried out with regard to the teeth or tooth structures preparatory to specified dental therapeutic and surgical measures. [NIH] Topical: On the surface of the body. [NIH]

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Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicokinetics: Study of the absorption, distribution, metabolism, and excretion of test substances. [NIH] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxins: Specific, characterizable, poisonous chemicals, often proteins, with specific biological properties, including immunogenicity, produced by microbes, higher plants, or animals. [NIH] Trachea: The cartilaginous and membranous tube descending from the larynx and branching into the right and left main bronchi. [NIH] Transduction: The transfer of genes from one cell to another by means of a viral (in the case of bacteria, a bacteriophage) vector or a vector which is similar to a virus particle (pseudovirion). [NIH] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Transmitter: A chemical substance which effects the passage of nerve impulses from one cell to the other at the synapse. [NIH] Trauma: Any injury, wound, or shock, must frequently physical or structural shock, producing a disturbance. [NIH] Trees: Woody, usually tall, perennial higher plants (Angiosperms, Gymnosperms, and some Pterophyta) having usually a main stem and numerous branches. [NIH] Tryptophan: An essential amino acid that is necessary for normal growth in infants and for nitrogen balance in adults. It is a precursor serotonin and niacin. [NIH] Tuberculosis: Any of the infectious diseases of man and other animals caused by species of Mycobacterium. [NIH] Tumor marker: A substance sometimes found in an increased amount in the blood, other body fluids, or tissues and which may mean that a certain type of cancer is in the body. Examples of tumor markers include CA 125 (ovarian cancer), CA 15-3 (breast cancer), CEA (ovarian, lung, breast, pancreas, and gastrointestinal tract cancers), and PSA (prostate cancer). Also called biomarker. [NIH] Tumor suppressor gene: Genes in the body that can suppress or block the development of cancer. [NIH] Tumour: 1. Swelling, one of the cardinal signs of inflammations; morbid enlargement. 2. A new growth of tissue in which the multiplication of cells is uncontrolled and progressive; called also neoplasm. [EU] Tyrosine: A non-essential amino acid. In animals it is synthesized from phenylalanine. It is also the precursor of epinephrine, thyroid hormones, and melanin. [NIH] Unconscious: Experience which was once conscious, but was subsequently rejected, as the "personal unconscious". [NIH] Urethra: The tube through which urine leaves the body. It empties urine from the bladder. [NIH]

Urinary: Having to do with urine or the organs of the body that produce and get rid of

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urine. [NIH] Urine: Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra. [NIH] Uterus: The small, hollow, pear-shaped organ in a woman's pelvis. This is the organ in which a fetus develops. Also called the womb. [NIH] Vaccine: A substance or group of substances meant to cause the immune system to respond to a tumor or to microorganisms, such as bacteria or viruses. [NIH] Vagina: The muscular canal extending from the uterus to the exterior of the body. Also called the birth canal. [NIH] Vaginitis: Inflammation of the vagina characterized by pain and a purulent discharge. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vasodilator: An agent that widens blood vessels. [NIH] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Venous: Of or pertaining to the veins. [EU] Ventricle: One of the two pumping chambers of the heart. The right ventricle receives oxygen-poor blood from the right atrium and pumps it to the lungs through the pulmonary artery. The left ventricle receives oxygen-rich blood from the left atrium and pumps it to the body through the aorta. [NIH] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Viral: Pertaining to, caused by, or of the nature of virus. [EU] Virulence: The degree of pathogenicity within a group or species of microorganisms or viruses as indicated by case fatality rates and/or the ability of the organism to invade the tissues of the host. [NIH] Virus: Submicroscopic organism that causes infectious disease. In cancer therapy, some viruses may be made into vaccines that help the body build an immune response to, and kill, tumor cells. [NIH] Vitro: Descriptive of an event or enzyme reaction under experimental investigation occurring outside a living organism. Parts of an organism or microorganism are used together with artificial substrates and/or conditions. [NIH] Volition: Voluntary activity without external compulsion. [NIH] Wart: A raised growth on the surface of the skin or other organ. [NIH] White blood cell: A type of cell in the immune system that helps the body fight infection and disease. White blood cells include lymphocytes, granulocytes, macrophages, and others. [NIH]

Windpipe: A rigid tube, 10 cm long, extending from the cricoid cartilage to the upper border of the fifth thoracic vertebra. [NIH] Withdrawal: 1. A pathological retreat from interpersonal contact and social involvement, as may occur in schizophrenia, depression, or schizoid avoidant and schizotypal personality disorders. 2. (DSM III-R) A substance-specific organic brain syndrome that follows the cessation of use or reduction in intake of a psychoactive substance that had been regularly used to induce a state of intoxication. [EU] Xanthoma: A tumour composed of lipid-laden foam cells, which are histiocytes containing cytoplasmic lipid material. Called also xanthelasma. [EU] X-ray: High-energy radiation used in low doses to diagnose diseases and in high doses to

