Spit Tobacco Use Research Articles

Factors Affecting High School Baseball Coaches’ Enforcement of School Tobacco Policy

In spite of policy bans and recommendations against spit tobacco (ST) use, baseball athletes have demonstrated ST prevalence rates ranging from 34% to 50% in high school, 42% in the National Collegiate Athletic Association (NCAA), and 50% in the professional ranks. To evaluate enforcement of ST bans, high school baseball coaches in North Carolina (N = 93) completed a survey about ST attitudes, behaviors, and intentions to use and enforce tobacco use policies. Findings revealed that coaches who were current ST users, considered ST pleasant, did not value health impacts, and stated the baseball environment influenced their ST use were less likely to enforce school ST policy with their players.

Coaches' knowledge and awareness of spit tobacco use among youth athletes: results of a 2009 Ontario survey

Public health professionals have become concerned that spit tobacco (ST) use among athletes is increasing. However, little is known about the issue in Canada, particularly among youth. The Not to Kids Coalition and the Coaches Association of Ontario surveyed coaches regarding ST knowledge and awareness and their perceived roles as coaches in influencing ST use among their athletes. Surveys were distributed electronically to individuals who coached male and female youth aged 9 to 18 years in baseball, basketball, football, soccer, and track and field, in Ontario. Almost all of the surveyed coaches responded correctly to questions about the health effects of ST use, and about 80% of respondents answered correctly to the question about legislation associated with ST and youth. Most coaches are interested in receiving information about ST, particularly the health effects of ST use and how to prevent ST use among athletes. Multiple formats should be used to provide information to coaches, including both electronic and hard copy materials.

PROLIFERATIVE VERRUCOUS LEUKOPLAKIA AND VERRUCOUS CARCINOMA –A DIAGNOSTIC DILEMMA - CASE REPORT

The definition of leukoplakia is unusual in that it makes the diagnosis dependent not so much on definable appearances as on the exclusion of other entities that appear as oral white plaques. Leukoplakia or tobacco pouch keratosis may be seen on adjacent mucosal surfaces, and verrucous carcinoma is a lesion that may develop from the high risk precancer, proliferative verrucous leukoplakia (PVL). Verrucous carcinoma represents 1 % to 10% of all oral squamous cell carcinomas, depending on the local popularity of spit tobacco use. Many verrucous carcinomas arise from the oral mucosa in people who chronically use chewing tobacco or snuff, typically in the area where the tobacco is habitually placed. Both PVL and verrucous carcinoma may have been reported in the past by the name Oral florid papillomatosis.

Prevalence of Spit Tobacco Use and Health Effects Awareness in Baseball Coaches

To assess spit tobacco usage and knowledge of health effects in baseball coaches. Participants (N = 509) were affiliated with the American Baseball Coaches Association and completed a Web-based survey. Data was ascertained in spit tobacco use, health effects, and possible intervention areas. The prevalence of use in respondents was 18.5 percent. The authors feel that the coaching profession is a fertile environment to decrease spit tobacco use in adolescents through positive role modeling and appropriate intervention techniques.

Patterns and correlates of spit tobacco use among high school males in rural California.

To assess patterns and correlates of spit [smokeless tobacco (ST)] use among high school males in rural California. An 18-item, self-administered questionnaire was used to assess ST use among young males in 41 randomly selected high schools in 21 rural counties in California. To ensure confidentiality, students were instructed to seal their completed questionnaire in an attached envelope prior to returning it to the questionnaire administrator. Overall prevalence of ST use was 9.8 percent, significantly increasing with year in school from 5 percent among freshmen to 15 percent among seniors. ST use was highest among rodeo athletes at 42 percent compared with <6 percent among nonathletes; ST use was significantly higher among smokers (32 percent) who were 2.5-30 times more likely to use ST compared with nonsmokers, depending on race/ethnicity as a result of a significant race/ethnicity x smoking interaction of degree/magnitude. In addition, students who believed there was no, or slight risk of, harm from ST use were significantly more likely to use ST than students perceiving moderate or great risk, depending on race/ethnicity (odds ratios 3.6-13). Among all ST users, 40 percent used ST on at least 5 days in the previous week, 80 percent of those reporting a brand used the brand Copenhagen, and 41 percent (189) used ST within 30 minutes of waking. Dental public health practitioners, scholars, and policy-makers need to promote dental health through organized community efforts targeting high school male subgroups in rural areas that are at risk for ST-associated adverse health effects.

Spit Tobacco Use Among College Students—A Changing Scenario in India

ISEE-832 Objective: Teenagers, especially students in this state are increasingly getting addicted to tobacco products, especially spit tobacco. Some take to it despite knowing its harmful effects. The government may not be in a position to take every righteous step for our children. The government should cancel the license of shops that sell tobacco products. The warning “selling tobacco products to those below 18 years is punishable” is displayed at shops. However, these serve as indirect advertisement that tobacco products are available there. No agency is deployed to ensure that tobacco products are not sold to those below 18 years. This study was conducted to determine the tobacco habit among college students. Materials and Methods: A total of 1800 college students participated in the study. Results: About 23% of the students were with the habit of using spit tobacco. Only 12% were with the habit of using both spit tobacco and smoking tobacco. Most of them developed this habit at the age of 14 years itself. This is, to a large extent, because of peer pressure, desire to seem fashionable, and also the influence of their role models. None of their parents or relatives was aware of this habit. Conclusions: The role of teacher and parents in society is very crucial in this regard. They need to inculcate sincerity, morality, and other values in children. Parent-Teachers Association should play a proactive role in combating the menace by warning shopkeepers against selling tobacco products in the school or college premises.

