Spit tobacco: baseball's hidden health hazard.
Many of us look forward to spring not only because it marks the end of winter but because of the nice things that come with it: sunshine, warmth, longer days, and the baseball season.
Baseball is steeped in tradition, but not all of it is salubrious. Take the habit of "chewing tobacco." It began on the dusty baseball fields of the early 1900's and burgeoned into a pernicious habit.
Whatever the reason - hero worship of major leaguers or a misguided sense of machismo - adolescents are gravitating toward spit tobacco in increasing numbers. Although the habit is usually initiated in adolescence, the U.S. Dept. of Health and Human Service reports that in some parts of the country it is beginning as early as the preschool years.
A check of the student-athletes in your school district will probably reveal that the use of spit tobacco is not confined to baseball players nor boys. In our own community, a high school nurse in an affluent suburb discovered that most of the girls on the school field hockey team were dipping snuff!
One of the more misguided notions among users is that the nicotine buzz produced by spit tobacco is a safe alternative to the smoke inhaled from a cigarette. Nothing could be further from the truth. Nearly everyone now knows that cigarette smoke can cause lung cancer, but only a small percentage of the public is aware that spit tobacco in various forms (snuff, plug, chew, bandits) can lead to fatal mouth cancer. Most adolescents think of themselves as invincible and that if something is going to happen, it will happen to someone else. Take the case of an eighteen year-old high school athlete named Sean Marsee. Sean was in mint physical condition. He didn't smoke or drink, and he won 28 medals running the anchor leg in a 400-meter relay.
At the age of 12, he had begun secretly to use spit tobacco. Despite repeated warnings from his mother, a registered nurse, Sean continued to dip snuff. In his senior year in high school, Sean developed a sore in his mouth that required the removal of a portion of his tongue.
The biopsy revealed a tumor that soon spread, requiring radical neck surgery and radiation therapy. The cancer then metastasized to Sean's brain and nine months after his first surgery, he was dead.
The U.S. Centers of Disease Control estimated that 30,300 individuals in 1992 wound up with carcinoma of the oral cavity and pharynx. Such cancers kill more than 8,000 people a year, a figure that is likely to climb as the use of spit tobacco continues to rise.
The potential harm from spit tobacco increases in proportion to the length of time it is used. In addition to oral cancer, millions of spit tobacco users will experience bad breath, stained teeth, inflamed and receding gums, or periodontal disease with bone loss.
Others will be faced with the frightening discovery of a raised white patch (leukoplakia) in the area between the cheek and gums, where the tobacco is held for extended periods of time. Leukoplakia is a potentially precancerous condition that can often be reversed by discontinuing the habit.
The body can also react in other ways to the concentrated nicotine absorbed through the tissues of the mouth. Spit tobacco increases heart rate and blood pressure, and can increase the risk of coronary artery disease, occlusive vascular disease, cerebrovascular disease, and stroke.
In an effort to counteract the influence of the tobacco advertising blitz, numerous medical and dental organizations such as the American Dental Association, the American Academy of Pediatric Dentistry, and the Academy of Sports Dentistry, have condemned the use of spit tobacco.
For many years, the American Cancer Society has published high-quality brochures, pamphlets, and posters that are readily available for classroom or locker room use. The booklet, Beat The Smokeless Habit: Game Plan For Success, is an outstanding resource that uses the analogy of a nine-inning baseball game to introduce and promote a nine-step program to quit the spit tobacco habit.
In 1991, Baseball Commissioner Fay Vincent banned spit tobacco for all on-field personnel in four minor leagues. In August, 1994 the NCAA implemented a ban on tobacco products during both practice and games. This regulation covers more than 300,000 collegiate athletes, coaches, and game officials.
Athletic directors and coaches at the high school level also have an obligation and a professional responsibility to take action against the escalating spit tobacco epidemic. And, finally, coaches, umpires, and referees have to enforce existing regulations that prohibit the use of all tobacco products on our athletic playing fields.
Athletic directors and coaches, in conjunction with school board officials, superintendents, and principals have to:
1. Be made aware of the split tobacco epidemic, and then follow through with programs that provide information to faculty and students about the serious threat this habit poses to users.
2. Provide information and resources to health teachers, guidance counselors, and school nurses that encourage users to make the decision to quit the spit tobacco habit.
3. Provide referrals to appropriate health-care professionals as needed to assist users in their efforts to quit the spit tobacco habit.
Dennis N. Ranalli, D.D.S., M.D.S. and Daniel Cianflone, D.M.D., Ph.D., School of Dental Medicine, University of Pittsburgh