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The authors examined the effect of smokeless tobacco use on the athletic performance of major league baseball players during the 1988 season. They evaluated performance records of 158 players on seven major league teams who played or pitched at least 10 games or innings during the 1988 season. ST use, they concluded, is not related to player performance in major league baseball but does place players at significantly increased risk for mucosal lesions and other oral pathology.
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... Although Job (1988) cited the need for more studies on alternatives to fear appeals in health promotion campaigns, there has been scant research on tactics for making anti-spit tobacco media campaigns more effective . However, several studies have explored the incidence of and attitudes toward ST use among high school and college baseball players and the effectiveness of certain clinical interventions in cessation of ST use (e.g., Connolly et al. 1988; Cummings et al. 1989; Ernster et al. 1990; Wisniewski et al. 1990; Gingiss and Gottlieb 1991; Sinusas et al. 1992; Robertson et al. 1995). Those studies have shown that chewing and dipping have long been popular, not just with baseball players but also with the general population. ...
... Those studies have shown that chewing and dipping have long been popular, not just with baseball players but also with the general population. Snuff use increased in the United States during the 1980s and 1990s (Robertson et al. 1995), and the overall number of smokeless tobacco users rose from almost 7 million in 1995 (Centers for Disease Control 1995) to 9.6 million in 1998 (Mathias 2001). The incidence of use has climbed dramatically among baseball players, especially those in the college and professional ranks. ...
Anti-spit tobacco information is replete with fear appeals, including firsthand accounts of death and debilitation, to make users aware of the health risks and dangers. Those dangers, however, are well known by baseball players whose association with spit tobacco is historic. A survey of 217 Iowa and Nebraska college players showed that despite their awareness of spit tobacco's dangers, the players use spit tobacco to relax and focus on the field. This study supports other research showing that fear appeals may not be the most appropriate approach for anti-tobacco advertising campaigns. The study suggests that campaigns should promote relaxation and stress reduction techniques as alternatives to spit tobacco.
... The scoring performances of baseball players were similar for users and nonusers . SLT use induced a decrease in the muscular strength of athletes . ...
... mokeless tobacco use than for cigarette smoking, due to the likely nicotine depot effect in the lining of the mouth as can occur with administration of transdermal patch medications whereby nicotine is absorbed by tissues surrounding its physical placement; these tissues can then release their nicotine for many minutes after the product is removed. Robertson et al. (1995) have reported that baseball players show no difference in their performance as a function of whether they are snuff dippers or had successfully quit smokeless tobacco for a year. However, if a baseball player quit on the day of a baseball game, it is plausible that his performance would be adversely affected during that game and on game ...
In 1986, the Surgeon General concluded that smokeless tobacco is an addictive drug sharing many qualities with other drugs of abuse such as morphine and cocaine. Smokeless tobacco can be used to deliver psycho-active and dependence-producing levels of nicotine. Tolerance develops with repeated use, causing the user to increase nicotine dosing through increased use and/or switching to products with higher nicotine yields. Clinical signs of nicotine withdrawal develop upon cessation of use. Recent data show that smokeless tobacco products vary widely in their nicotine dosing capabilities. Low-dose products tend to be those commonly marketed toward, and used by, young people without previous smokeless tobacco experience. Many of these people develop dependence and switch to high-dose products. The present article discusses each of these qualities of smokeless tobacco in greater detail. The article also discusses qualities of smokeless tobacco that make it an effective nicotine delivery device that leads to addiction.
... Recently, we examined our data to determine whether there was an effect of ST use on the athletic performance of major league baseball players during the 1988 season (Robertson et al., 1995). About 42% of these major league players were non-users, 44% were current users, and 14% were former users of ST. ...
This is a review of studies conducted from 1988-90 on the oral consequences of snuff and chewing tobacco use among professional baseball players. About half of the players studied were smokeless tobacco (ST) users, the majority of whom used snuff. Compared with non-users, players who used ST showed a significantly higher prevalence of leukoplakia, which was related to placement of the ST quid, and the frequency, amount, duration, and type of ST used. Sites adjacent to these mucosal lesions showed an increased prevalence of gingival recession with associated attachment loss, cervical abrasion, and root caries than did comparable sites in non-users. Extrinsic stain and occlusal attrition were also more frequent in ST users than in non-users. While ST use placed players at significantly increased risk for mucosal lesions and other oral problems, no differences were found between ST non-users and users in measurements of batting, fielding, and pitching performance during the baseball season.
