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Program Profile: Spit Tobacco Intervention for Athletes

Evidence Rating: Promising - More than one study Promising - More than one study

Date: This profile was posted on December 27, 2012

Program Summary

An education program about the dangers of addiction and long-term use of using spit (smokeless) tobacco. It is targeted at young male athletes—especially baseball players—who use or are at risk of using spit tobacco. The program is rated Promising. There were mixed results on the intervention preventing the initiation and cessation of spit tobacco use.

This program’s rating is based on evidence that includes at least one high-quality randomized controlled trial.

Program Description

Program Goals/Target Population
The Spit Tobacco Intervention for Athletes is an education program about the dangers of addiction and long-term use of using spit tobacco. It is targeted at young male athletes—especially those who play baseball—who use or are at risk of using spit tobacco.

Program Components
The intervention consists of two parts: a) a single-session, peer-led component and b) a dental component. The first component typically consists of a 50-minute, interactive meeting that includes a video tailored to baseball athletes, 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 use of spit tobacco 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.

Program Theory
The intervention is grounded in cognitive social learning theory, which speaks to the importance of motivation to behavioral change. Behavioral change depends on an interest in making a change, having the skills to replace old behaviors with new ones, and a belief in one’s ability to perform the change.

Evaluation Outcomes

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Study 1
Spit Tobacco Initiation

Walsh and colleagues (2003) found that the intervention appears to be ineffective in preventing the initiation of spit-tobacco use by nonusers. There was no significant difference between groups in the prevalence of spit-tobacco initiation.

Spit Tobacco Cessation
The intervention appeared to be effective in promoting spit-tobacco cessation. Prevalence of cessation was 27 percent in intervention high schools and 14 percent in control high schools. The intervention was most effective in promoting cessation among those who, at baseline, lacked confidence that they could quit, among freshman, and among nonsmokers.

Study 2
Spit Tobacco Initiation

Gansky and colleagues (2005) found that the intervention appeared to be more effective at preventing initiation than in promoting cessation. Intervention school athletes were less likely to initiate (5 percent) than control school athletes (8.4 percent).

Spit Tobacco Cessation
The intervention appeared to be ineffective in promoting spit-tobacco cessation. There was no significant difference in cessation rates between the two groups.
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Evaluation Methodology

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Study 1
Walsh and colleagues (2003) used a cluster-randomized controlled trial to assess the impact of the intervention on spit-tobacco use cessation rates and on initiation rates. The study was conducted in rural areas of California and recruited 516 participants in 22 intervention schools and 568 participants in 22 control schools. Schools were stratified by baseline number and size of the baseball teams, as well as by baseline prevalence of spit-tobacco use. An eligible high school was required to have a baseball team with at least a 20 percent estimated baseline spit-tobacco use prevalence, according to the coach, and at least a 10 percent actual baseline prevalence, as determined by responses to questionnaires administered to team members before randomization.

The control sample was made up of 27.7 percent seniors, 34.3 percent juniors, 28.9 percent sophomores, and 9.0 percent freshman. The intervention sample consisted of 29.1 percent seniors, 40.4 percent juniors, 17.0 percent sophomores, and 13.5 percent freshman. Parental consent was obtained for students to participate in the study.

Self-report was used to measure prevalence of cessation and initiation at baseline and over 1 year. Saliva samples were collected at baseline and 1-year postintervention, and assays were performed on a random subsample of 8 percent of the spit-tobacco nonusers. Analyses used multivariate logistic regression models for clustered responses.

Study 2
Gansky and colleagues (2005) used a cluster-randomized controlled trial to assess the impact of the spit (smokeless) tobacco intervention on collegiate baseball athletes. Eighty-seven colleges were contacted to participate in the study; 59 agreed to participate, but 7 were dropped from the study. Fifty-two California colleges participated in the study, for a total of 883 participants in 27 intervention colleges and 702 participants in 25 control colleges. Schools were stratified on the basis of spit-tobacco use prevalence.

The sample was 70 percent white, 17 percent Latino, 4 percent Asian American, 3 percent African American, and 2 percent each for multiethnic Native American and for “other.” Most athletes were between the ages of 17 and 20.

Spit-tobacco use was assessed over the course of 1 year through self-report. Data was collected on demographic factors, alcohol and lifetime tobacco use, current spit-tobacco use, and type and brand of spit tobacco used. On the follow-up survey, data was collected on tobacco cessation methods tried in the previous year. Analyses to assess group differences were conducted using multivariable logistic regression models for clustered responses. Eighty-one percent of eligible athletes participated in the baseline survey. Seventy-nine percent (1,248 participants) of the original 1,585 athletes recruited completed the 12-month survey. Ninety-two percent (48 of the 52) of the athletic trainers responded to the 1-year follow-up survey.
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Cost

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There is no cost information available for this program.
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Evidence-Base (Studies Reviewed)

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These sources were used in the development of the program profile:

Study 1
Walsh, Margaret M., Joan F. Hilton, James A. Ellison, Lauren Gee, Margaret A. Chesney, Scott L. Tomar, and Virginia L. Ernster. 2003. “Spit (Smokeless) Tobacco Intervention for High School Athletes: Results After 1 Year.” Addictive Behaviors 28:1095–1113.

Study 2
Gansky, Stuart A., James A. Ellison, Diane Rudy, Ned Bergert, Mark A. Letendre, Lisa Nelson, Catherine Kavanagh, and Margaret M. Walsh. 2005. “Cluster-Randomized Controlled Trial of an Athletic Trainer–Directed Spit (Smokeless) Tobacco Intervention for Collegiate Baseball Athletes: Results After 1 Year.” Journal of Athletic Training 40(2):76–87.
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Additional References

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These sources were used in the development of the program profile:

Gansky, Stuart A., James A. Ellison, Catherine Kavanagh, Joan F. Hilton, and Margaret M. Walsh. 2002. “Oral Screening and Brief Spit-Tobacco Cessation Counseling: A Review and Findings.” Journal of Dental Education 66(9):1088–98.
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Program Snapshot

Age: 13 - 20

Gender: Male

Race/Ethnicity: Black, American Indians/Alaska Native, Asian/Pacific Islander, Hispanic, White, Other

Geography: Rural

Setting (Delivery): School, Campus

Program Type: Alcohol and Drug Therapy/Treatment, Gender-Specific Programming, Alcohol and Drug Prevention

Current Program Status: Active

Listed by Other Directories: Model Programs Guide, National Registry of Evidence-based Programs and Practices