INDEX ABBREVIATIONS constituents of smokeless tobacco, 70 ABRASION (DENTAL) defined, 128 relation to smokeless tobacco, 130 ABUSE LIABILITY OF NICOTINE defined, 145,157 evidence for abuse potential, 166-167 experimental studies, 157-166 implications of studies, 162 phannacodynamic effects, 158 research needs, 184 self-administration, 159-l 62 ACANTHOSIS clinical report, 115-118 defined, 113 ADENOCARCINOMA relation to snuff use, 48 ADOLESCENT USE attitudes, 24 data criteria, 17 ethnic groups, 20 males vs. females, 20 National Program Inspection study, 24 peer and family influences, 24 rural vs. urban areas, 20 ADULT USE patterns, 16-17 ADVISORY COMMIlTEE TO THE SURGEON GENERAL, REPORT carcinogens revealed, vii conclusions, vii-viii, xxii gingival recession, viii historical perspective of report, Xvii-xix nicotine addiction and effects, viii noncancerous conditions, xxi oral leukoplakia. viii organization of report, xvii overview, xx-xxii precancerous oral health conditions, xxi review methods, xix-xx ALCOHOL CONSUMPTION relation to smokeless tobacco, 35 ANIMAL MODELS bioassays with chewing tobacco, 79, 82-83 bioassays with constituents of smokeless tobacco, 86-88 bioassays with snuff, 83-86 metabolism of NMOR, 74-75 metabolism of NNK, 71-73 metabolism of NNN, 73-74 mutagenicity assays, 88-89 pharmacodynamic effects of nicotine, 158 physiologic effects of nicotine, 178 sdivmy glands, 126-127 short-term tests, 88-89 ASIAN DATA case-control studies, 42-43, 119 chewing of quids, 42-43, 50 esophageal neoplasms, 50 rates of oral cancer, 42-43 smokeless tobacco products, 42-43 smoking and oral cancer risk, 43-44 BIOASSAYS FOR CL4RCTVOGEVIC Ati'UK'TY OF CZEWiVG TOBACCO OR tZi%`W;wG iYm4ccoIiYxmAcr$8o BIOASSAYS FOR CARClhDGEVIC ACTNITY OF Sh?UFF OR SNUFF EXlTUCI$81 BIOASSAYS WITH CHEWING TOBACCO (See dso ANIMAL MODELS) application to the cheek pouch, 79, 82-83 application to the oral mucosa, 79, 82-83 oral administration, 79 skin application, 83 subcutaneous application, 83 BJOASSAYS WITH CONSTITUENTS OF SMOKELESS TOBACCO (See also ANIMAL MODELS) inducement of tumors, 86-88 187 BIOASSAYS WITH SNUFF (See also ANIMAL MODELS) application to the lip, oral mucosa, or cheek pouch, 84-86 oral administration, 83-84 relation to herpes simplex virus, 86-87 subcutaneous administration, 86 Bladder Neophsms, See URINARY TRACT NEOPLASMS Blockade Therapy, See NICOTINE ADDICTION TREATMENT BUCCAL CARCINOMA case studies, 34-36 CALCULUS (DENTAL) defined, 129 use of smokeless tobacco, 130 CARC~OGHCflY OF TOBACCO SPECIFIC NITROSAMINES 82 CARCINOGENS daily exposure from snuff and chewing tobacco usage, 64 in smokeless tobacco, 58-60. 64-65 N-nitrosamines, 58-60, 64 polonium-210 (21oPo), 58, 65 polynuclear aromatic hydra carbons (PAH), 58,65 saliva analysis, 64 CARCINOMA hVSlTU defined, 114 diagnoses differ, 123 squamous cell carcinoma study, 120 Cardiovascular System, See PHYSIOLOGIC EFFECTS OF NICOTINE Central Nervous System, See PHYSIOLOGIC EFFECTS OF NICOTINE ChXRACTERLSTICS OF SMOKE I2239 TOBACCO PRODUCT$6 CHEEK NEOPLASMS (See also ORAL CANCER) animal models, 79, 82, 84 case study, 120 CHEMICAL COMPOSITION processed tobacco, 58 nicotine, 58 CHEMICAL CONSTITUENTS OF SMOKELESS TOBACCO