Dictionary 203

treat cancer. [NIH] X-ray therapy: The use of high-energy radiation from x-rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy) or from materials called radioisotopes. Radioisotopes produce radiation and can be placed in or near the tumor or in the area near cancer cells. This type of radiation treatment is called internal radiation therapy, implant radiation, interstitial radiation, or brachytherapy. Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that circulates throughout the body. X-ray therapy is also called radiation therapy, radiotherapy, and irradiation. [NIH] Yohimbine: A plant alkaloid with alpha-2-adrenergic blocking activity. Yohimbine has been used as a mydriatic and in the treatment of impotence. It is also alleged to be an aphrodisiac. [NIH]

205

INDEX A Abdomen, 163, 176, 184, 190, 199 Abdominal, 163, 189, 190 Aberrant, 16, 163 Abrasion, 13, 147, 163 Acceptor, 163, 184, 189 Acetylcholine, 15, 148, 163, 170, 188 Acetylcholinesterase, 15, 163 Acoustic, 163, 195 Actinic keratosis, 113, 115, 163 Adaptability, 163, 169 Adaptation, 69, 163 Adduct, 20, 163 Adenosine, 163, 200 Adjustment, 163 Adjuvant, 163, 178 Adrenal Cortex, 164, 172 Adrenal Medulla, 164, 169, 176, 188 Adrenergic, 164, 174, 176, 199, 203 Adverse Effect, 94, 148, 164, 197 Aerobic, 164, 186 Affinity, 164, 198 Agar, 164, 191 Age Distribution, 11, 164 Age Factors, 145, 164 Age Groups, 164 Age of Onset, 30, 164 Agonist, 164, 166, 174, 188 Algorithms, 164, 167 Alkaloid, 94, 164, 166, 184, 188, 200, 203 Alpha Particles, 164, 194 Alternative medicine, 113, 124, 165 Ameliorating, 98, 104, 165 Amino Acid Sequence, 165 Amino Acids, 98, 104, 165, 192, 194 Amputation, 114, 165 Anabasine, 41, 165 Anaesthesia, 165, 181 Anal, 165, 176 Analog, 102, 165 Anaphylatoxins, 165, 171 Anaplasia, 165 Anatomical, 165, 175, 184, 197 Anoikis, 19, 165 Antagonism, 165, 200 Antibodies, 38, 72, 80, 165, 181, 185, 191, 195

Antibody, 164, 165, 166, 171, 181, 182, 183, 187, 195, 203 Antidepressant, 165, 168, 172 Antigen, 48, 164, 165, 166, 171, 181, 182 Antigen-Antibody Complex, 166, 171 Antihypertensive, 113, 166 Anti-inflammatory, 166, 190 Antimicrobial, 166, 193 Antimycotic, 166, 193 Antioxidant, 67, 102, 104, 166, 189 Apoptosis, 15, 18, 38, 58, 83, 165, 166 Aqueous, 16, 100, 106, 166, 167, 173, 180, 184 Arachidonic Acid, 166, 193 Areca, 77, 81, 82, 166 Arecoline, 166 Arginine, 165, 166, 188 Aromatic, 77, 166 Arterial, 48, 166, 181, 194, 200 Arteries, 166, 168, 172, 186 Astringents, 166, 177 Autonomic, 163, 166, 188, 190 Autopsy, 24, 166 B Bacteria, 166, 167, 173, 186, 195, 201, 202 Bacterial Physiology, 163, 167 Bacteriophage, 167, 191, 201 Basal cell carcinoma, 115, 167 Basal cells, 167 Base, 20, 92, 93, 106, 167, 173, 183 Benign, 113, 114, 116, 167, 179, 183, 184, 187, 188, 195, 196 Benign tumor, 167, 184 Bile, 167, 184, 199 Binding agent, 99, 167 Bioassay, 167 Biochemical, 19, 23, 66, 167 Biological Assay, 16, 167 Biomarkers, 47, 48, 167 Biopsy, 22, 167 Biotechnology, 26, 27, 112, 124, 135, 167 Biotransformation, 167 Bladder, 6, 32, 168, 193, 201, 202 Blood Glucose, 168, 179, 182 Blood pressure, 6, 7, 30, 78, 113, 144, 146, 166, 168, 169, 181, 187, 198 Blood vessel, 168, 169, 170, 175, 198, 199, 200, 202