... Although there has been a modest decline in smoking prwilence, an estimated 46 million Americans continue to sniol\c and about 5.3 million adults use smokeless tobacco p r d u c t s (Rodu 1994; US. Department of Health and Hun i m Service, 1994; Robertson ef uf. 1995). Tobacco use is coiisidered the chief preventable cause of premature disease and death in the United States (Marcus et al. 1993; U.S. ...
This study assessed the effects of two months nicotine treatment on bone formation and resorption end-points in adult, female rats. In addition, the concentrations of calciotropic hormones which included parathyroid hormone, calcitonin, 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D in rats (7 months old) were determined. All animals received either saline (n = 7/group), nicotine (3.0 mg/kg/day) (n = 7/group) or nicotine (4.5 mg/kg/day) (n = 7/group) via subcutaneous implantation of osmotic minipumps containing either saline or nicotine for a period of two months. Serum, right tibia, left femur and lumbar vertebra (3-5) were collected for determination of hormonal concentrations as well as various parameters, including histomorphometry, bone mineral density, bone mineral content and vertebral strength. Although nicotine-treated rats showed a lower level of 25-hydroxyvitamin D [54.4 +/- 3.1 ng/ml for the 3.0 mg/kg/day and 55.8 +/- 2.8 for the 4.5 mg/kg/day group] (mean +/- S.E.M.) as compared to controls (74.8 +/- 2.8 ng/ml) (P < 0.01, Newman-Keuls test), no significant difference could be detected for the levels of the remaining hormones. Similarly, no statistical differences were detected on histomorphometric end-points, bone mineral density, bone mineral content and vertebral strength of rats. We conclude that, in spite of lowering serum 25-hydroxyvitamin D by about 30%, nicotine administration of two months duration does not alter bone mass, strength or formation and resorption end-points.
Oral habits can, and all too frequently do, cause esthetic and/or functional problems in the mouth. For this reason, destructive habits need to be diagnosed and corrected as early as possible. Most patients are unaware that their oral habits are causing permanent damage to their teeth, such as bruxism, holding their eyeglasses between their teeth, or chewing on ice. Management of the habit should involve enlisting the parent and child in a cooperative effort to stop the digit sucking. Dental procedures and corrective behavioral techniques may be helpful in breaking such oral habits. However, unless these habits are totally discontinued, treatment will inevitably serve as only a temporary measure. Oral habits should be foremost in the examination and diagnosis of pediatric patients. There are many more examples of damaging oral habits, but the principles of diagnosis and treatment are similar for all of them.
Throughout the years, the dental profession has held a variety of theories about the causes of tooth wear, including chemical wasting of the teeth, the effects of tooth brushing, and lateral forces. Tooth wear may present as abfraction, abrasion, attrition, and erosion. It is well established that the most common cause of attrition is bruxism. According to only a few clinical studies, cervical wear was related to erosion and abrasion rather than abfraction or occlusal loading. When treating a patient with worn dentition, it is essential to first diagnose the cause and the type of wear, and whether restorative space is available. As a profession, it is important that dentists recognize that anthropologic evidence related to tooth wear and the consequences of basic stomatognathic function on the longevity of teeth and restorations.
The first record of the use of unburned tobacco (i.e. smokeless tobacco) placed in the mouth dates from Columbus's second voyage to the New World in 1494. At the present time, tobacco is only used in this way to a significant extent in the USA, Sweden, the Indian subcontinent and in limited regions of Central and South East Asia and the Middle East. In the US, 16% of young males use smokeless tobacco; in Sweden, 18% of all men use it. The form of smokeless tobacco used in different regions varies greatly, from dry powder to moistened cut leaf, but it is frequently treated with an alkali to facilitate absorption of nicotine across the lining of the oral mucosa. Nicotine causes elevated heart rate and systolic blood pressure, which might be expected to increase the risk of hypertension and cardiovascular disease among smokeless tobacco users but there is no unequivocal evidence for such an effect. Use of smokeless tobacco is associated with local oral changes, including gingival recession, mucosal lesions and oral cancer. A white thickened mucosal lesion at the site of tobacco placement is one of the most common oral changes seen in smokeless tobacco users; this is regarded as a premalignant oral lesion. There is an increased risk of oral cancer as a result of smokeless tobacco use (US studies have suggested relative risks of 2.3-11.2) and this increases greatly with duration of exposure to tobacco.