carcinogens, 58-59,60,6465 chemical composition, 58 CHEVRON KERATINIZATION case report, 116-l 17 defined, 114 CHEWING TOBACCO (See also SMOKELESS TOBACCO, BIOASSAYS) case-control studies, 36,40 characteristics, 5 looseleaf, 5,7 plug, 5, 7 twist, 5, 7 CommonaIities Between Tobacco and Other Addictive Substances, See NICOTINE ADDICTION CONCEPTUAL MODEL of smokeless tobacco lesions, 121 CONCEPTUAL NflVRAL HISTORY OF ORAL MucosAL CRANGES ASlSOCiWED WITH TdcE USE OF SMO- TOBACCO, 122 CORONARY AND PERIPHERAL VASCULAR DISEASE acute coronary events, 177-178 and nicotine, 177-178 atherosclerosis, 177 effect on platelets, 177 endothelial injury, 177 research needed, 185 ventricular fibrillation, 178 Cotinine, See PHARMACQ KINETICS OF NICOTINE CURRENT POPULATION SURVEY (CPS) survey data, 12,14 DATA: ABUSE LUBIUTY .!U'tLVm AT ADDICTION RESEARCH CENTER 160 DENTAL CARIES defined, 128 relation to smokeless tobacco, 129-130 DOSE RESPONSE EFFECTS (See also ANIMAL MODELS) and oral leukoplakia, 13 1 nicotine, 147, 152-153, 158, 182-183 DRUG DEPENDENCE commonalities between tobacco and other substances, 146-147, 152-157 defined, 145 physiologic or physical dependence, 145-146 188 DYSPLASIA defined, 114 diagnoses differ, 121. 123 relation to oral lesions, 115-l 16 Endocrine System, See PHYSIOLOGIC EFFECTS OF NICOTINE EPIDEMIOLOGIC STUDIES AND SMOKELESS TOBACCO data from Asia, 42-44 data from North America and Europe, 33-42 oral cancer, 33-44 other cancers, 47-55 EROSION (DENTAL) defined, 128 ERYTHROPLAKIA defined, 113 ESOPHAGEAL NEOPLASMS case-control study, 39, 48-50 cohort study, 49-50 ESTMTED E2XkX?RE OF US RESIDm To NITROSmES 64 ESTLlzATED RELATWE RISKS ASSOCL4TED WITH SNUFF USE FOR ClANCERS OF TljlE ORAL CAV7TI: PHARYNX, AND LARYNX, CASECONTROL DATA FROM VOGLER ETAL., Fm ONLY 38 EST~TEDRELAT~RLSKFOR CMCER OF THEHEADAND NECK FROM SMOKELESS TOBACCO USE BY ANATOMIC SITE, Tm NATIONAL CAN- CER SUR VEX MALES ONLY 39 EST~TEDRELAT~RLSK OF OROPHARYNGEU CANCER ACCORDING To DURATION OF SNUFF USEANDANAToM7C SITE, Wm ET AL, 41 ESTWTES OF RELATNE RISKS OF BLADDER CANC' LN PERSONS WHO HA VE EVER USED C%!EW~G TOBACCO AND SNUFF 53 ETHNIC USE OF SMOKELESS TOBACCO of youth, 21-22 Experimental Studies Exposing Laboratory Animals, See ANIMAL MODELS FORMATION OF TOBACCO SPECUIC NITROSmES 60 FREQUENCY OF SMOKELESS TOBACCO USE LN PAST YEARi 14 Gastric Neoplasms, See STOMACH NEOPLASMS GENERAL PRINCTPLESLN EVALUATmTG CARCXNOGENIC RISK OF CHEMC~S OR COM- PLEX MLX-TURES (INTERNA- TIONAL AGENCY FOR RESEARCH ON CANCER, xxi GINGIVAL AND PERIODONTAL HEALTH bone loss, 125 effects of smokeless tobacco, 101, 103-104, 123 inflammation, 126 studies in Sweden, 126 studies in the United States, 125 GINGIVAL CARCINOMA case studies, 34, 36, 44, 120 GINGIVAL RECESSION Advisory Committee report, viii defined, 123 related to oral leukoplakiai mucosal pathology, 112 studies in the United States, 125 GINGIVITIS defined, 123 relation to smokeless tobacco, 125, 129 studies in the United States, 125 GLYCYRRHIZIC ACID metabolic consequences, 179 HEAD AND NECK NEOPLASMS case-control study, 38-39.38-39 HEROIN ADDICTION THERAPY model used, 156 HERPES SIMPLEX VIRUS relation to oral cancer, 86-87, 93 HISTORICAL PERSPECTIVE