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Body Fluids, 167, 168, 175, 198, 201 Brachial, 168, 185 Brachial Plexus, 168, 185 Brachytherapy, 168, 182, 183, 195, 203 Bradykinin, 168, 188 Branch, 159, 168, 173, 185, 190, 194, 198, 200 Bronchi, 168, 176, 200, 201 Bronchial, 168, 200 Bronchitis, 168, 170, 177 Buccal, 32, 44, 62, 98, 99, 115, 130, 168, 180, 199 Buccal mucosa, 32, 44, 62, 98, 168 Bupropion, 15, 28, 66, 168 Burns, 30, 34, 116, 168 Burns, Electric, 168 C Calcium, 168, 171, 197 Callus, 169, 183 Candidiasis, 116, 169 Candidosis, 169 Capsid, 48, 169 Capsules, 106, 169, 177, 178 Carcinogen, 4, 14, 19, 22, 124, 163, 169 Carcinogenesis, 12, 18, 31, 77, 79, 144, 169 Carcinogenic, 19, 20, 145, 169, 182, 188, 199 Carcinoma, 32, 59, 72, 79, 114, 115, 144, 169, 176 Cardiac, 39, 169, 175, 176, 187, 198 Cardiovascular, 6, 7, 15, 32, 39, 49, 58, 60, 88, 94, 104, 110, 116, 145, 148, 169 Cardiovascular disease, 6, 15, 58, 94, 104, 110, 169 Carotene, 80, 169 Catecholamine, 169, 174 Causal, 48, 169, 176, 182 Cause of Death, 24, 169 Cell Cycle, 16, 169 Cell Death, 18, 166, 169, 187 Cell Differentiation, 169, 197 Cell Division, 166, 169, 170, 173, 185, 186, 191, 200 Cell proliferation, 170, 197 Cell Respiration, 170, 186, 195 Cellobiose, 170 Cellulose, 91, 170, 178, 191 Central Nervous System, 163, 170, 178, 200 Cerebrovascular, 169, 170 Cervical, 13, 168, 170, 185, 196 Cervix, 170

Cheilitis, 114, 116, 170 Chemotactic Factors, 170, 171 Chemotherapy, 18, 115, 170 Cholesterol, 7, 167, 170, 172, 180, 199 Choline, 15, 163, 170 Cholinergic, 15, 170, 184, 188 Chromatin, 166, 170, 200 Chromosomal, 45, 170, 186, 196 Chromosome, 170, 184, 186, 196 Chronic, 6, 16, 18, 33, 56, 88, 104, 114, 151, 170, 182, 199 Chronic Disease, 56, 151, 170 Chronic Obstructive Pulmonary Disease, 104, 170 CIS, 140, 170 Clinical trial, 13, 135, 171, 172, 194, 195 Cloning, 167, 171 Codons, 72, 171 Cofactor, 171, 194 Cohort Studies, 171, 176 Collagen, 80, 171, 178, 191, 193 Complement, 45, 73, 82, 165, 171, 172 Complementary and alternative medicine, 77, 85, 171 Complementary medicine, 77, 172 Compress, 90, 172 Computational Biology, 135, 172 Conception, 172, 177 Connective Tissue, 171, 172, 177, 178, 185, 196 Constriction, 172, 196 Consultation, 18, 172 Consumption, 12, 14, 22, 30, 55, 59, 98, 106, 172, 174, 195 Contraindications, ii, 172 Control group, 8, 9, 23, 172 Convulsion, 167, 172 Coronary, 78, 169, 172, 186 Coronary heart disease, 169, 172 Coronary Thrombosis, 172, 186 Cortisol, 148, 172 Cotinine, 5, 23, 49, 66, 172 Cross-Sectional Studies, 172, 176 Crowns, 173, 174 Cues, 39, 81, 173 Curative, 173, 200 Cutaneous, 104, 114, 169, 173 Cyclic, 173, 179, 188, 193, 200 Cytogenetics, 173, 196 Cytokine, 18, 173 Cytoplasm, 166, 173, 175, 179, 200 Cytotoxic, 173, 195, 197

