UCSF Study Finds Teenage Athletes More Likely To Quit Using Spit Tobacco With Intervention

September 01, 1998

High school baseball players are nearly twice as likely to stop using spit tobacco when dentists or dental hygienists, as well as their teammates, actively intervene then when they don't, a new UC San Francisco study found. The study, first reported this summer at the International Association for Dental Research meeting in Nice, France, found that 27 percent of spit tobacco users stopped using the potentially cancer-causing substance for at least one year when dental health professionals, with the help of teammates, intervened. About 14 percent 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. There was no intervention 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 mouth 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.

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, Walsh said, shows 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, Walsh said, because the early onset of the spit tobacco habit among young athletes can lead to a dangerous long-term nicotine addiction. It also increases the potential that the athletes will be exposed to the high concentration of carcinogens in spit tobacco for many years, she said. Most pre-cancerous lesions caused by spit tobacco, called leukoplakia, are usually found on the inside of the cheek or lip tissue and go away without treatment if tobacco use stops, Walsh said. However, about 5 percent to 20 percent of those lesions may become malignant, she said. And by the time that happens, the disease already has become very serious, Walsh said.

"Treatment of oral cancer involves disfiguring surgery, which gives you a 50 percent chance of living five years," Walsh said. "Without surgery, you're dead in one." Dentists and dental hygienists screened athletes at the 22 schools for the pre-cancerous lesions caused by spit tobacco. About 67 percent of the students who participated in those screenings had the lesions, which generally cause a change in the color and texture of cheek tissue, Walsh said.

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. Researchers had recruited those teammates to help after fellow students identified them as being among the peers they most admired. In those sessions, students watched an anti-tobacco video designed for baseball players, saw graphic slides of oral cancer, participated in question and answer sessions and discussed symptoms of nicotine withdrawal, such as irritability and anxiety. No special attention was paid to spit tobacco use at the 22 other schools involved in the study.

The study focused on high school baseball players because of the high prevalence of use of spit tobacco among baseball players, a habit that often starts in high school, Walsh said.

In addition, rural youths are more prone to use spit tobacco than urban youths are, Walsh said. Previous studies have shown that about 46 percent of baseball players in California's rural and urban high schools have used spit tobacco. But comparisons of the two groups show that 57 percent of athletes in rural high schools have used chewing tobacco, versus 38 percent in urban environments, Walsh said.

The study was funded by the Tobacco Surtax Fund of the State of California. Co-researchers included Joan F. Hilton, ScD, MPH, UCSF assistant professor of 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.

University of California - San Francisco

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