Although research reveals that the prevalence of smoking has in general stabilized or is even decreasing among military personnel, this trend does not ultimately apply. Being young, being deployed, or being a member of Army personnel, for instance, is proven to increase the risk of being or beginning to be a tobacco user. Usually there are no immediate links emphasised between tobacco habits and their serious health-related consequences during the service period because of the long time lag between tobacco use and its consequences. With some exceptions, the impact of smoking on military performance is defined indirectly rather than directly. However, findings in the Estonian military sample (n=135) indicate that an increase in smoking behaviour while on deployment not only corresponds with poorer psychological wellbeing and general health, but also with absence from duty because of physical aches. These results can be taken as indicators that smo-king behaviour decreases fitness for military operations and should be targeted by performance enhancement activities. The role of the military culture of smoking behaviour and the arguments for an effective strategy for tobacco use cessation among military personnel are discussed.
Unlike various research studies conducted to address dependence among smokers, only a few studies have examined smokeless tobacco (ST) dependence. The Fagerström Tolerance Questionnaire (FTQ) and Fagerström Test for Nicotine Dependence (FTND) based scales are the most widely used measures of nicotine dependence for both ST users and smokers. These scales were initially developed to measure physical dependence and tolerance and not to assess other salient dimensions of dependence such as craving, compulsion, or withdrawal, as defined by DSM-IV and ICD-10. The aim of this study is to develop and validate a multidimensional scale that has better content coverage, factor structure, and psychometric properties to measure dependence among ST users.
100 adult male smokeless tobacco users were recruited through email distribution lists and community referral. Participants completed three different nicotine dependence questionnaires and provided information related to their tobacco use and demographic characteristics. They also provided a saliva sample for cotinine measurement. In order to develop the new ST scale, subscales and items were selected based on correlation and factor analysis of the modified WISDM-68. Reliability and validity of the new scale, Oklahoma Scale for Smokeless Tobacco Dependence (OSSTD) were also assessed.
The new ST scale identified seven latent constructs including 23 items to measure ST dependence. Internal consistency as measured by Cronbach's coefficient (α=0.925) indicated better reliability of OSSTD than FTND-ST. Concurrent validity of OSSTD as evaluated by comparing it with dependence diagnosis and FTND-ST was affirmative. There was a significant correlation between the OSSTD total score and the cotinine levels and tobacco use characteristics among study participants.
OSSTD possesses better psychometric properties and provides an effective and efficient tool to measure ST dependence as a multidimensional construct.
The purpose of this study was to determine the prevalence of smokeless tobacco use and clinical leukoplakia in a specific military population. Two hundred fourteen soldiers participated in this study. Each participant completed a questionnaire-type survey regarding tobacco use and received an annual-type dental examination that included extra-oral and intra-oral examination of hard and soft tissues and counseling regarding the risks associated with the use of tobacco. More than 50% of the participants were between the ages of 18 and 24. Survey response indicated that 7.0% used smokeless tobacco, 29.0% smoked cigarettes, and 7.9% used both cigarettes and smokeless tobacco. Leukoplakia was seen in 4 of the current smokeless tobacco users. Difficulty in cessation was experienced by 10 of 32 smokeless tobacco users; 5 continue to use smokeless tobacco. Due to the concentration of users in the 18 to 24 age group, efforts toward detection and reduction of smokeless tobacco use should be focused on junior ranks and younger age groups.