chewing tobacco, xvii consequences of use, xviii-xix decline of use, 5 early uses, xviii-xix, 5 snuff, xvii-xix HYPERKERATOSIS ccrhort study, 117-l 18 defined, 113 relation to snuff use, 125 189 HYPERORTHOKERATOSIS cohort study, 118 defined, 113 HYPERPARAKERATOSIS cohort study, 118-l 19 defined, 113 HYPOKALEMIA nonnicotine metabolic consequences, 179 INHALED SNUFF relation to nasal carcinoma, 93 Kidney Neoplasms, See URINARY TRACT NEOPLASMS LARYNGEAL NEOPLASMS /See also THIRD NATIONAL CANCER STUDY) case-control study, 37,38, 50-51 Leukoplakia, Oral, See ORAL LEUKOPLAKIA LIP NEOPLASMS (See also ORAL CANCER) animal models, 84-85 case-control study, 36 labial mucosa, 116-117 Looseleaf, See CHEWING TOBACCO MANLT?ACTURLNG TRENDS QUANTLTLES OF SMORELESS TOBACCO MANUFACTURED LN THE UiWTED STATES FROM 1961 To 1985 EXPRESSED LN JDLLION POUNDS. 8 MEAN FREQUENCY OF SMOKE LESS TOBACCO USE DURING LAST 7 DAYS BY ETHNLCITY BY MALE RESPONDENTS, 23 METABOLIC PATHWAYS OF NMOR, 74 ME;X&Xl$IC PATHWAYS OF ,A . METkOLIC PATmA YS OF Nvy 73 METABOLISM OF CONSTITUENTS OF SMOKELESS TOBACCO conversion of products, xx-xxi of NMOR, 74-75 of NNK, 71-73 of NNN, 73-74 MOUTH NEOPLASMS (See also ORAL CANCER) case-control study, 36-37.36, 37, 39,120 MUCOSAL PATHOLOGY snuff-induced lesions, 114-l 16 studies in Scandanavia, 11 l-l 12 studies in the United States, 107, 108-109110-112 MUTAGENICITY ASSAYS AND OTHER SHORT-TERM TESTS (See also ANIMAL MODELS) chewing tobacco, 88 snuff, 88 tobacco-specific N-nitrosamines, 88-89 NASAL NEOPLASMS posterior nasal space tumors, 48 relation to snuff use, 48 Nass, See ASIAN DATA NATIONAL BLADDER CANCER STUDY relation to smokeless tobacco use, 52-53 NATIONAL BLOOD CANCER STUDY survey data, 16 NATIONAL HEALTH INTER- VIEW SURVEY (NHIS) survey data, 10, 14-15 NATIONAL INSTITUTE ON DRUG ABUSE (NIDA) survey data, 13-15 NATIONAL PREVALENCE OF CURRENT USE OF SNUFF BY GENDER AGE, AND RACE FOR 1980 THROUGH 1985,ll NATION& PREVALENCE OF SMOEELESS TOBACCO USE BY ADCZT STATUS AND SEX, INIDA SAMPLE, 1935, 13 NATIONAL PREVXLENCE OF SMOKES TOBACCO USE: DATA SOURCES, 9 NATIONAL SURVEY DATA conclusions, 24-25 Current Population Survey, 12,14 discussion of data, 14-15 National Health Interview survey, 10, 14-15 National Institute on Drug Abuse Household Survey, 13-15 Office on Smoking and Health Surveys, 7,10,12,14 Simmons Market Research Bureau, 10, 12, 14-15 190 NEUROADAPTATION (See also PHYSICAL DEPENDENCE POTENTIAL OF NICOTINE, PHYSIOLOGIC EFFECTS OF NICOTINE) defined, 145. demonstrated, 153 nicotine, 162 NICOTINE (See also PHARMA. COKINETICS OF NICOTINE, NICOTINE ADDICTION, NICOTINE EXPOSURE, ABUSE LIABILITY, PHAR- MACODYNAMICS OF NICO- TINE, PATHOLOGIC EFFECTS OF NICOTINE, AND SMOKELESS TOBACCO) absorption, 141-142, 185 cotinine levels, 143 dependence, 154 distribution, 142 elimination, 142-143 habituating agent, 58 levels, 143 physical dependence, 162-166 self-administration, 159-161 therapeutic effects, 154-155 turnover, 143 NICOTINE ADDICTION /See also NICOTINE EXPOSURE, PHYSICAL DEPENDENCE POTENTIAL OF NICOTINE) commonalities with other addictive substances, 146-147, 152-157, 184 dose manipulations, 153 encourages other drug use, 184 pattern of use, 152 