Index 207

Cytotoxicity, 73, 82, 173 D Databases, Bibliographic, 135, 173 Deception, 31, 173 Deletion, 166, 173 Delivery of Health Care, 173, 179 Density, 173, 192 Dental Abutments, 173, 174 Dental Assistants, 125, 173 Dental Care, 115, 173, 190 Dental Caries, 3, 116, 149, 173 Dental Hygienists, 10, 28, 38, 173 Dentists, 3, 8, 113, 125, 174 Dentures, 22, 174 Depolarization, 174, 197 Deprivation, 37, 62, 72, 81, 174 Dermal, 174, 184 Detoxification, 22, 45, 174 Deuterium, 174, 180 Developing Countries, 174, 200 Diabetes Mellitus, 174, 179 Diagnostic procedure, 89, 124, 174 Diarrhea, 174, 177 Diarrhoea, 174, 180 Diastolic, 174, 181 Digestion, 167, 174, 184, 199 Digestive tract, 15, 174, 198 Direct, iii, 16, 20, 129, 174, 195 Disposition, 51, 174 Distal, 37, 174, 194 Diuresis, 174, 200 Dopamine, 15, 168, 174 Drive, ii, vi, 6, 71, 113, 114, 115, 120, 148, 174 Dross, 174, 193 Drug Interactions, 130, 175 Drug Tolerance, 175, 200 Duct, 175, 177, 196 Duodenum, 167, 175, 199 Dysplasia, 22, 175 E Ectopic, 116, 175 Effector, 163, 171, 175 Efficacy, 10, 15, 18, 23, 24, 26, 28, 175 Elastin, 171, 175 Electrocardiogram, 78, 175 Electrolyte, 175, 198 Electrons, 166, 167, 175, 183, 189, 194, 195 Embryo, 169, 175, 181 Emphysema, 94, 102, 170, 175 Empirical, 26, 175 Enamel, 173, 175, 183

Endocarditis, 169, 175 Endothelial cell, 41, 175 Endothelium, 175, 188 Endothelium-derived, 175, 188 Endotoxins, 171, 175 Environmental Exposure, 176, 189 Environmental Health, 134, 136, 176 Environmental tobacco smoke, 16, 176 Enzymatic, 98, 104, 169, 171, 173, 176 Enzyme, 15, 163, 175, 176, 178, 179, 186, 194, 197, 202 Epidemic, 24, 176 Epidemiologic Studies, 6, 176 Epidemiological, 11, 176 Epidermal, 44, 176, 183, 184, 185 Epidermis, 167, 176, 179, 183, 184, 192 Epidermoid carcinoma, 176, 198 Epigastric, 176, 189 Epinephrine, 164, 174, 176, 188, 201 Epithelial, 18, 22, 31, 36, 45, 48, 79, 115, 176, 183, 184 Epithelial Cells, 18, 45, 48, 176 Epithelium, 16, 81, 175, 176, 190 Epstein, 38, 40, 63, 72, 176, 184 Epstein-Barr virus, 38, 40, 72, 176, 184 Erectile, 113, 176 Erection, 176 Erythroplakia, 113, 114, 115, 177 Esophageal, 15, 177 Esophagus, 15, 19, 104, 144, 174, 177, 191, 199 Eucalyptus, 106, 177 Exocrine, 177, 189 Exogenous, 167, 177 External-beam radiation, 177, 183, 195, 203 Extracellular, 165, 172, 177, 198 Extracellular Matrix, 165, 172, 177 Extraction, 22, 177 Extrapyramidal, 174, 177 Extremity, 106, 168, 177, 185 F Facial, 94, 115, 177, 185 Family Planning, 135, 177 Family Practice, 7, 59, 61, 66, 177 Fat, 166, 169, 172, 177, 184, 196, 198 Fathers, 30, 177 Fatty acids, 177, 193 Femoral, 32, 177 Femur, 177 Fetus, 20, 177, 202 Fibrosis, 77, 80, 82, 114, 115, 116, 177

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Filler, 92, 96, 177 Filtration, 94, 177 Flavoring Agents, 92, 110, 177 Flexor, 178, 184 Foam Cells, 178, 202 Forearm, 41, 168, 178, 185 Fungus, 169, 178 G Gamma Rays, 178, 194, 195 Ganglia, 163, 178, 187, 190 Gas, 41, 178, 180, 188, 199 Gelatin, 92, 178, 199 Gene, 112, 167, 178, 189 Gingival Recession, 13, 22, 144, 178 Ginseng, 113, 178 Gland, 164, 178, 185, 189, 193, 196, 199 Glucose, 148, 168, 170, 174, 178, 179, 182 Glutathione Peroxidase, 178, 197 Glycoprotein, 34, 178 Governing Board, 178, 192 Government Agencies, 147, 178, 192 Grade, 20, 46, 64, 178 Granular Cell Tumor, 114, 178 Granulocytes, 179, 197, 202 Granuloma, 114, 179 Guanylate Cyclase, 179, 188 H Habitual, 5, 44, 99, 179 Habituation, 12, 179 Halitosis, 148, 179 Health Care Costs, 13, 150, 179 Health Education, 47, 150, 179 Health Expenditures, 179 Health Promotion, 17, 25, 36, 78, 119, 151, 179 Health Status, 22, 179 Heart attack, 169, 179 Hemoglobin, 6, 19, 179 Hemorrhage, 179, 199 Hepatic, 44, 74, 82, 180 Hereditary, 116, 180 Heredity, 178, 180 Herpes, 31, 79, 180 Herpes Zoster, 180 Histology, 180, 190 Hormonal, 148, 167, 180 Hormone, 167, 172, 176, 180, 182, 197 Human papillomavirus, 36, 43, 48, 113, 126, 180 Hybrid, 180 Hybridization, 43, 180

