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Coaches' Attitudes Toward Smokeless Tobacco and Intentions to Intervene with Athletes.

"Sport is the vehicle by which we pass many of our treasured national values on to the nation's young people ... The harmful effects of tobacco are camouflaged against the backdrop and thrill of athletic victory. All of this must end."[1]

The high level of smokeless tobacco use among athletes is alarming. Results from a 1997 NCAA survey of student-athletes indicated that 22.5% of college male and female athletes reported using smokeless tobacco, including both chewing tobacco and snuff.[2] For male athletes only, the survey revealed smokeless tobacco use is much higher among the following groups: 55% of athletes from rifle; more than 40% of athletes from lacrosse, skiing, water polo, wrestling, and baseball; and more than 30% of athletes from golf, ice hockey, soccer, swimming, and football. Only three male sports reported smokeless tobacco use rates below 15%: track and field/cross country (14.4%), gymnastics (11.3%), and fencing (5.7%). Though overall female smokeless tobacco use was approximately 5%, ice hockey, skiing, and lacrosse reported surprisingly high rates of smokeless tobacco use (22.3%, 12.5%, and 12.4%, respectively). More than one-half of both male and female college athletes reported they first used smokeless tobacco in high school or before.

A study of tobacco use among high school male athletes[3] revealed that 21% chewed tobacco and 18% used snuff. African American and White male athletes used smokeless tobacco at a rate 1.5 times greater than that of their male nonathlete counterparts. In general, athletes were more likely to use smokeless tobacco than were nonathletes, even when controlling for race and school performance. Another study[4] of 43 male, college varsity athletes revealed their knowledge about smokeless tobacco was inadequate: 65% did not know that the nicotine in cigarettes and smokeless tobacco were comparable and 51% did not know that smokeless tobacco raised blood pressure.

Prevalence of smokeless tobacco use among young athletes, coupled with a lack of knowledge, suggests the need for interventions directed at athletes. Health educators have implemented education, prevention, and cessation programs at both the college[4-6] and professional[7] sport levels. However, prevalence of smokeless tobacco use among high school athletes suggests that prevention and intervention efforts should be targeted at middle and high school athletes as well.

Average age of initiation for smokeless tobacco use has been found to occur between the ages of 10-16.[8-13] Though health educators are attempting to curb smokeless tobacco use among athletes, a large problem has been the length of time between smokeless tobacco initiation and receipt of medical help or intervention for smokeless tobacco-related problems.[14]

Because coaches have access to athletes at different stages of smokeless tobacco initiation and use (eg, experimentation, regular use, etc.), they may be critical agents in addressing smokeless tobacco intervention. Unfortunately, few smokeless tobacco intervention training programs are designed specifically for coaches,[15] particularly for middle and high school levels. Corcoran and Feltz[15] maintain that "... there is a need for programs that will educate high school coaches regarding critical chemical information and methods for developing intervention skills so that they may adequately, intelligently, and successfully discourage their young athletes from engaging in unhealthy behavior."

Coach-driven interventions may be uncommon for several reasons. For example, athletes often believe their coaches are indifferent about their smokeless use.[14,16] In addition, athletes are sometimes confused and surprised by the mixed messages conveyed by coaches chewing tobacco at sporting events or practice.[17] Though research is needed to discern the veracity of these beliefs, it is essential that coaches develop an awareness of athletes who use smokeless tobacco and those who may be at risk. Coaches also should recognize that their own knowledge, attitudes, or indifferences about smokeless tobacco use might have powerful influences on their athletes.[3]

Populations at highest risk for smokeless tobacco use are White youth/young adults aged 10 to 30. The southern, blue-collar population of the United States is at greatest risk.[18,19] West Virginia, a predominately white, blue-collar, rural, southern state[20] consistently ranks among the highest users of smokeless tobacco in the nation. For example, 7.7% of West Virginia adults (15.6% of men, 0.6% of women) use smokeless tobacco as compared to 3.3% of the US population (6.2% for men, 0.6% for women)[21] More alarming, among West Virginia adolescents in grades 9-12, 15.8% (31% of boys, 1.3% of girls) use smokeless tobacco as compared to 9.3% in the total population.[22]

These facts, taken together, make young, West Virginia athletes highly vulnerable to smokeless tobacco use. Thus, the state is a particularly appropriate site for assessing coaches' attitudes and behaviors regarding smokeless tobacco use and intervention among athletes. This study explored West Virginia middle and high school coaches' 1) attitudes toward smokeless tobacco, 2) actions toward athletes who use smokeless tobacco, and 3) intentions to provide intervention among users. In addition, coaches' personal tobacco use history was examined.

