Great American Spit Out - Better Starts Today - Edward Hines, Jr. VA Hospital
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Edward Hines, Jr. VA Hospital


Great American Spit Out - Better Starts Today

Great American Spit Out

Feb. 21 - Great American Spit Out - Better Starts Today

Wednesday, February 20, 2019

Thursday, February 21, VA is participating in the Great American Spit Out. For the approximately 8.7 million Americans who use smokeless tobacco, quitting can be extremely difficult. The U.S. Department of Veterans Affairs’ (VA) Better Starts Today campaign encourages you to think about the many reasons to quit smokeless tobacco.  

We sat down with Cheryl Czerlanis, M.D., Chief of Hematology/Oncology at Hines VA Hospital to better understand the risks associated with chewing tobacco. Below are some questions we asked about tobacco use and her answers.

First, let’s talk about the risks associated with chewing tobacco. What are the main problems you see with people who use chewing tobacco?

The main risks with chewing tobacco include changes in the lining of the mouth and throat, which can lead to developing cancers of the mouth and throat. People who use dip, chew, and snuff increase their risk for cancers of the lip, tongue, floor, and the roof of their mouth. Another problem we’re aware of is that people who use chewing tobacco often pass down these unhealthy behaviors to their family members. We also know that it’s an expensive habit to feed.

There seems to be an assumption that chewing tobacco isn’t as bad as smoking cigarettes. Is this true?

That’s a myth. The risks are different. Chewing tobacco can lead to head and neck cancer, whereas the bigger risk for cigarette smokers is lung cancer. The risks are similar, but they’re associated with the exposure area, which for chewing tobacco is the lining of the mouth, throat and the lip.

It seems that chewing tobacco is especially attractive or enticing to younger people. Are they impacted by this more than older populations?

People pick up this habit at all points of life, but yes, chewing tobacco is something often picked up by teenagers and younger people who are experimenting. Similar to cigarette smoking and now vaping, peer pressure plays a role in this.

What is the prognosis when someone is diagnosed with mouth or throat cancers associated with chewing tobacco?

The prognosis is based largely on stage when it’s discovered. It varies depending upon whether someone is diagnosed at an early stage or with advanced disease. Certainly, being diagnosed sooner is better. The prognosis for head and neck cancers is really tied into how quickly it’s found. When it is found after the disease spreads from where it started to other organs in the body, we consider it to be largely incurable at that point. We then use therapies that are effective in treating symptoms and stop the spreading of the disease, and sometimes delaying the progression of the disease. But ultimately it is much more difficult to cure when the disease is advanced and spreading to other parts of the body.

Why do people still use tobacco products with so much information about the risks and dangers?

I think it’s still a highly addictive chemical and it’s a hard habit to break – probably one of the most difficult habits to break more than even some very addictive highly illicit drugs. The best approach to quitting tobacco is for the person trying to quit to really understand their reasons for wanting to quit, picking a quit date, and coming up with a quit plan. VA can help Veterans develop a quit plan that may include medications, individual counseling, group classes, or telephone counseling.

You mentioned vaping earlier. Do you see similarities between chewing tobacco and vaping?

Yes. Vaping is really fascinating in the fact that it’s become an epidemic, especially for younger people. It’s been called an epidemic for the youth. The number of middle and high schoolers vaping is in the millions. I think a lot of it has to do with the fact this is marketed as a safe alternative to cigarette smoking. It’s still too new to know to know the long-term effects and too early to assume it’s risk free. We’ll have to follow this over the years to see. Incidence of cigarette smoking is on the decline while vaping is on the rise. It really is an epidemic for the young people. 

To learn about steps you can take to quit smokeless tobacco, visit: For more information about tobacco cessation, visit and check out the following resources: 

•             Quit VET: Speak with a tobacco cessation counselor to make a quit plan and to receive ongoing support and counseling after your quit date by calling 1-855-QUIT-VET (1-855-784-8838). Quitline counselors are available between 9 a.m. and 9 p.m. Eastern time, Monday through Friday. Quitline counselors offer continued support through follow-up calls and counseling. 
•             SmokefreeVET: Sign up for VA’s text-messaging program to receive three to five text messages a day of support, advice, and encouragement when you are quitting tobacco. You can sign up for the program by texting the word VET to 47848 from your mobile phone or by visiting  You can text the keywords URGE, STRESS, and DIPPED anytime to get an immediate tip for coping with an urge to use, stress, or a slip.

Like most things in life, the journey of quitting smokeless tobacco products happens one day at time. Know your reasons for quitting and remember to focus on everything you don’t like about dipping and chewing. Make Feb. 21 the day you begin. Better Starts Today. 



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