Cotinine as a biomarker of systemic nicotine exposure in spit tobacco users

Unlike cigarette smokers, spit tobacco (ST) users absorb a significant amount of nicotine through the gastrointestinal tract while swallowing tobacco juice. The majority of the absorbed nicotine is rapidly converted to cotinine during first-pass hepatic metabolism. This process potentially compromises the utility of cotinine as a biomarker for systemic nicotine exposure in ST users. To investigate this question, we correlated nicotine and cotinine concentrations with clinical measures of ST use in 68 daily ST users enrolled in a nonnicotine pharmacologic intervention trial. We found that a higher frequency of swallowing tobacco juice ( P=.007) was an independent predictor of higher serum cotinine concentrations. Serum nicotine concentrations, on the other hand, were not correlated with a higher frequency of swallowing. In the absence of a reliable way to measure frequency of swallowing, we conclude that cotinine should not be used for guiding clinical decisions that depend upon a precise quantification of systemic nicotine exposure, such as tailored nicotine replacement therapy.

Bupropion Sustained Release for Treatment of Tobacco Dependence

Bupropion Sustained Release for Treatment of Tobacco Dependence

Treatments for spit tobacco use: a quantitative systematic review.

Spit tobacco use is prevalent in the United States and is associated with adverse health consequences. Health-care providers have neither evidence summaries nor evidence-based guidelines to assist them in treating patients who use spit tobacco. We completed a systematic review of the literature to determine the efficacy and safety of pharmacological and behavioral interventions for the treatment of spit tobacco use. We found six randomized controlled trials testing pharmacological interventions and eight testing behavioral interventions. Using random-effects meta-analyses,bupropion sustained-release (SR) increased point prevalence tobacco abstinence at 12 weeks [odds ratio (OR) 2.1; 95% confidence interval (CI), 1.0-4.2]. Nicotine replacement therapy with patch or gum increased point prevalence tobacco abstinence at 6 months (OR 1.3; 95% CI, 1.0-1.6). Behavioral interventions increased long-term (6 month)point prevalence tobacco abstinence (OR 1.7; 95% CI, 1.1-2.9). Studies including an oral examination followed by feedback to the patient had the highest treatment effect. Behavioral interventions for ST users are effective for increasing ST abstinence rates. Bupropion SR is probably effective and nicotine replacement therapy may be effective. This evidence from randomized controlled trials provides health-care professionals with information necessary to effectively treat spit tobacco use.

Spit (Smokeless) Tobacco Intervention for High School Athletes: Results after 1 year

Objective: To determine the efficacy of a spit tobacco (ST) intervention designed to promote ST cessation and discourage ST initiation among male high school baseball athletes. Methods: This study was a cluster-randomized controlled trial. Forty-four randomly selected high schools in rural California were randomized within strata (prevalence of ST use and number and size of baseball teams) to either the intervention or the control group. Ninety-three percent of eligible baseball athletes participated, yielding 516 subjects in 22 intervention schools and 568 subjects in 22 control schools. Prevalences of sustained ST cessation and ST use initiation over 1 year were assessed by self-report. Multivariate logistic regression models for clustered responses were used to test the null hypotheses of no association between group and the two outcomes, adjusted for the stratified design and baseline imbalances between groups in significant predictors of ST use. Results: Prevalence of cessation was 27% in intervention high schools and 14% in control high schools (odds ratio (OR)=2.29; 95% confidence interval (CI), 1.36–3.87). The intervention was especially effective in promoting cessation among those who, at baseline, lacked confidence that they could quit (OR=6.4; 95% CI, 1.0–4.3), among freshmen (OR=15; 95% CI, 0.9–260), and among nonsmokers (OR=3.2; 95% CI, 0.9–11). There was no significant difference between groups in the prevalence of ST initiation. Conclusions: This intervention was effective in promoting ST cessation, but was ineffective in preventing initiation of ST use by nonusers.