Hydrogen, 94, 163, 167, 174, 178, 180, 184, 187, 188, 189, 194 Hydrogen Cyanide, 94, 180 Hydrogen Peroxide, 178, 180, 184 Hydrolysis, 163, 168, 170, 180, 191, 192, 194 Hydrophilic, 100, 101, 180 Hydroxylysine, 171, 180 Hydroxyproline, 171, 180 Hygienic, 99, 180 Hypercholesterolemia, 69, 180 Hyperkeratosis, 10, 116, 180 Hyperplasia, 114, 181, 184 Hypertension, 6, 30, 37, 43, 81, 113, 143, 169, 181 Hypertrophy, 180, 181 I Id, 75, 84, 140, 152, 158, 160, 181 Idiopathic, 116, 181 Immune response, 163, 166, 181, 199, 202 Immune system, 181, 185, 202 Immunization, 181, 193 Immunohistochemistry, 16, 181 Immunologic, 170, 181, 195 Implant radiation, 181, 182, 183, 195, 203 Impotence, 113, 176, 181, 203 In situ, 43, 181 In vitro, 44, 167, 181 In vivo, 167, 181 Indicative, 110, 181, 190, 202 Induction, 44, 45, 58, 181 Infancy, 114, 181 Infarction, 172, 181, 186 Infection, 31, 79, 126, 169, 170, 181, 184, 185, 199, 202 Inflammation, 63, 166, 168, 170, 177, 180, 182, 190, 194, 199, 202 Informed Consent, 26, 182 Ingestion, 37, 179, 181, 182, 192 Inhalation, 94, 182, 192 Initiation, 7, 12, 23, 25, 30, 32, 40, 45, 182 Initiator, 167, 182 Innervation, 168, 182, 185 Inotropic, 174, 182 Insight, 19, 182, 196 Insomnia, 182, 184 Insulin, 148, 167, 182 Insulin-dependent diabetes mellitus, 182 Interleukin-1, 6, 37, 55, 63, 182 Interleukin-2, 182 Internal radiation, 182, 183, 195, 203 Interstitial, 168, 182, 183, 203

Index 209

Intervention Studies, 8, 182 Intestinal, 169, 182 Intoxication, 183, 202 Intracellular, 182, 183, 188, 193, 197 Intraepithelial, 116, 183 Involuntary, 10, 172, 176, 183, 187, 198 Ionization, 183 Ionizing, 19, 165, 176, 183, 195 Ions, 167, 175, 180, 183 Irradiation, 18, 183, 203 J Joint, 115, 178, 183, 199 K Kb, 134, 183 Keratin, 183, 196 Keratinocytes, 15, 55, 83, 183 Keratoacanthoma, 114, 115, 183 Keratolytic, 173, 183 Keratosis, 33, 52, 115, 116, 163, 183 Kinetic, 183 L Labile, 171, 183 Large Intestine, 174, 183, 195 Larynx, 15, 144, 184, 201 Latency, 37, 184 Latent, 40, 72, 184 Lesion, 7, 11, 179, 183, 184, 185 Lethal, 94, 184 Leukoplakia, Hairy, 116, 184 Library Services, 158, 184 Lichen Planus, 113, 116, 184 Ligament, 184, 193 Linkage, 16, 170, 184 Lip, 73, 96, 113, 184 Lipid, 74, 82, 170, 178, 182, 184, 189, 202 Lipid Peroxidation, 74, 82, 184, 189 Lipoma, 114, 116, 184 Lipopolysaccharide, 7, 184 Liquor, 184, 194 Liver, 19, 163, 166, 167, 180, 184 Lobeline, 37, 72, 81, 184 Local Government, 52, 184 Localization, 181, 185 Localized, 20, 173, 182, 184, 185, 191 Lymph, 170, 175, 185 Lymph node, 170, 185 Lymphatic, 175, 182, 185 Lymphocyte, 58, 166, 185 Lymphoid, 116, 165, 185 Lymphokine, 45, 185 Lymphoma, 114, 176, 185

