Nicotine-derived JV-Nitrosamines and Tobacco-related Cancer: Current Status and Future Directions1

Although per capita use of cigarettes among adults (18 years of age and over) has declined from 4345 in 1963 to 3494 in 1983, there are still about 53 million cigarette smokers in the United States (89, 92). Six hundred thirty billion cigarettes were con sumed in 1983. An alarming development is the increasing prevalence of snuff dipping. Snuff dipping is the practice of extracting juices from a pinch of moist fine-cut chewing tobacco, placed between the cheek and the gum. The general popularity of snuff dipping, especially among young people, is a relatively recent trend but women in the southeastern parts of the United States have been snuff dippers for many decades. A recent case-control study showed that the relative risk of oral cavity cancer among white nonsmoking, snuff-dipping women was 4.2. Among chronic users, the relative risk of cancers of the gum and oral cavity approached 50 (96). In 1983, consumption totaled 21,000 tons of snuff tobacco and 39,000 tons of chewing tobacco (89). Presently, there are an estimated 7 million snuff dippers in the United States (80). The main reason for the continued use of tobacco, in spite of its well-known adverse health effects, is dependence on nicotine (64). This compound is the major alkaloid2 in United States