SPIT TOBACCO PREVENTION AND CESSATION COUNSELING: STATEWIDE SURVEY OF HEALTH-CARE PROFESSIONALS AND EDUCATORS

The use of spit tobacco (ST) products is a serious public health problem in the United States. Use of ST is associated with increased risk of oral cancer, gastrointestinal neoplasms, and other deleterious effects. The prevalence of ST use among adolescents is high in many areas, especially in predominantly rural states (e.g., South Dakota, Montana). Community-wide efforts aimed at prevention and cessation of ST use among young people are needed. A total of 4089 clinicians and educators were surveyed in 1998 regarding their personal ST use and several other characteristics associated with ST prevention and cessation counseling. Educators reported significantly higher rates of ST use than did clinicians. The most prevalent barriers to ST counseling among clinicians were perceptions of patient resistance to referral to ST cessation programs and the lack of community services that effectively treat ST use. Lack of training was a major barrier to ST counseling among all educator subgroups. Although knowledge of the health effects of ST was fairly high among all subgroups, more than 10% of dentists and dental hygienists failed to report that ST use causes gum disease. Most clinicians believed that they should demonstrate leadership in efforts aimed at ST control; however, only 64% of dentists believed that repeated counseling attempts were necessary with patients who continued to use ST. Compared with clinicians, educators generally felt less obligated to provide ST counseling. Eighty percent of physicians reported counseling activities, but fewer than half of the dental professionals did. More than 75% of Drug Abuse Resistance Education (DARE) officers reported having delivered ST counseling, whereas only 4% of volunteer leaders did. Fewer than 50% of educators believed that the ST program they taught was effective. Training of various professionals in ST interventions may benefit from emphasizing different issues (reduction of personal ST use, knowledge, commitment, etc.). Our findings have implications for community-based efforts aimed at controlling ST use among young people.

Prevalence of Spit Tobacco Use Across Studies of Professional Baseball Players

A review of published data, together with previously unpublished information, shows that the use of spit tobacco among professional baseball players continues to be alarmingly high. In spite of efforts to make players aware of the harmful effects, approximately 35 percent to 40 percent of professional baseball players still use spit tobacco, and about half of those have associated lesions. However, current efforts of the National Spit Tobacco Education Program, Major League Baseball, the Professional Baseball Athletic Trainers Society and the Major League Baseball Players Association are expected to result in a significant reduction in spit tobacco use in this population in the next decade.

A Dental-Based, Athletic Trainer-Mediated Spit Tobacco Cessation Program for Professional Baseball Players

During 1997 spring training, the National Spit Tobacco Education Program provided a spit (smokeless) tobacco intervention program to 16 professional baseball clubs. The program consisted of an awareness-raising presentation and an opportunity to discuss quitting spit tobacco use with an expert cessation counselor. For two clubs, however, a more extensive intervention was pilot-tested for feasibility and acceptability among their major- and minor-league teams during their regularly scheduled health examinations at the beginning of spring training. The intervention included an oral exam by a dentist who advised spit tobacco users to stop and pointed out any spit tobacco-associated lesions in the player's mouth, brief cessation counseling by a specially trained dental hygienist, and ongoing support and follow-up by the certified athletic trainer to promote cessation. Findings from this pilot study indicate that this intervention, which is dependent upon involvement of dental professionals, was feasible to implement during spring training and appeared to be well-received by the athletes. Dental professionals are in an excellent position to advise and help spit tobacco users to quit and can have an important role in helping youth overcome this rapidly growing addiction.

Planning a spit tobacco cessation intervention: Identification of beliefs associated with addiction

We examine the relationship between beliefs regarding spit tobacco (ST) use and addiction among 473 male college athletes who currently use ST. Beliefs were assessed using methods prescribed by the Theory of Reasoned Action. Independent associations between beliefs and addiction, defined by self-reported amount of ST used per week, were found via multivariate polychotomous regression modeling. We found that with increasing addiction level, athletes were significantly more likely to believe that “ST helps me relax,” “ST keeps me alert,” “ST tastes good,” and “ST is addicting.” All athletes believed that clinicians, parents, and girlfriends do not approve of their ST use, but that male peers, coaches, and professional athletes are fairly indifferent about it. To increase quit rates, highly addicted ST users may require an intensive cessation program including nicotine replacement to overcome symptoms of withdrawal, oral substitutes for the enjoyable taste of ST, and the support of male peers and athletes who influence their social norms.

Prevalence, patterns, and correlates of spit tobacco use in a college athlete population

We surveyed varsity athletes ( N = 1,328) in 16 California colleges about their patterns of spit (smokeless) tobacco (ST) use, related habits, reasons for use, and preferred methods for quitting. Prevalence of use was analyzed by sport and demographic characteristics, and patterns of use in players using snuff exclusively, using chewing tobacco exclusively, and those using both were compared. Odds ratios and 95% confidence intervals were calculated, adjusting for ethnic group. Prevalence was highest in Whites (44%) and Native Americans (48%) and lowest in African Americans (11%), and higher in varsity baseball (52%) than varsity football players (26%), in players attending rural colleges, and among those who ever smoked cigarettes or used alcohol. Forty-one percent of ST users initiated regular use during their high school years. Athletes who used snuff exclusively used it more intensively and for more years than those who used chewing tobacco exclusively. Snuff users indicated a greater perceived need for ST, but also were more ready to quit. These data suggest ST programs with prevention and cessation components are appropriate for high school as well as college athletes. Such interventions should focus on baseball players, distinguish snuff from chewing tobacco users in planning quit strategies, integrate intervention programs for cigarette smoking and alcohol consumption, provide training in refusal skills, and attempt to change social norms in support of ST use by integrating popular peers and significant others (e.g., wives/girlfriends) to endorse nonuse of ST.