relation to smokeless tobacco, 58, 144-147, 152, 185 self-administration, 152-153 social tolerance, 156 therapeutic effects, 154-155 tolerance of use developed, 153 treatment for, 155-156 NICOTINE ADDICTION TREATMENT blockade therapy, 156 nicotine gum, 156 pretreatment, 156 substitution, 156 supportive therapy, 156 NICOTINE CHEWING GUM as substitution, 156 reinforcing properties, 166-167 research needs, 184 self-administration, 167 NICOTINE EXPOSURE /See also NICOTINE, NICOTINE ADDICTION) delivery to the central nervous system, 147 other physiological effects, . vm, xxii, xxvi pharmacokinetics, xxiv, 141-144 peer pressure, 147, 152 reinforcer for animals, 147 relation to addiction, xxiv-xxv, 144-157 XICOT~E SELF-ADMINISTRATION PATTERIS. 161 NMOR /See also ABBREVIATIONS) metabolism in rats, 74-75 N-NITROSAMINES (See also CARCINOGENS) exposure in nontobacco products, 64, 64 in snuff, 60 in tobacco leaves, 59 metabolized by tissue, 70-75 nonvolatile, 60, 62 tobacco-specific, 60, 63 volatile, 60. 61 N-NflROSAMINES lN SMOKELESS TOBACCO, 59 NNK (See also ABBREVIATIONS) metabolism in rats, 71-73 NNN (See also ABBREVIATIONS) metabolism in rats, 73-74 relation to buccal mucosa, 73 relation to lingual mucosa, 73 NONCANCEROUS CONDITIONS (See also PRECANCEROUS CONDITIONS) relation to smokeless tobacco, 100105 NONVOLATILE NITROSAWES IN SMOIfELESS TOBACCO (PPB), 62 OFFICE ON SMOKING AND HEALTH (OSH) survey data, 7, 10, 12, 14 ORAL CANCER (See also ORAL LEUKOPLAKIA, ORAL SOFT TISSUES, LIP NEOPLASMS, MOUTH NEOPLASMS, CHEEK NEOPLASMS, AND TONGUE NEOPLASMS) case studies, 34-41 191 ORAL CANCER-Cont. epidemiologic studies, 33-55 in rats, 72, 79, 84-86, 88-89 ORAL LEUKOPLAKIA causation, vii defined, 113 prospective study, 118 relation to smokeless tobacco, viii, xxiii-xxiv, 107, 110-112, 121 studies in Scandanavia, 11 l-l 12 studies in the United States, 107, lot?-10!9, 110-112 ORAL SOFT TISSUES clinical reports of lesions, 114-117 cohort studies, 117-119 definitions, 113-l 14 oral lesions, 119-120 transformation, 113-123 PANCREATIC NEOPLASMS chewing tobacco use, 54-55 PARANASAL SINUS NEOPLASMS relation to snuff use, 48 PATHOLOGIC EFFECTS OF NICOTINE AND SMOKELESS TOBACCO coronary and peripheral vascular disease, 177-178 hypertension, 178 nonnicotine metabolic consequences, 179 peptic ulcer disease, 178 pregnancy risks, 178-179 PERIODONTAL TISSUE DEGENERATION (See also MUCOSAL PATHOLOGY, GINGIVAL AND PERIODONTAL HEALTH) and teenagers, 110 PERMIsslLE LlMIll!3 FOR INDIVWUAL N-NITROSAMINES AV CONSlIlX!TR PRODUCTS, 65 PHARMACODYNAMICS OF NICOTINE Liking Scale, 158 Morphine Benzadrine Group Scale, 158 research needs, 184 self-administration implications, 162 PHARMACOKINETICS OF NICOTINE absorption, 141-142 cotinine blood levels, 143 PHARMACOKINETICS OF NICOTINE-Cant . distribution, 142 elimination, 142-143 levels in smokeless tobacco, 141 nicotine blood levels, 143 time course of turnover, 143 PHARYNGEAL NEOPLASMS case-control study, 37,38, 39-40 cohort study, 41-42 PHYSICAL DEPENDENCE POTENTIAL OF NICOTINE (See also NEUROADAPTATION) defined, 145,162 determination, 153-154 evidence for physical dependence, 157-166 evidence of withdrawal symptoms, 164-166 implications of physical