SURVEY PLANNING

Participants

In 1998, a sample of 566 middle and high school coaches employed by the West Virginia public school system provided the mail survey data analyzed for this study. Among the respondents, 404 (71.4%) were male, 120 (21.2%) were female, and 42 (7.4%) did not indicate gender. The sample was predominantly White (93.4%). Coaches ranged in age between 22 and 63, with a mean age of 41.6 years (SD = 7.9). Represented sports included baseball, basketball, cheerleading, cross country, football, golf, soccer, softball, swimming, tennis, track, volleyball, and wrestling. Years of past coaching experience ranged from 0 to 37, with a mean of 15.3 years (SD = 8.7).

Procedure

Trained survey researchers from the Survey Research Center at West Virginia University administered the surveys which were mailed to the school addresses of 1,500 individuals selected at random from the 2,500 West Virginia middle and high school coaches. The sample was drawn from a complete database of coaches compiled by the state's education department. Three weeks after the first mailing, a second identical mailing was sent to all individuals in the sample; 566 surveys were returned, yielding a response rate of 37.7%.

Setting

The population of West Virginia, a rural state, is predominantly White (approximately 95%) and has a low per capita income (approximately $15,598); about 23% of the citizens live below the poverty level.[20] The state's 55 counties are largely comprised of small towns and communities.[20] The sample represented all 55 West Virginia counties. The student population of the represented schools ranged between [is less than] 250 and [is greater than] 1,501. The greatest frequency of responses (34%) occurred from coaches in schools with student populations between 251 and 500, followed by schools with populations between 501 and 750 (22.5%) and 751 and 1,000 (17%). The athletic division of corresponding schools varied as follows: AAA (28.3%), AA (25.8%), A (18.7%), and no rating (27.2%).

Instrument

An extensive literature review revealed limited instrumentation for measuring middle and high school coaches' smokeless tobacco use, attitudes, and intent to intervene with athletes who use smokeless tobacco. As a result, it was necessary to develop an instrument. In collaboration with the Survey Research Center staff, the authors developed the "West Virginia Middle And High School Coaches Smokeless Tobacco Survey" to specifically assess the following factors: coaches' use of smokeless tobacco; knowledge, attitudes, and actions toward smokeless tobacco; and intent to intervene with young athletes who use smokeless tobacco. The survey was comprised of 42 items and five sections: 1) Demographics of School; 2) Attitudes Toward Smokeless Tobacco; 3) Smokeless Tobacco and Your School; 4) Smokeless Tobacco and Intervention; and 5) Personal Profile.

Instrument content validity was assessed by expert review and pilot testing. Experts in tobacco intervention research and health services research reviewed the instrument and determined the questions were relevant to conceptual domains and current literature on smokeless tobacco use. Following the expert review, the Survey Research Center conducted a pilot test with a small sample of adults (N = 6). In this study, internal consistency was determined where appropriate. In Section 2 (a multi-item attitude scale) reliability was confirmed by calculating the coefficient alpha and item-to-total correlation.

Section 1: Demographics of School. Three items assessed schools' basic demographic information. Respondents were queried about their school's county, student population, and athletic division.

Section 2: Attitudes Toward Smokeless Tobacco. This section consisted of a 12-item scale regarding general attitudes toward smokeless tobacco ([Alpha] = .71). Respondents were asked to rate each item on a 5-point Likert-scale, with 1 anchored by "strongly agree" and 5 by "strongly disagree." Questions assessed perceived benefits and health risks of smokeless tobacco, roles of coaches in prevention of smokeless tobacco use, and perceived ability of individuals to stop using smokeless tobacco. To make all items consistent in wording and theme (ie, attitudes about smokeless tobacco), some items were reverse scored and four items were deleted from the original 16 questions due to low item-to-total correlations, using 0.3 as a lower limit.