Tobacco use continues to occur in epidemic proportions and with it, significant morbidity and mortality. One third of smokers will die prematurely of a smoking-related disease. In fact, of the five major causes of death in the United States, tobacco use is implicated in four: MI, lung cancer, strokes, and chronic obstructive lung disease. Tobacco use also contributes to many other disorders including other cancers (e.g., oral, esophageal, and cervical), other respiratory conditions such as asthma and infections, and perinatal morbidity and mortality. Environmental tobacco smoke contributes to illness and even death (e.g., SIDS). The costs of these ailments, in both economic and human terms, is staggering. This article has reviewed the adverse health effects of tobacco use, therefore, clinicians should be aware of the benefits patients will reap when they stop using this lethal substance. In many cases, the risk of tobacco-related morbidity and mortality is reduced after cessation to levels approaching those of never- users of tobacco (Fig. 1).
To describe the prevalence, patterns, and correlates of spit (smokeless) tobacco (ST) use in a sample of high school baseball athletes in California.
This cross sectional study was a survey of 1226 baseball athletes attending 39 California high schools that were randomly selected from a list of all publicly supported high schools with baseball teams. At a baseball team meeting, athletes who agreed to participate and had parental consent completed the study questionnaire. To enhance the accuracy of self reported ST use status, a saliva sample was collected from each subject. The questionnaires and saliva samples were coded and salivary cotinine assay was performed on a random subsample of 5% of non-users who also were non-smokers. Biochemical assay indicated that 2% tested positive for cotinine inconsistent with self reported ST non-use.
Overall, 46% had ever used ST and 15% were current users. Odds ratios and 95% confidence intervals (CI) suggested that, among high school baseball athletes, age, living in a rural area, being white, smoking cigarettes, drinking alcohol, not knowing about the adverse effects of ST, perceiving little personal risk associated with ST use, and believing that friends, role models, teammates, and same age baseball athletes in general used ST, increased the likelihood of being an ST user.
The findings indicate that considerable experimentation with ST products occurs among high school baseball athletes in California, and many are current users. ST interventions targeting this population are needed to stop the transition from experimental ST use to tobacco dependence. Correlates of ST use for consideration in future intervention studies are identified.
OBJECTIVE: To describe the prevalence and characteristics of spit (smokeless)-tobacco (ST) use in rookie baseball players as they enter the professional ranks and to identify factors associated with use before entering professional baseball. DESIGN AND SETTING: This cross-sectional study was an anonymous questionnaire survey administered during the 1999 baseball season by professional baseball athletic trainers at 30 professional baseball clubs. SUBJECTS: The target group was all rookie professional baseball players entering professional baseball. Of 862 eligible players in the summer of 1999, 616 participated in the survey. MEASUREMENTS: The questionnaire assessed tobacco use, demographic variables relevant to rookie professional baseball players, and factors hypothesized to be associated with current ST use (ie, other forms of tobacco use, social norms, environmental cues, and risky behavior intentions). Univariate associations with ST use were described by relative risks with 95% confidence intervals. For continuous variables, mean values of ST users and nonusers were compared. RESULTS: Overall, 67% of the players had tried ST and 31% were current users. Significant risk factors for ST use were being a current cigarette or cigar smoker, having a family member who used ST, and perceiving ST use by peers and role models. CONCLUSIONS: Almost one third of rookie baseball players in the 1999 season were regular ST users on entering professional baseball. Interventions for prevention and cessation of the use of ST targeting young baseball players are needed.
Data from a sample of 338 male university varsity and intramural football and baseball players were used to specify a model
of smokeless tobacco (SLT) use based on the Theory of Reasoned Action. Differences between athletes who did and did not intend
to use SLT within the next 2 weeks were found for nine of 12 outcome beliefs, nine of 12 outcome evaluations, seven of seven
normative beliefs and four of seven items measuring motivation to comply. Principal components analysis of the attitude items
resulted in four components: health, immediate effects, health effects relative to smoking and addiction. Likewise, three
components were found for subjective norms: family, peers and advertising figures. Stepwise hierarchical multiple regression
indicated that immediate effects were most strongly related to intention, followed by siblings' and teams' use of SLT and
advantage of use relative to smoking. Implications for prevention and cessation programming from the findings are discussed.