dependence, 166 reinforcement with nicotine gum, 167 studies conducted, 157, 162-163 tobacco withdrawal, 163-164 PHYSIOLOGIC EFFECTS OF NICOTINE /See also NEURO- ADAPTATION, PHYSICAL DEPENDENCE POTENTIAL OF NICOTINE) cardiovascular system, 175-l 76 central nervous system, 147,176, 183 differentiation possible, 162 endocrine system, 176 pleasant effects produced, 162, 176 PLAQUE defined, 128 use of smokeless tobacco, 130 Plug, See CHEWING TOBACCO Polonium2Ia (21OPo), See CARCINOGENS Polynuclear Aromatic Hydrocarbons (PAHI, See CARCINOGENS POSTERIOR NASAL SPACE TUMORS relation to liquid snuff, 48 PRECANCEROUS CONDITIONS (See also NONCANCEROUS CONDITIONS) Advisory Committee Report, xxi defined, 113 relation to leukoplakia, 119 relation to smokeless tobacco, xxi 192 PRECANCEROUS LESION defined, 113 oral lesions, 119 PREVXLENCE OFSMOKELESS TOBACCO USE BY CENSUS REGION, 1985,16 PREVALENCE OF USE OF SMOKE LESS TylBACCO AMONG YOUTH BYGENDERANDGRADE LOCAL SUR KEYS USING STAN- DARDIZED QUESTIONS, 21-22 PREVALENCE OF USE OF SMOKE LESS TOBACCO AMONG YOUTH BY GENDER AND GRADE.. REGIONAL AND STATE LEVEL SURVEYS REPORTED SINCE 1980,1&19 PREVALENCE OFSNUFFAND CHEWING TOBACCO USE BY ADULTM4LESlN10 GEOGRAPHIC AREAS 17 PREVALENCE OF SNUFF USE AMONG COLLEGE STUDENTS 18 YEARS OF AGE OR OLDER BY GENDER AND YEAR, 12 PREVALENCE OF THE USE OF SNUFFAND CHEWmG TOBACCO AMONG MALES BY AGE, 1970 NHLsAND1985cpssURVEY$ll Quids, See ASIAN DATA RECENCY OF SMOKELESS TOBACCO USE BY SEXAND AGE GROUP, 13 RELATmRfSK OFORAL CANCER FROMBETEL QUID W7TLjlAND W!IT.HOUT To&1CCO (WITH95 PERCENT CONFIDENCE -), 43 RELATNERLSKS OF ESOPHAGEAL CANCER lN PERSONS ExposED To CHEW- &VG TOBACCO AND SXX'i'?~ .!XlWXR Y OF M)UR CASE CONTROL STUDHi! 49 Renal Neoplasms, See URINARY TRACT NEOPLASMS RESEARCH NEEDS carcinogenesis, 93-94 nicotine exposure, 184-185 oral health effects 131-132 prevalence/trends of use, 25 standardizing methods, 25 SALIVA ANALYSIS of snuff dippers, 64 SALIVARY GLANDS effects of smokeless tobacco, lOl-l&3, 126-128 SCHEME LLNKLNG NICOTLNE TO FORMATION OF THE PROMUTAGENIC DNA ADDUCT O%METHYLGUANINE, 72 SELECTED STUDY Sm FOR THE NONC'CEROUS ORAL HEALTH EFFECTS FROM THE USE OF SMOKELESS TOBACCO, lm105 SIALADENITIS defined, 123 relation to smokeless tobacco, 127 relation to snuff dippers, 127 SIMMONS MARKET RESEARCH BUREAU survey data, 10, 12, 14-15 SMOKELESS TOBACCO (See also CHEWING TOBACCO, SNUFF) carcinogenesis associated with, 33-93 chemical constituents, 58-69 cohort studies, 41-42 commonalities with other addictive substances, 146-147, 152-157 conclusions, 24-25, 92-93, 130-131, 182-183 effect on oral leukoplakia/ mucosal pathology, 107-l 12 epidemiologic studies and case reports of oral cancer, 33-44 epidemiologic studies of other cancers, 47-55 evidence for abuse and dependence, 166-167 experimental studies exposing laboratory animals, 78-79 experimental studies of abuse and dependence, 157-166 metabolism of constituents, 70-75 nicotine addiction, 144-146 nicotine exposure, xxiv, 141-185 noncancerous and precancerous oral health effects, xxiii-xxiv, 99-130 pharmacokinetics of nicotine, 141-144 physiologic and pathologic effects, 175-l 79 prevalence and trends of use. xxii, 4-24 193 