Section 3: Smokeless Tobacco and Your School Eight items were assessed in this section: 1) school consequences for smokeless tobacco violations (eg, suspension, fines); 2) coaches' responses to athletes' use of smokeless tobacco during school, practice, and games/events; 3) frequency to which coaches provide information about and discuss drugs and health with their athletes; 4) reasons athletes reported for using smokeless tobacco; 5) perceived use of smokeless tobacco by various individuals (eg, students, student-athletes, faculty, staff, coaches) in school; 6) existence of a school tobacco policy; 7) consistency of tobacco enforcement at school; and 8) if smokeless tobacco was included in the school's tobacco regulation policy.

Section 4: Smokeless Tobacco and Intervention. This section consisted of 12 heterogeneous items assessing coaches' attitudes and opinions regarding smokeless tobacco intervention. Items measured the degree to which respondents 1) had tried to help athletes stop using smokeless tobacco in the past, 2) were able to talk to students about their problems and concerns in general, and 3) intended to offer help to their athletes who used smokeless tobacco. In addition, this section assessed coaches' perceptions of the need for smokeless tobacco cessation at their school and their ability to help athletes stop using smokeless tobacco if provided with appropriate intervention training. Coaches also were queried about whether they would attend intervention training, and what conditions or circumstances would encourage their attendance (eg, cash stipend, distance from school, length of training, etc.).

Section 5: Personal Profile. The final section assessed respondents' demographics, such as gender, race, coaching experience, sport coached, and history of cigarette and smokeless tobacco use and number of previous quit attempts.

SURVEY FINDINGS

Attitudes Toward Smokeless Tobacco

Most participants disagreed with the following myths: smokeless tobacco improves attention, M = 4.50 (SD = 0.83); smokeless tobacco improves athletic performance, M = 4.80 (SD = 0.59); smokeless tobacco is acceptable for athletes to use regardless of age, M = 4.81 (SD = 0.58); harmful effects of smokeless tobacco can be offset through physical activity, M = 4.42 (SD = 0.87); and smokeless tobacco poses no health risks for youth, M = 4.82 (SD = 0.70). In addition, most coaches disagreed with statements that "adults should not be discouraged from using smokeless tobacco," M = 4.39 (SD = 1.19); "adolescents should not be discouraged from using smokeless tobacco," M = 4.69 (SD = 0.78); and "teenagers cannot become addicted to smokeless tobacco," M = 4.73 (SD = 0.79). Though means for these items are similar, distribution of Likert responses differed across items (Table 1). Contrary to research indicating that male athletes are more likely to use smokeless tobacco than male nonathletes,[3,23] coaches in this study appeared to be unsure or uninformed about whether "smokeless tobacco use is more common among male nonathletes than male athletes," M = 2.85 (SD = 1.18). However, significant differences existed between the attitudes of coaches who used smokeless tobacco and those who did not. Smokeless tobacco users maintained stronger mythical beliefs about smokeless tobacco and were less optimistic about intervention (Table 2).
Table 1
Coaches' Attitudes about Smokeless Tobacco

                                                   Percentage of
                                                 responses in each
                                                      category

Item                                               1      2      3

 1. ST use increases a person's
    attention span.                               0.9    2.7    8.6
 2. ST improves athletic performance.             1.1    0.4    2.0
 3. It is OK for athletes to use ST
    regardless of age.                            1.3    0.4    0.4
 4. Physical activity offsets the harmful
    effects of tobacco use.                       1.8    3.8    3.8
 5. Smoking is worse for your health than ST.     5.1   23.6   28.0
 6. There are no health risks associated
    with ST among youth.                          2.7    0.4    0.2
 7. Adults should not be discouraged
    frum using ST.                                8.0    2.2    4.2
 8. Adolescents should be discouraged
    frum using ST.                                2.9    0.5    1.1
 9. Teen-agers cannot become addicted to ST.      3.1    0.4    0.7
10. ST use is more common among male
    non-athletes than male athletes.             10.5   34.5   26.5

                                                  Percentage of
                                                responses in each
                                                    category

Item                                                4      5

 1. ST use increases a person's
    attention span.                                21.2   66.6
 2. ST improves athletic performance.              10.6   85.9
 3. It is OK for athletes to use ST
    regardless of age.                             12.3   85.7
 4. Physical activity offsets the harmful
    effects of tobacco use.                        32.1   58.6
 5. Smoking is worse for your health than ST.      24.0   19.3
 6. There are no health risks associated
    with ST among youth.                           5.6    91.2
 7. Adults should not be discouraged
    frum using ST.                                 14.2   71.5
 8. Adolescents should be discouraged
    frum using ST.                                 12.0   83.5
 9. Teen-agers cannot become addicted to ST.       16.4   79.4
10. ST use is more common among male
    non-athletes than male athletes.               16.2   12.3