Surveillance of and knowledge about cancer associated with smokeless tobacco use Smokeless tobacco or health. An international perspective
Winn DM. Surveillance of and knowledge about cancer associated with smokeless tobacco use. In: Shopland DR, Stotts RC, Schroeder KL, Burns DM, eds. Smokeless tobacco or health. An international perspective. Bethesda, Md.: National Institutes of Health; 1992; NIH publication no. 92-3461;11-18.
Oral mucosal lesions: clinical findings in relation to smokeless tobacco use among U.S. baseball players Smokeless tobacco or health. an international perspective. Bethes-da
Greene JC, Ernster VL, Grady DG, Robertson PB, Walsh MM, Stillman LA. Oral mucosal lesions: clinical findings in relation to smokeless tobacco use among U.S. baseball players. In: Shopland DR, Stotts RC, Schroeder KL, Burns DM, eds. Smokeless tobacco or health. an international perspective. Bethes-da, Md.: National Institutes of Health; 1992; NIH publication no. 92-3461:41-50.
Periodontal ef-fects associated with the use of smokeless to-bacco: Results after one year Smokeless tobacco or health: an international perspective
Robertson PB, Ernster V, Greene J, Walsh M, Grady D, Hauck W. Periodontal ef-fects associated with the use of smokeless to-bacco: Results after one year. In: Shopland DR, Stotts RC, Schroeder KL, Burns DM, eds. Smokeless tobacco or health: an international perspective. Bethesda, Md.: National Institutes of Health; 1992; NIH publication no. 92-1120 JADA, Vol. 126, August 1995 on July 15, 2011 jada.ada.org Downloaded from COVER STORY-3461;78-86.
Periodontal effects associated with the use of smokeless tobacco: Results after one year Smokeless tobacco or health: an international perspective Prevalence, patterns , and correlates of spit tobacco use in a college athlete population
J Periodontol 1990;61(7):438-43.
14. Robertson PB, Ernster V, Greene J,
Walsh M, Grady D, Hauck W. Periodontal effects associated with the use of smokeless tobacco: Results after one year. In: Shopland
DR, Stotts RC, Schroeder KL, Burns DM, eds.
Smokeless tobacco or health: an international
perspective. Bethesda, Md.: National Institutes of Health; 1992; NIH publication no. 92-
15. Walsh MM, Hilton JF, Ernster VL, Masouredis CM, Grady DG. Prevalence, patterns, and correlates of spit tobacco use in a
college athlete population. Addict Behav
Surveillance of and knowledge about cancer associated with smokeless tobacco use Smokeless tobacco or health. An international perspective Smokeless tobacco addiction: a threat to the oral and systemic health of the child and adolescent
Winn DM. Surveillance of and knowledge
about cancer associated with smokeless tobacco use. In: Shopland DR, Stotts RC, Schroeder
KL, Burns DM, eds. Smokeless tobacco or
health. An international perspective. Bethesda, Md.: National Institutes of Health; 1992;
NIH publication no. 92-3461;11-18.
3. Christen AG, McDonald JL, Olson BL,
Christen JA. Smokeless tobacco addiction: a
threat to the oral and systemic health of the
child and adolescent. Pediatrician 1989;16(3-
The smokeless tobacco problem: risk groups in North America
Glover ED, Glover PN. The smokeless tobacco problem: risk groups in North America.
Smokeless tobacco or health. an international perspective NIH publication no. 92-3461:3-10. 9 Use of smokeless tobacco among adults-United States Smokeless tobacco use and health effects among baseball players
In: Shopland DR, Stotts RC, Schroeder KL,
Burns DM, eds. Smokeless tobacco or health.
an international perspective. Bethesda, Md.:
National Institutes of Health; 1992; NIH publication no. 92-3461:3-10.
