NEW YORK (Reuters Health) - Chewing tobacco can cause mouth sores, cancer of the mouth and receding gums. But more than 25% of adolescents who use smokeless tobacco do not know that it is harmful to their health, researchers report.

On the other hand, more than 90% of adolescents and young adults who do not chew tobacco said they knew that it was harmful to health, according to a report in the journal Nicotine and Tobacco Research. ``Children who use smokeless tobacco are either not receiving the message that it is harmful to their health or they are ignoring this information,'' Dr. Lynne J. Goebel, from Marshall University School of Medicine in Huntington, West Virginia and the study's lead author, told Reuters Health. However, the findings may not apply to all adolescents since the study included only those who lived in West Virginia, the state with the highest rate of adult smokeless tobacco use, the authors note. The researchers interviewed 160 males who used smokeless tobacco, also known as snuff or chew, and 648 males who did not use smokeless tobacco. All students were in the fifth, eighth and eleventh grades and attended public school in West Virginia. Seven percent of 5th-grade students, 22% of 8th-grade students and 32% of 11th-grade students reported using smokeless tobacco daily or monthly. The majority of students who used snuff or chew regularly began in the 7th grade. But 10% of kids who had tried smokeless tobacco did so before the 3rd grade. ``Intervention to prevent use should begin in kindergarten,'' Goebel said. The study also found that kids who used snuff or chew were more likely to have a close friend who used it, to play school football, to have tried cigarettes, to have parents who permitted them to use smokeless tobacco at home, and to have a family member who used smokeless tobacco but did not live at home. ``Uncles and cousins living nearby may act as both peers and family members and thus exert a stronger influence than brothers and fathers,'' study authors suggest. According to researchers, every day about 2,200 11- to 19-year-old kids in the US try smokeless tobacco for the first time and many become hooked. But a second study in journal found that a self-help manual supplemented by an instructional video and two counseling sessions conducted over the phone could help people quit within six months. Counselors helped people explain their reasons for quitting and share these reasons with family and friends. Counselors also helped people to set a date to give up tobacco and handle withdrawal symptoms, instructed them to chew gum, and consider relapses to be temporary setbacks rather than failures. Dr. Herbert H. Severson, from the Oregon Research Institute in Eugene, Oregon and the study's lead author, notes that this low-cost approach could target people in rural areas, where chewing tobacco is more popular than in other areas.

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