Item                                            Category Mean

 1. ST use increases a person's
    attention span.                                 4.50
 2. ST improves athletic performance.               4.80
 3. It is OK for athletes to use ST
    regardless of age.                              4.81
 4. Physical activity offsets the harmful
    effects of tobacco use.                         4.42
 5. Smoking is worse for your health than ST.       3.29
 6. There are no health risks associated
    with ST among youth.                            4.82
 7. Adults should not be discouraged
    frum using ST.                                  4.39
 8. Adolescents should be discouraged
    frum using ST.                                  4.69
 9. Teen-agers cannot become addicted to ST.        4.73
10. ST use is more common among male
    non-athletes than male athletes.                2.85


Ratings are as follows: 1 = Strongly agree, 2 = Agree, 3 = Neutral, 4 = Disagree, 5 = Strongly disagree.

Table 2 Coaches' Attitudes about Smokeless Tobacco as a Function of Smokeless Status
Item                                      Users

1. ST use increases a
person's attention span.            4.10 [+ or -] 1.03
2. There are no health risks
associated with ST among
youth.                              4.71 [+ or -] 0.77
3. Adults should be
discouraged from using ST.          2.13 [+ or -] 1.30
4. With intervention,
adolescent ST users could
stop using ST.                      2.10 [+ or -] 1.02
5. ST improves athletic
performance.                        4.44 [+ or -] 0.95
6. Smoking is worse for your
health than ST.                     2.84 [+ or -] 1.23
7. It is OK for athletes to use
ST regardless of age.               4.50 [+ or -] 0.75
8. Teen-agers can become
addicted to ST.                     1.33 [+ or -] 0.65
9. Cigarettes are more
additive than ST.                   3.51 [+ or -] 1.24
10. Adolescents should be
discouraged from using ST.          1.35 [+ or -] 0.63
11. Physical activity offsets the
harmful effects of ST.              4.37 [+ or -] 0.70
12. ST is more common
among male athletes than
male non-athletes.                  3.19 [+ or -] 1.08
13. Coaches play important
roles in preventing ST use
among athletes.                     2.05 [+ or -] 0.91
14. Coaches can be helpful to
athletes who want to stop
using ST.                           1.87 [+ or -] 0.75
15. ST is a problem at
my school.                          2.60 [+ or -] 1.11

Item                                    Non-Users

1. ST use increases a
person's attention span.            4.56 [+ or -] 0.79
2. There are no health risks
associated with ST among
youth.                              4.84 [+ or -] 0.69
3. Adults should be
discouraged from using ST.          1.54 [+ or -] 1.16
4. With intervention,
adolescent ST users could
stop using ST.                      1.92 [+ or -] 1.01
5. ST improves athletic
performance.                        4.85 [+ or -] 0.52
6. Smoking is worse for your
health than ST.                     3.36 [+ or -] 1.15
7. It is OK for athletes to use
ST regardless of age.               4.86 [+ or -] 0.53
8. Teen-agers can become
addicted to ST.                     1.32 [+ or -] 0.83
9. Cigarettes are more
additive than ST.                   3.51 [+ or -] 1.08
10. Adolescents should be
discouraged from using ST.          1.26 [+ or -] 0.79
11. Physical activity offsets the
harmful effects of ST.              4.43 [+ or -] 0.91
12. ST is more common
among male athletes than
male non-athletes.                  3.18 [+ or -] 1.18
13. Coaches play important
roles in preventing ST use
among athletes.                     1.65 [+ or -] 0.87
14. Coaches can be helpful to
athletes who want to stop
using ST.                           1.61 [+ or -] 0.64
15. ST is a problem at
my school.                          2.37 [+ or -] 1.07