9. Centers for Disease Control and Prevention. Use of smokeless tobacco among
adults-United States, 1991. MMWR
10. Ernster VL, Grady D, Greene JC, et al.
Smokeless tobacco use and health effects
among baseball players. JAMA
11. Grady D, Greene J, Ernster VL, et al.
Attitudes, subjective norms and models of use for smokeless tobacco among college athletes: implications for prevention and cessation programming The measurement of interexaminer agreement on periodontal disease The baseball encyclopedia: the complete and official record of major league baseball
Gottlieb NH, Levinson Gingiss P, Weinstein RP. Attitudes, subjective norms and
models of use for smokeless tobacco among
college athletes: implications for prevention
and cessation programming. Health Educ Res
17. Fleiss JL, Chilton NW. The measurement of interexaminer agreement on periodontal disease. J Periodontal Res 1983;
18. The baseball encyclopedia: the complete
and official record of major league baseball.
8th ed. New York: Macmillan; 1990.
Effects of varying doses of smokeless tobacco at rest and during brief high-intensity exercise Van Duser BL, Raven PB. The effects of oral smokeless tobacco on the cardiorespiratory response to exercise Smokeless tobacco abstinence effects and nicotine gum dose
Anton D Keenan
Baldini PD, Skinner JS, Landers DM,
O'Connor JS. Effects of varying doses of smokeless tobacco at rest and during brief high-intensity exercise. Mil Med 1992;157:51-5.
25. Van Duser BL, Raven PB. The effects of
oral smokeless tobacco on the cardiorespiratory response to exercise. Med Sci inSports Exercise 1992;24:389-95.
26. Hatsukami D, Anton D, Keenan R, Callies A. Smokeless tobacco abstinence effects
and nicotine gum dose. Psychopharmacology
Periodontal disease in pregnancy. I. Prevalence and severity Biostatistics: a methodology for the health sciences The statistical analysis of multiple binary measurements The effects of smokeless tobacco on performance and psychophysiological response
G Van Belle
Loe H, Silness J. Periodontal disease in
pregnancy. I. Prevalence and severity. Acta
Odontol Scand 1963;21:533-51.
20. Fisher LD, van Belle G. Biostatistics: a
methodology for the health sciences. New
York: Wiley; 1993:540-9.
21. Donner A, Donald A. The statistical
analysis of multiple binary measurements. J
Clin Epidemiol 1988;41(9):899-905.
22. Landers DM, Crews DJ, Boutcher
SH, Skinner JS, Gustafsen S. The effects
of smokeless tobacco on performance and
psychophysiological response. Med Sci Sports
23. Edwards SW, Glover ED, Schroeder KL.
In brief: To determine the acute effects of smokeless tobacco on heart rate and neuromuscular performance, heart rate was monitored in college men as they performed perceptual-motor tasks. Two studies were conducted using 25 subjects (both athletes and nonathletes) who were either regular smokeless tobacco users or nonusers. Significant differences in favor of athletes over nonathletes were noted for reaction time. Tobacco-using subjects (but not the nonuser controls) showed significant increases in heart rate. The results indicate that smokeless tobacco use can increase heart rate but does not affect reaction time, movement time, or total response time among athletes or nonathletes.
The statistic kappa is presented as a more appropriate measure of interexaminer agreement than simple percentage agreement scores, because it incorporates an adjustment for the degree of agreement to be expected purely on the basis of chance. When applied to data from an interexaminer reliability study of six variables measuring periodontal pathology, the kappa statistic confirmed and strengthened many of the conclusions drawn in the original paper. In addition, thanks to the use of kappa in the study of other variables, comparisons were possible with the degree of interexaminer agreement attained in clinical medicine and in dental caries.
Consumption of moist snuff and other smokeless tobacco products in the United States almost tripled from 1972 through 1991 (1). Long-term use of smokeless tobacco is associated with nicotine addiction and increased risk of oral cancer (2)--the incidence of which could increase if young persons who currently use smokeless tobacco continue to use these products frequently (1). To monitor trends in the prevalence of use of smokeless tobacco products, CDC's 1991 National Health Interview Survey-Health Promotion and Disease Prevention supplement (NHIS-HPDP) collected information on snuff and chewing tobacco use and smoking from a representative sample of the U.S. civilian, noninstitutionalized population aged > or = 18 years. This report summarizes findings from this survey.
