Spit Tobacco Intervention for High School Athletes

The Spit Tobacco Intervention for High School Athletes subjects young males who use or are at risk of using spit-tobacco--especially baseball players--to an education program about the dangers of addiction and long-term use. The program aims to prevent or cease their spit-tobacco use.

Grounded in cognitive social learning theory, the intervention consists of two parts: a single-session, peer-led component and a dental component. The first component typically consists of a 50-minute, interactive meeting that includes a video, graphic slides of facial disfigurement associated with oral cancer and its surgical treatment, and a small group discussion of spit-tobacco advertisements aimed at young males. The dental component includes an oral exam from a dentist. In addition, a behavioral counseling session helps participants establish a quit date. The brief counseling also explains nicotine addiction and suggests coping strategies for spit-tobacco cravings either to increase positive feelings or to decrease negative emotions and other withdrawal symptoms. Moreover, counseling points out that spit-tobacco use can be a highly automatic behavior intensely learned and practiced over time, so that the user can find himself using spit-tobacco without deliberate realization or conscious desire. To address this automatic use of spit-tobacco, counselors have athletes recall their spit-tobacco use in a typical day to identify reasons for use and to target dips used automatically for initial elimination in planning a schedule to taper down spit-tobacco use and gradually reduce nicotine exposure. Program participants also receive a follow-up call from a dental hygienist to discuss a quit date.

The goal of this program is to prevent young athletes from using spit tobacco.

The Spit Tobacco Intervention program has been evaluated through five randomized controlled trials. The most recent was a cluster-randomized controlled trial in which 44 randomly selected high schools in rural California were randomized within strata (prevalence of spit-tobacco use and number and size of baseball teams) to either the intervention (n=516) or control group (n=568). The intervention appears to be effective in promoting spit-tobacco cessation but ineffective in preventing the initiation of spit-tobacco use by nonusers. Prevalence of cessation was 27 percent in intervention high schools and 14 percent in control high schools (odds ratio (OR)=2.29; 95% confidence interval (CI), 1.36-3.87). The intervention was most effective in promoting cessation among those who, at baseline, lacked confidence that they could quit, among freshman, and among nonsmokers. There was no significant difference between groups in the prevalence of spit-tobacco initiation. The researchers concluded that the intervention was effective in promoting ST cessation, but was ineffective in preventing initiation of ST use by nonusers.