Item                                        t

1. ST use increases a
person's attention span.                -3.45(***)
2. There are no health risks
associated with ST among
youth.                                  -1.25
3. Adults should be
discouraged from using ST.               3.69(***)
4. With intervention,
adolescent ST users could
stop using ST.                           1.29
5. ST improves athletic
performance.                            -3.31(***)
6. Smoking is worse for your
health than ST.                         -3.33(***)
7. It is OK for athletes to use
ST regardless of age.                   -3.57(***)
8. Teen-agers can become
addicted to ST.                          0.06
9. Cigarettes are more
additive than ST.                       -0.04
10. Adolescents should be
discouraged from using ST.               0.93
11. Physical activity offsets the
harmful effects of ST.                  -0.54
12. ST is more common
among male athletes than
male non-athletes.                       0.05
13. Coaches play important
roles in preventing ST use
among athletes.                          3.42(***)
14. Coaches can be helpful to
athletes who want to stop
using ST.                                3.03(**)
15. ST is a problem at
my school.                               1.64


Ratings are as follows: 1 = Strongly agree, 2 = Agree, 3 = Neutral, 4 = Disagree, 5 = Strongly disagree.

(**) = p < .01. (***) = p < .001.

Smokeless Tobacco Interventions

Overwhelmingly, coaches reported responding to athletes caught using smokeless tobacco during regular school hours, team practice, or a game/event. Coaches reported the following actions: 1) advising them to quit; 2) informing them about the health hazards; 3) referring them to the principal; 4) forbidding use while in training; and 5) informing parents. Most coaches (62.9%) reported that they inquired about athletes' smokeless tobacco use at least once during the past school year (Table 3). However, 37.1% reported never asking athletes about smokeless tobacco use. Even when coaches did not specifically inquire about individual athletes' smokeless tobacco use, most (89%) reported they told athletes not to use smokeless tobacco at least once during the school year.
Table 3
Coaches' Actions Towards Smokeless Tobacco (ST) Users

                                         Percentage of responses
                                             in the category

Item                                         1      2      3

How often do you do the following?:
Ask athletes if they use ST                  6.7   10.6   22.3
Provide educational materials to
 athletes who use ST                         3.6    6.7   15.5
Tell athletes not to use ST                 15.3   21.9   27.9
Tell athletes not to smoke                  23.2   22.5   29.5
Tell athletes not to use illegal drugs      28.2   23.8   26.9
Talk to athletes about their
 overall health                             35.0   27.4   24.0
How often in the past year have you:
Wanted to help a student stop using
 ST, but did not know what to do             4.5    6.6    9.7
Advised your athlete(s) about the
 harmful effects of ST                       5.4   12.8   15.8
Advised other coaches' athletes
 about harmful effects of ST                 1.9    7.5    8.8

                                         Percentage of responses in
                                                each category

Item                                              4      5

How often do you do the following?:
Ask athletes if they use ST                      23.3   37.1
Provide educational materials to
 athletes who use ST                             24.2   49.9
Tell athletes not to use ST                      23.9   11.0
Tell athletes not to smoke                       21.0    3.9
Tell athletes not to use illegal drugs           18.8    2.4
Talk to athletes about their
 overall health                                  11.2    2.4
How often in the past year have you:
Wanted to help a student stop using
 ST, but did not know what to do                 17.0   62.1
Advised your athlete(s) about the
 harmful effects of ST                           41.1   24.9
Advised other coaches' athletes
 about harmful effects of ST                     28.7   53.1

Item                                     Category Mean

How often do you do the following?:
Ask athletes if they use ST                  3.67
Provide educational materials to
 athletes who use ST                         4.10
Tell athletes not to use ST                  2.92
Tell athletes not to smoke                   2.60
Tell athletes not to use illegal drugs       2.43
Talk to athletes about their
 overall health                              2.19
How often in the past year have you:
Wanted to help a student stop using
 ST, but did not know what to do             4.26
Advised your athlete(s) about the
 harmful effects of ST                       3.67
Advised other coaches' athletes
 about harmful effects of ST                 4.24


Ratings are as follows: 1 = 1 or more times a week, 2 = 1 to 4 times a month, 3 = 2 to 6 times a year, 4 = once a year, 5 = never.

Most coaches reported that intervention efforts were verbal. Only 23.9% provided written educational materials during the past year, and 49.9% never provided educational materials. Coaches (71.1%) believed the best time to talk with their athletes about quitting smokeless tobacco use was before or after practice. The second most desirable setting for these discussions was during a scheduled private meeting (14.1%).

