Teenage Athletes Using Spit Tobacco More Likely to Quit With Intervention

A new University of California San Francisco (UCSF) study found that high school baseball players who use spit tobacco are nearly twice as likely to stop using spit tobacco when dentists or dental hygienists, as well as their teammates, actively intervene than when they receive no intervention.

The study, funded by the Tobacco Surtax Fund of the State of California, was first reported at the 1998 International Association for Dental Research Meeting in Nice, France. Results showed that 27% of athletes using spit tobacco stopped using the potentially cancer-causing substance for at least 1 year when dental health professionals, with the help of teammates, intervened. (About 14% of the athletes who received no intervention quit using spit tobacco, which includes chewing tobacco and snuff.)

The study tracked baseball players at 44 high schools throughout rural California. Dental health professionals intervened at 22 of those schools, and no intervention took place at the other 22.

“High school baseball players who participated in a peer-led team discussion of the negative health effects of spit tobacco use, and who received an oral cancer screening exam by a dentist or dental hygienist who pointed out to players sores in their mouths related to spit use and advised them to stop their tobacco use, were twice as likely to stop using than those players who received nothing,” said Margaret Walsh, EDD, UCSF professor of dental public health and the study’s principal investigator.

Aggressive Involvement by Dental Professionals Important

Because dentists and dental hygienists regularly examine oral tissues, they are the appropriate health professionals to advise youths on the dangers of spit tobacco and the benefits of quitting, Walsh said. The study’s results also showed that oral health experts must become more aggressively involved in teaching youths the risk of using spit tobacco—and hopefully help them quit as a result. That is particularly important, because the early onset of the spit tobacco habit among young athletes can lead to a dangerous long-term nicotine addiction; it increases the potential that the athletes will be exposed to the high concentration of carcinogens in spit tobacco for many years.

Most precancerous lesions caused by spit tobacco, called leukoplakia, are typically found on the inside of the cheek or lip tissue and go away without treatment if tobacco use stops. However, about 5% to 20% of those precancerous lesions may become malignant. By the time that happens, the disease already has become very serious.

“Treatment of oral cancer involves disfiguring surgery, which gives you a 50% chance of living 5 years,” said Walsh. “Without surgery, you’re dead in one.”

Study Targeted High School Baseball Players in Rural Areas

The study focused on high school baseball players because of the high use of spit tobacco among baseball players—a habit that often starts in high school. About 67% of the students who participated in those screenings had the lesions, which generally cause a change in the color and texture of cheek tissue.

At those screenings, the oral health professionals also discussed with students the risks of using tobacco, and offered them help with quitting. Students then participated in informational and discussion groups led by teammates who had been recruited by researchers after fellow students identified those teammates as being among the peers they most admired. In those sessions, students watched an antitobacco video designed for baseball players, saw graphic slides of oral cancer, participated in question-and-answer sessions, and discussed symp-toms of nicotine withdrawal, such as irritability and anxiety.

Walsh noted that rural youths are more prone to use spit tobacco than are urban youths. Previous studies have shown that about 46% of baseball players in California’s rural and urban high schools have used spit tobacco. Comparisons of the two groups show that 57% of athletes in rural high schools have used chewing tobacco vs 38% in urban environments.

Co-researchers included Joan F. Hilton, SCD, MPH, UCSF assistant professor or epidemiology; James Ellison, DDS, UCSF assistant clinical professor of dentistry; Lauren Gee, MPH, UCSF senior statistician, department of biostatistics; Margaret A. Chesney,PhD, UCSF adjunct professor of medicine; Curtis Henke, PhD, UCSF assistant adjunct professor of medicine; and Virginia Ernster, PhD, UCSF professor and vice-chair of epidemiology and biostatistics.