Since athletes in the United States are at high risk for using spit (smokeless) tobacco (ST) and incurring its associated adverse health effects, the current study examined whether an athletic trainer-directed ST intervention could decrease initiation and promote cessation of ST use among male collegiate baseball athletes.
The study used a stratified, cluster-randomized controlled trial that involved 52 California colleges, patients or other participant(s). There were 883 subjects in 27 intervention colleges and 702 subjects in 25 control colleges, along with 48 certified athletic trainers. For college athletic trainers and associated dental professionals, a 3-hour video conference was conducted; and for collegiate athletes, an oral cancer screening with feedback and brief counseling during the preseason health screenings, athletic trainer support for cessation, and a peer-led educational baseball team meeting were conducted. The subjects' ST use over 1 year was assessed by self-report. At the end of the study, the certified athletic trainers were mailed a survey to assess their tobacco use and perceptions and behavior related to tobacco control in the athletic environment. Multivariable logistic regression models for clustered responses (generalized estimating equations) were used to test the difference between groups in ST-use initiation and cessation and to identify significant overall predictors of non-initiation and cessation of ST use. The study found that of the 1,585 athletes recruited, 1,248 (78.7 percent) were followed up at 12 months. In addition, 48 of the 52 athletic trainers (92 percent) responded to the 1-year follow-up survey. The ST-use initiation (incidence) was 5.1 percent in intervention colleges and 8.4 percent in control colleges (generalized estimating equation odds ratio = 0.58, 95 percent confidence interval = 0.35-0.99). Predictors of ST non-initiation were low lifetime tobacco and monthly alcohol use (odds ratio = 1.98, 95 percent confidence interval = 1.40- 2.82) and athletic trainers' report that the baseball coach supported ST-use prevention activities (odds ratio = 1.43, 95 percent confidence interval = 1.11-1.83). Although at 1 year, cessation of ST use was relatively high in both groups (36 percent), there was no significant difference between the groups (odd ratio = 0.94, 95 percent confidence interval = 0.70-1.27). The study concluded that the intervention was significantly effective in preventing incident ST use, but did not significantly increase cessation beyond that observed in the control group. The latter finding is inconsistent with previous studies and may be explained by spillover of the intervention to control colleges, other anti-tobacco activity in control colleges, and/or the small sample of dependent ST users enrolled in the study. (publisher abstract modified)