Coaches advised their athletes about the harmful effects of smokeless tobacco slightly less than once per month and rarely thought they did not know what to do (Table 3). In addition, 69.7% of coaches were willing to offer help daily to their athletes who wanted to stop using smokeless tobacco; only 0.6% were unwilling to help at all. Coaches were willing to devote up to 50 minutes or more talking with athletes about smokeless tobacco use in a single interaction. Specifically, coaches indicated they would be willing to provide 10 minutes (33.5%); 11 to 20 minutes (25.6%); 21 to 30 minutes (21.3%); 31 to 40 minutes (4.4%); 41 to 50 minutes (1.8%); and more than 50 minutes (11.9%) of intervention with individual athletes.

Generally, coaches believed a need existed for a program at their school to help youth stop using smokeless tobacco, M = 3.70 (SD = 1.03). Approximately 74% of coaches were willing to attend a program training them to effectively intervene with smokeless tobacco users. Specifically, 59% believed that such a program would be effective in training them to help teen-agers stop using smokeless tobacco; 36.1% were unsure whether such a program could teach them to be more helpful to athletes who wanted to quit.

Most coaches (79%) agreed or strongly agreed that adolescent smokeless tobacco users could stop using smokeless tobacco with appropriate intervention. Further, more than 90% of coaches believed programs to help youth stop using smokeless tobacco should be available as part of schools' antitobacco programs or policies. Overall, coaches acknowledged that smokeless tobacco use is a problem at their schools. Specifically, 64% agreed or strongly agreed, 17% were unsure, and 19% disagreed or strongly disagreed that smokeless tobacco use is problematic. Approximately 80% of the surveyed coaches agreed or strongly agreed that coaches play important roles in preventing smokeless tobacco use among athletes, and 86.3% believed that coaches could help youth stop using smokeless tobacco.

Coaches' Use of Smokeless Tobacco

Sixteen percent (16%) of male coaches (10% of whom were everyday users) and 0% of female coaches reported being current smokeless tobacco users. These figures appear consistent with data for the general West Virginia population (15.6% for men, 0.6% for women).[21] In addition, 11.5% of male coaches used smokeless tobacco in the past but had quit, and 20.3% of men and 8.8% of women reported trying smokeless tobacco once or twice. Among coaches who reported using smokeless tobacco, 35.5% used smokeless tobacco when their athletes were present.

Smokeless tobacco usage by sport is reflected by both current use and previous use. Everyday use was highest among male coaches from wrestling and football. The highest percentage of previous users were from golf, baseball, and football (Table 4).
Table 4
Male Coaches' Smokeless Tobacco Use as a Function of Sport (%)

Sport             _n    Everyday   Occasionally   Quit

Baseball           29      3.4         6.9        17.2
Basketball        112      6.3         6.3        12.5
Cheerleading        2     50.0         0.0         0.0
Cross Country      17      5.9         0.0         0.0
Football          100     17.0         7.0        15.0
Golf               16     12.5         0.0        18.8
Soccer             24      4.2         4.2        12.5
Softball            7      0.0         0.0         0.0
Tennis              7      0.0        14.3         0.0
Track and Field    25     12.0        12.0         4.0
Volleyball          8     12.5         0.0         0.0
Wrestling          19     26.3         0.0        30.5
Other               9      0.0         0.0         0.0
Total             375     10.4         5.6        11.5

Sport             Tried   Never

Baseball          24.1    48.3
Basketball        18.8    56.3
Cheerleading      50.0     0.0
Cross Country     35.3    58.8
Football          22.0    39.0
Golf              25.0    43.8
Soccer            16.7    62.5
Softball          14.3    85.7
Tennis             0.0    85.7
Track and Field    8.0    64.0
Volleyball        25.0    62.5
Wrestling         23.1    42.1
Other             22.2    77.8
Total             20.3    52.3


SURVEY IMPLICATIONS

Overall, coaches reported unfavorable attitudes toward smokeless tobacco. Moreover, they did not support the prevailing sport myths that smokeless tobacco improves athletic performance and that physical activity offsets the harmful effects. Most coaches were aware of factual information about smokeless tobacco. The only two areas where coaches indicated ambivalence related to 1) whether or not smoking is worse for your health than smokeless tobacco, and 2) whether or not smokeless tobacco use is more common among male athletes than nonathletes.