M Macrophage, 182, 185 Malignant, 5, 6, 73, 113, 114, 115, 185, 187, 195, 196 Malignant tumor, 115, 185 Mastication, 92, 185 Maxillary, 115, 185, 190 Maxillary Sinus, 115, 185 Meatus, 185 Median Nerve, 37, 185 Mediate, 174, 185 MEDLINE, 135, 185 Meiosis, 185, 186, 199 Melanocytes, 185, 186, 188 Melanoma, 114, 186 Membrane, 163, 171, 174, 177, 179, 184, 186, 187, 190, 192, 197, 199 Mental Disorders, 186, 193 Mental Health, iv, 13, 134, 136, 186, 193, 194 Mental Processes, 186, 194 Metabolite, 19, 168, 186 Metastasis, 115, 186 Metastatic, 114, 186, 196 Methyltransferase, 20, 186 MI, 49, 161, 186 Microbe, 186, 201 Microbiology, 163, 186 Micronuclei, 44, 186 Microorganism, 171, 186, 202 Micro-organism, 173, 186 Migration, 15, 186 Mitochondria, 44, 186 Mitosis, 166, 186 Modification, 66, 186, 194 Molecular, 6, 16, 18, 20, 22, 45, 58, 135, 137, 167, 172, 173, 186 Molecule, 166, 167, 171, 175, 180, 187, 189, 195, 197 Monitor, 21, 24, 94, 187, 188 Monoclonal, 183, 187, 195, 203 Monocyte, 59, 82, 187 Mononuclear, 6, 7, 49, 179, 187 Mucinous, 115, 187 Mucins, 187, 196 Mucosa, 10, 19, 27, 45, 52, 113, 115, 116, 184, 187, 199 Mucus, 187 Mutagenic, 187, 188 Mydriatic, 187, 203 Myocardium, 186, 187

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N Nasal Cavity, 185, 187, 190 Nasal Mucosa, 19, 187 NCI, 1, 14, 21, 121, 133, 140, 141, 143, 150, 170, 187 Necrosis, 166, 181, 186, 187 Need, 3, 7, 16, 26, 31, 63, 90, 97, 101, 109, 112, 115, 116, 119, 125, 126, 153, 164, 187, 200 Neoplasia, 20, 187 Neoplasm, 179, 187, 196, 201 Neoplastic, 114, 165, 183, 185, 187 Nerve, 164, 168, 182, 185, 187, 188, 192, 196, 199, 201 Nervous System, 170, 187, 188, 190, 199, 200 Networks, 17, 187, 200 Neurofibroma, 114, 188 Neuroma, 114, 188 Neuromuscular, 163, 188 Neuromuscular Junction, 163, 188 Neuronal, 15, 188 Neurons, 178, 188, 199 Neutrons, 164, 183, 188, 194 Nevus, 116, 188 Nitric Oxide, 58, 188 Nitrogen, 164, 180, 188, 201 Nitrosamines, 11, 19, 20, 105, 110, 188 Norepinephrine, 15, 164, 174, 188 Nuclear, 45, 175, 178, 187, 188 Nuclei, 164, 175, 186, 188, 194, 200 Nucleic acid, 169, 180, 188 Nucleic Acid Hybridization, 180, 189 Nucleus, 166, 170, 173, 174, 178, 185, 186, 187, 188, 189, 194 O Odds Ratio, 22, 189 Odour, 166, 189 Office Visits, 11, 189 Ointments, 189, 190 Oncogene, 72, 189 On-line, 25, 161, 189 Oral Health, 4, 9, 11, 22, 23, 46, 74, 79, 113, 125, 143, 144, 145, 147, 148, 149, 150, 189 Oral Hygiene, 97, 148, 179, 189 Oropharynx, 79, 189 Otolaryngology, 59, 69, 120, 140, 147, 150, 189 Oxidation, 163, 166, 168, 178, 184, 189 Oxidative Stress, 55, 83, 189 P P53 gene, 55, 80, 189

