This study determined the effectiveness of a spit tobacco (ST) intervention intended to promote ST cessation and discourage ST initiation among male high school baseball athletes.
Using a cluster-randomized controlled trial, 44 randomly selected high schools in rural California were randomized within strata (prevalence of ST use and number and size of baseball teams) to either the intervention or the control group. Ninety-three percent of eligible baseball athletes participated, yielding 516 subjects in 22 intervention schools and 568 subjects in 22 control schools. The prevalence of sustained ST cessation and ST use initiation for 1 year were assessed by self-report. Multivariate logistic regression models for clustered responses were used to test the null hypotheses of no association between group and the two outcomes, adjusted for the stratified design and baseline imbalances between groups in significant predictors of ST use. The prevalence of cessation was 27 percent in intervention high schools and 14 percent in control high schools (odds ratio (OR)=2.29; 95 percent confidence interval (CI), 1.36–3.87). The intervention was especially effective in promoting cessation among those who, at baseline, lacked confidence that they could quit (OR=6.4; 95 percent CI, 1.0–4.3), among freshmen (OR=15; 95 percent CI, 0.9–260), and among nonsmokers (OR=3.2; 95 percent CI, 0.9–11). There was no significant difference between groups in the prevalence of ST initiation. The study concluded that this intervention was effective in promoting ST cessation, but was ineffective in preventing initiation of ST use by nonusers. (publisher abstract modified)