Respondents overwhelmingly acknowledged that smokeless tobacco use is a problem at their schools and among their athletes. Most actions taken by coaches in response to athletes' use were didactic, verbal instruction, or verbal warning. Coaches indicated they consistently asked about athletes' smokeless tobacco use and encouraged athletes not to use smokeless tobacco. However, few coaches did so more than once per week, and more than one-third used smokeless tobacco while their athletes were present. It was not a common weekly or monthly practice for coaches to advise athletes about the harmful effects of smokeless tobacco use. Despite limited frequency, coaches were taking action toward athletes who use smokeless tobacco.

Most coaches surveyed believed interventions should be provided to athletes who use smokeless tobacco, that their school needed programs to help youth quit, and that intervention could make a difference in assisting with the quitting process. Most coaches believed that cessation programs should be a part of school tobacco control policy, a viewpoint consistent with the Centers for Disease Control and Prevention's 1994 Guidelines for School Health Programs to Prevent Tobacco Use and Addiction.[24] Almost two-thirds of coaches reported they were willing to attend a program to teach them how to effectively intervene with smokeless tobacco users. Coaches' commitments to intervene on behalf of young athletes is further illustrated by their willingness to offer their athletes help daily.

The belief that coaches are indifferent about smokeless tobacco use by athletes[14,16] was not supported by the results of this survey. Coaches' responses indicated a belief that smokeless tobacco use is a problem, a belief in the importance of intervention, and a willingness to be trained and to serve as intervention agents. All three factors are necessary to sustain training programs for coaches and to ensure the training results in coaches taking an active role in smokeless tobacco prevention and intervention.

CONCLUSION

Results from this survey provide support for developing training programs for coaches to serve as smokeless tobacco intervention agents. However, training coaches is not enough. Programs need to be developed, implemented, and evaluated. Further, effective programs need to be available and accessible to schools and coaches. State and local departments of education must see a need for such programs and make cessation an important component of their school tobacco control policies.

This effort already has begun in West Virginia. The West Virginia Dept. of Education collaborated with a university-based research team to assess the state's school-based tobacco control policies and programs and to improve practice among all school-based personnel.[25] This effort resulted in a revision of the state's tobacco control policy to be more consistent with the CDC's 1994 Guidelines[24] and increased emphasis on access to tobacco cessation programs.

Strong school tobacco control policies provide the impetus and support for cessation efforts at various levels of education. Reducing access to tobacco, increasing tobacco prices, and conducting media campaigns also are important components of a comprehensive tobacco control strategy. Perhaps as coaches become more integrated into the tobacco control effort at all levels of policy and practice, sport may become a vehicle for passing on the values of tobacco-free health.

References

[1.] Connolly GN, Orleans CT, Blum A. Snuffing tobacco out of sport. Am J Public Health. 1992;82:351-353.

[2.] National Collegiate Athletic Association. NCAA study of substance use and abuse habits of college student-athletes. Report presented to the National Collegiate Athletic Association Committee on Competitive Safeguards and Medical Aspects of Sports; 1997.

[3.] Davis TC, Arnold C, Nandy I, et al. Tobacco use among male high school athletes. J Adolesc Health. 1997;21:97-101.

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Kimberly A. Horn, EdD, Assistant Professor, Dept. of Community Medicine, Office of Drug Abuse Intervention Studies, Prevention Research Center; or <khorn@hsc.wvu.edu>; Sameep D. Maniar, MA, Graduate Research Assistant, Dept. of Counseling, Rehabilitation Counseling, and Counseling Psychology; Geri A. Dino, PhD, Research Assistant Professor, Prevention Research Center, Dept. of Community Medicine; Xin Gao, MS, Graduate Research Assistant, School of Pharmacy; and Richard L. Meckstroth, DDS, Professor, School of Dentistry, West Virginia University, 3820 Health Sciences South, P.O. Box 9190, Morgantown, WV 26506-9190. This article was submitted August 20, 1999, and accepted for publication November 22, 1999.
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Author:Horn, Kimberly A.; Maniar, Sameep D.; Dino, Geri A.; Gao, Xin; Meckstroth, Richard L.
Publication:Journal of School Health
Article Type:Statistical Data Included
Geographic Code:1USA
Date:Mar 1, 2000
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