Palate, 115, 189, 199 Palliative, 189, 200 Pancreas, 15, 19, 163, 167, 182, 189, 201 Papillary, 180, 190 Papillomavirus, 190 Paraffin, 22, 190 Paranasal Sinuses, 185, 190 Patch, 17, 141, 177, 184, 190 Pathogenesis, 6, 80, 115, 116, 190 Pathologic, 52, 115, 166, 167, 169, 172, 190 Pathologic Processes, 166, 190 Pathologies, 7, 115, 190 Patient Education, 142, 156, 158, 161, 190 Pediatric Dentistry, 114, 190 Pelvic, 190, 193 Periodontal disease, 6, 15, 17, 114, 149, 190 Periodontics, 114, 190 Periodontitis, 7, 114, 190 Peripheral blood, 7, 49, 190 Peripheral Nervous System, 190, 196, 199 Peritoneal, 44, 190 Peritoneum, 190 Petroleum, 190, 191 Pharmaceutical Preparations, 170, 178, 191 Pharmacist, 16, 191 Pharmacokinetic, 191 Pharmacologic, 9, 191, 201 Pharynx, 22, 104, 116, 187, 189, 191 Phospholipases, 191, 197 Physical Examination, 114, 191 Physical Fitness, 45, 191 Physiologic, 53, 164, 191, 193, 195 Physiology, 116, 190, 191 Pigment, 185, 186, 191 Pilot study, 4, 11, 12, 15, 17, 28, 36, 57, 79, 191 Plants, 164, 170, 178, 188, 191, 201 Plaque, 52, 113, 191 Plasma, 27, 38, 67, 165, 178, 179, 191, 197 Plasma cells, 165, 191 Platelet Activation, 191, 197 Platelet Aggregation, 165, 188, 191 Platelets, 188, 191, 192 Poisoning, 144, 149, 183, 192 Policy Making, 178, 192 Polyethylene, 102, 192 Polyp, 114, 192 Polypeptide, 165, 171, 180, 192 Polysaccharide, 166, 170, 192 Population Growth, 38, 192 Posterior, 165, 189, 192

Index 211

Postoperative, 121, 147, 192 Postsynaptic, 192, 197, 200 Potentiates, 182, 192 Potentiating, 167, 192 Potentiation, 192, 197 Practice Guidelines, 17, 136, 192 Precancerous, 163, 192 Precursor, 166, 170, 174, 175, 176, 188, 192, 201 Premalignant, 73, 81, 112, 113, 114, 115, 192 Prickle, 183, 192 Primary Prevention, 22, 193 Progression, 16, 115, 193 Progressive, 169, 175, 179, 187, 191, 193, 201 Projection, 188, 193 Proline, 171, 180, 193 Proneness, 45, 193 Prophylaxis, 174, 193 Propolis, 106, 193 Prospective study, 24, 193 Prostaglandin, 6, 37, 55, 63, 193 Prostaglandins A, 193 Prostate, 6, 167, 193, 201 Protective Devices, 100, 193 Protein S, 112, 167, 194 Proteins, 165, 166, 170, 171, 180, 182, 183, 187, 188, 191, 194, 195, 197, 201 Proteolytic, 171, 194 Protocol, 9, 194 Protons, 164, 180, 183, 194 Proximal, 174, 187, 194 Pruritic, 184, 194 Psychology, 13, 38, 53, 54, 72, 102, 194 Public Policy, 117, 135, 194 Publishing, 4, 7, 27, 112, 113, 114, 115, 145, 194 Pulmonary, 19, 168, 172, 194, 202 Pulmonary Artery, 168, 194, 202 Pulse, 78, 187, 194 Pyogenic, 114, 194 Q Quality of Life, 113, 194 R Race, 64, 67, 186, 194 Radiation, 19, 176, 177, 178, 182, 183, 194, 195, 202, 203 Radiation therapy, 177, 182, 183, 194, 203 Radioactive, 180, 181, 182, 183, 188, 195, 203 Radioimmunotherapy, 195

Radiolabeled, 183, 195, 203 Radiotherapy, 115, 168, 183, 195, 203 Randomized, 15, 17, 21, 25, 26, 88, 175, 195 Reactive Oxygen Species, 44, 73, 82, 195 Receptor, 16, 163, 166, 174, 195, 197 Rectum, 174, 178, 183, 193, 195, 199 Refer, 1, 164, 168, 171, 180, 185, 188, 195, 197 Reference point, 5, 195 Regimen, 175, 195 Relapse, 13, 23, 195 Reliability, 95, 195 Respiration, 187, 195 Restoration, 173, 195, 196 Retrospective, 24, 195 Risk factor, 4, 6, 7, 22, 24, 32, 40, 45, 46, 58, 78, 79, 80, 114, 126, 151, 176, 193, 195 Risk-Taking, 29, 196 Role Playing, 14, 196 Root Caries, 13, 196 Rural Population, 23, 196 S Saliva, 23, 93, 105, 106, 107, 196 Salivary, 5, 196 Salivary glands, 196 Sanitary, 100, 196 Sarcoma, 114, 196 Satellite, 17, 196 Schizoid, 196, 202 Schizophrenia, 196, 202 Schizotypal Personality Disorder, 196, 202 Schwannoma, 114, 196 Screening, 21, 81, 150, 171, 196 Sebaceous, 115, 196 Sebum, 196 Secondary tumor, 186, 196 Secretion, 7, 59, 82, 182, 187, 196, 197 Secretory, 38, 72, 197, 199 Selenium, 98, 197 Semen, 193, 197 Senile, 163, 197 Serum, 7, 17, 165, 171, 197 Sex Distribution, 197 Sex Factors, 145, 197 Sexually Transmitted Diseases, 115, 197 Shock, 197, 201 Side effect, 113, 129, 164, 197, 201 Signal Transduction, 19, 197 Signs and Symptoms, 98, 104, 143, 195, 197 Skeletal, 115, 197 Skeleton, 177, 183, 193, 197

