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NIH — Smokeless Tobacco: HHS Response to Rfc

June 29, 2004

Mr. Ken Boehm 
National Legal and Policy Center 
107 Park Washington Court 
Falls Church, VA 22046

Dear Mr. Boehm:

Thank you for your "Request for Correction of Information" under the National Institutes of Health Guidelines for Ensuring the Quality of Information Disseminated to the Public dated March 16, 2004. This office received your request on March 17, 2004.

The National Institute on Aging (NIA) is one of 27 Institutes and Centers at the National Institutes of Health (NIH). The mission of the NIA is "the conduct and support of biomedical, social, and behavioral research, training, health information dissemination, and other programs with respect to the aging process and the diseases and other special problems and needs of the aged." As part of our response to your Request for Correction we first state the goal of the Age Page fact sheets.

Age Pages are designed to provide lay readers with a brief and simple introduction to a particular topic. We aim for a middle school reading level so we keep the information straightforward and free of scientific jargon or citations. Each Age Page gives a short topical overview and, most importantly, provides readers with information on key resources where they will get specific details and, if they desire, up-to-date scientific resources.

Smoking: It's Never Too Late to Stop is an Age Page that introduces readers to the concept of quitting smoking, provides a short overview of the benefits of quitting even late in life, and looks at the health consequences of smoking and the dangers of nicotine. The section on quitting points readers to available aids (e.g., chewing gum or joining a support group) and also notes that under a doctor's care there are nicotine replacement therapy options to help control withdrawal symptoms. In addition, there is a short paragraph pointing out that cigars, pipes, chewing tobacco, and snuff are not safe alternatives to quitting cigarettes. An extensive list of resources at the end of the Age Page directs readers to organizations with the expertise to provide detailed information.

All NIA printed publications, including Age Pages, undergo a rigorous scientific review to assure the factual basis of the document. For example, prior to publication, this particular Age Page was read and approved by NIA researchers and administrators, as well as by experts at the Centers for Disease Control and Prevention (CDC)'s Office of Smoking and Health.

In response to your Request we carefully reviewed scientific literature on the subject of smokeless tobacco. Because NIA is committed to providing precise and scientifically accurate information we have decided to discard our existing inventory of Smoking: It's Never Too Late to Stop. We will print a new edition that is a more current statement of evidence-based information. The updated language on smokeless tobacco will be immediately reflected on our web version. This new language, in italics below, is fully supported by the scientific evidence.

Cigars, Pipes, Chewing Tobacco, and Snuff Are Not Safe

Some people think smokeless tobacco (chewing tobacco and snuff), pipes, and cigars are safe. They are not. Using smokeless tobacco can cause cancer of the mouth, a pre-cancerous lesion known as oral leukoplakia, nicotine addiction, and possibly cancer of the larynx and esophagus, as well as gum problems. Pipe and cigar smokers may develop cancer of the mouth, lip, larynx, pharynx, esophagus, and bladder. Those who inhale are also at increased risk of getting lung cancer.

You may appeal the agency's decisions either in writing or electronically within 30 days of receiving this response. Your request should state the reasons for your appeal. It does not need to reference a tracking number. The request may be sent electronically or in hard copy to the Associate Director for Communications, Office of the Director, National Institutes of Health, Building 1, Room 344, 1 Center Drive, Bethesda, Maryland 20892. If the appeal is sent in hard copy, please clearly mark the appeal and outside envelope with the phrase "Information Quality Appeal."

We appreciate your comments and hope the information provided above helps to clarify the state of our work in the area of smoking risks and our efforts to communicate it to the public.


Jane E. Shure 
Director, Office of Communications and Public Liaison 
National Institute on Aging