SMOKELESS TOBACCO-Cant . product characteristics, 5 research needs, 25, 93-94, 131-132, 184-185 transformation of oral soft tissue, 113-120 trends in production and sales, 5, 7 trends in self-reported use, 7, 10, 12-17, 20, 24 SMOKELESS mBACC0 AND h!EAD AND NECK CANCER BY ANA- RMfICSITE, CASECONTROL DATA FROM VtNCX!h'TAh?D MARCtlETZA, - ONLU, 38 SMO- lloBACC0 AND MOUTH CANCER CASE CONTROL DATA FROM MOOREETAL+ 36 SMO- TylBACCO AND MOUTH CANCER, CASE CONTROL DATA FROM PEACOCKETAL, 37 SNUFF (See also SMOKELESS TOBACCO, BIOASSAY8 ANIMAL MODELS) case-control studies, 37, 40 characteristics. 5 dry,7 historical uses, xviii-xix levels of carcinogens, 60, 64-66 moist, 7 relation to cancer, 41, 53-55 saliva analysis, 64 SNUFF-DIPPERS CARCINOMA defined, 113 exposure to nitrosamines, 64 oral lesions, 120 reports, 35 Scandinavian study, 111 SQUAMOUS CELL CARCINOMA case studies, 34-36 clinical study, 117 defined, 114 oral lesions, 119-120 snuff and ear neoplasms, 47 STAINING (DENTAL) defined, 129 STATE AND LOCAL SURVEY DATA adolescent use, 17, 20, 24-25 adult use, 16-17 STOMACH NEOPLASMS relation to smokeless tobacco, 51-52 Substitution Therapy, See NICOTINE ADDICTION TREATMENT SUMMRY OF DATA: LIABILJTY OF NICOTmTE AS mBACC0 SMOKE OR lNTRAVENOUS lh?JECTION$159 StJUX4RYOFREFOR~IN WZICHNICOT~ WAS AVAII ABLE uNoERINTR.AvENom DRUG SELF+tDMIhZXUATION PROC%!DiXE!$14&151 S-Y OFSELJXTZD CASE REpoRT$106 Supportive Therapy, See NICOTINE ADDICTION TREATMENT Surgeon General's Advisory Committee on the Health Consequences of Using Smokeless `Ibbacco, See ADVISORY COMMITTEE TO THE SUR- GEON GENERAL, REPORT TEETH dental caries, 129-130 effect of smokeless tobacco, 128-130 other hard tissue effects, 130 THERAPEUTIC EFFECTS OF NICOTINE as an anoretic, 154 mood regulator, 154 performance of cognitive tasks, 154 self-medication, 155 work enhancement, 154 THIRD NATIONAL CANCER STUDY (TNCS) bladder cancer, 54 laryngeal neoplasms, 50-51 other cancer sites, 55 stomach neoplasms, 52 TOBACCO SNIFFING rare practice, xvii TOBACCMPEC~IC N-NITR-B liV SMOKE LhXJ TOBACCO fPPB), 63 mBA CCO-SPECXFIC N-NITRO-Bmm' US. BRANI& 1985,66 TOBACCO WITHDRAWAL (See also PHYSICAL DEPEN- DENCE OF NICOTINE) evidence of symptoms, 164-166 194 TOBACCO WITHDRAWAL- Cont. study findings, 165 symptoms, 163-164 University of Minnesota studies, 164-166 `TONGUE NEOPLASMS (See also ORAL CANCER, MOUTH N-EOPLASMS) case-control study, 36,120 TRENDS IN PRODUCTION ANDSALES categories of products, 7 temporal trends, 7 United States Department of Agriculture (USDA) reports, 5 TRENDS IN SELF-REPORTED USE: SURVEY DATA national survey data, 7, 10, 12-15 state and local survey data, 15-1'7, 20, 24 Twist, See CHEWING TOBACCO URINARY TRACTNEOPLASMS castxontrol studies, 52-54 relationship to smokeless tobacco, 52-54 USEOFSMO-llylBAccOm THE UNITEB SZ4TEs BY VAlpIATIONs~ T- USEDm DEI?!ONS PROKiDED EylR GINGMTISAND GINGWXL RE C%ssIONBYS~~ CITED, 124 VMU4TIONS~ TERbis USEDAND D,W!MIONS PROKWED EylR USED BY STuDrn CITED, 108109 VERRUCOUS CARCINOMA defined, 114 dysplastic lesions, 13 1 voLAlzLEm-m MfOKI.hZSS mBACc0 IPPBJ, 61 WORLD HEALTH ORGANIZATION (WHO) Chnmittee on Drug Dependence, 145 defines oral leukoplakia, 107 differing diagnoses, 123 195