212

Smokeless Tobacco

Sneezing, 83, 198 Social Environment, 194, 198 Social Support, 26, 198 Sodium, 113, 198 Soft tissue, 116, 197, 198 Solvent, 106, 198 Specialist, 152, 198 Species, 27, 98, 104, 176, 180, 185, 186, 187, 194, 195, 198, 199, 201, 202 Sphincter, 184, 198 Spinal cord, 168, 170, 185, 187, 190, 198 Spinous, 176, 183, 198 Squamous, 114, 115, 126, 176, 179, 183, 198 Squamous cell carcinoma, 114, 115, 126, 176, 179, 183, 198 Squamous cells, 179, 198 Statistically significant, 126, 198 Steroid, 172, 198 Stimulants, 166, 178, 199 Stimulus, 174, 182, 184, 199, 200 Stomach, 15, 163, 167, 174, 177, 180, 191, 199 Stomatitis, 115, 116, 199 Stress, 39, 81, 169, 172, 189, 199 Stroke, 58, 134, 143, 169, 199 Subacute, 182, 199 Subclinical, 182, 199 Submucous, 77, 80, 114, 115, 116, 199 Subspecies, 198, 199 Substance P, 186, 196, 199 Suction, 177, 199 Supplementation, 113, 199 Support group, 143, 199 Suppositories, 178, 199 Sympathomimetic, 174, 176, 188, 199 Symphysis, 193, 199 Synaptic, 188, 197, 199 Synaptic Transmission, 188, 199 Synergistic, 22, 31, 79, 98, 104, 200 Systemic, 4, 6, 7, 12, 35, 40, 98, 130, 168, 169, 176, 182, 183, 195, 199, 200, 203 Systemic disease, 4, 200 Systolic, 181, 200 T Technology Transfer, 21, 200 Telophase, 186, 200 Theophylline, 34, 200 Therapeutics, 49, 53, 130, 200 Thigh, 177, 200 Thoracic, 168, 185, 200, 202 Threshold, 181, 200 Thrombosis, 194, 199, 200

Time Factors, 164, 200 Tobacco, Smokeless, 20, 151, 200 Tolerance, 7, 15, 163, 200 Tooth Loss, 79, 114, 146, 149, 200 Tooth Preparation, 163, 200 Topical, 166, 180, 190, 200 Toxic, iv, 94, 98, 100, 173, 176, 180, 188, 197, 201 Toxicity, 14, 24, 175, 201 Toxicokinetics, 201 Toxicology, 38, 40, 44, 66, 72, 73, 74, 82, 136, 201 Toxins, 94, 166, 175, 181, 195, 201 Trachea, 168, 184, 191, 201 Transduction, 197, 201 Transfection, 167, 201 Transmitter, 163, 174, 188, 201 Trauma, 114, 187, 201 Trees, 177, 201 Tryptophan, 171, 201 Tuberculosis, 172, 201 Tumor marker, 167, 201 Tumor suppressor gene, 115, 189, 201 Tumour, 201, 202 Tyrosine, 174, 201 U Unconscious, 181, 201 Urethra, 193, 201, 202 Urinary, 47, 66, 74, 201 Urine, 15, 19, 41, 47, 113, 168, 174, 201, 202 Uterus, 170, 202 V Vaccine, 163, 194, 202 Vagina, 169, 170, 202 Vaginitis, 169, 202 Vascular, 41, 175, 181, 182, 184, 188, 202 Vasodilator, 168, 174, 202 Vein, 188, 196, 202 Venous, 48, 194, 202 Ventricle, 194, 200, 202 Veterinary Medicine, 135, 202 Viral, 169, 201, 202 Virulence, 167, 201, 202 Virus, 31, 79, 167, 169, 176, 180, 191, 201, 202 Vitro, 202 Volition, 183, 202 W Wart, 183, 202 White blood cell, 165, 185, 187, 191, 202 Windpipe, 191, 202

Index 213

Withdrawal, 7, 17, 37, 53, 72, 81, 110, 116, 143, 202 X Xanthoma, 114, 202

X-ray, 178, 183, 188, 194, 195, 202, 203 X-ray therapy, 183, 203 Y Yohimbine, 113, 203

214

Smokeless Tobacco

Index 215

216

Smokeless Tobacco

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