A study of 25 male college students (both athletes and nonathletes) who where either regular smokeless tobacco users or nonusers as they performed perceptual-motor tasks revealed significant differences in favor of athletes over nonathletes in terms of reaction time. Tobacco-using subjects showed significant increases in heart rate. (Author/CB)
The effects of smokeless tobacco (ST) on psychophysiological response and performance were examined in two studies. Study 1 compared heavy and moderate ST users on psychomotor tasks (simple reaction time/anticipation time and choice reaction time/movement time) in ST (2 g amount) and no smokeless tobacco (NST) conditions. Moderate users performed significantly better than heavy users; there were no significant psychomotor performance differences comparing ST/NST conditions. Heart rate and blood pressure were elevated equally for both groups with the use of ST. Heavy users reported significantly less state anxiety in both ST and NST conditions than moderate users. Study 2 replicated the psychomotor performance results of study 1 when comparing nonusers and ST users who were given four dose amounts of ST (NST, 1/3 mean dose, mean dose, and 5/3 mean) over 4 d. For the math and Stroop tasks, ST use resulted in 12.1% and 10.4% better performance than the NST condition. Physiological measures showed significant elevations during the ST conditions. No differences between dose amounts of ST were apparent for any of the measures. These studies demonstrate that ST users perform better than nonusers when having to react to cognitively challenging task situations.
(C)1992The American College of Sports Medicine
The smokeless tobacco problem: risk groups in North America Smokeless tobacco or health. an international perspective
Glover ED, Glover PN. The smokeless tobacco problem: risk groups in North America. In: Shopland DR, Stotts RC, Schroeder KL, Burns DM, eds. Smokeless tobacco or health. an international perspective. Bethesda, Md.: National Institutes of Health; 1992; NIH publication no. 92-3461:3-10.
Use of oral snuff has risen sharply among baseball players following a tobacco industry marketing campaign that linked smokeless tobacco with athletic performance and virility. Millions of adolescents have copied these professional role models and, today, are at risk of developing oral cancer and other mouth disorders. New policies and programs are needed to break the powerful grip that the tobacco industry has on professional sport. Health agencies, including the National Cancer Institute and the National Institute for Dental Research, have teamed up with major league baseball to help players quit and reduce public use of oral tobacco. If these efforts are successful, our national pastime will once again become America's classroom for teaching health and fitness, not nicotine addiction.
The purpose of this investigation was to determine the effects of oral smokeless tobacco (OST) usage on oxygen uptake (VO2), cardiac output (Qc), stroke volume (SV), heart rate (HR), and plasma lactate concentration (Lc) during rest and exercise. Fifteen asymptomatic subjects were recruited from 18 to 33-yr-old male users of OST. Comparisons of the responses of VO2, Qc, SV, HR, and Lc were made between 2.5-g OST and placebo experimental conditions during rest and at 60% and 85% maximal VO2 treadmill exercise. Plasma nicotine concentrations (Nc) were determined by radioimmunoassay. There were significant increases in HR and Lc and a decrease in SV during rest and at 60% and 85% maximal exercise (P less than 0.05). Furthermore, there were no significant differences in maximal HR, Lc, and VO2 (P greater than 0.05). In conclusion, these data indicate that the increased Nc incurred by OST usage increases anaerobic energy production and produces an increased tachycardiac response to a given relative submaximal workload.
To determine the influence of varying doses of smokeless tobacco (moist snuff) on resting heart rate and blood pressure and the performance of brief, high-intensity exercise, 12 snuff users were examined at rest and while performing Wingate Anaerobic Tests after taking six different doses of snuff. Snuff caused an increase in heart rate; the larger the dose, the larger the response. Increases in systolic and diastolic blood pressure also occurred but were similar at all doses. Performance of brief, high-intensity exercise was unaffected, so that there was no benefit for such activities (e.g., sprinting bases in base ball).
There were two experiments on abstinence from smokeless tobacco. The purpose of the first experiment was to determine abstinence effects from smokeless tobacco. The purpose of the second experiment was to examine the effects of different doses of nicotine gum on smokeless tobacco abstinence effects. The subjects were male Copenhagen smokeless tobacco users who underwent 3 days of baseline measurement while continuing to use smokeless tobacco ad libitum, and 5 days of the experimental condition. In the first experiment, the subjects were assigned randomly to one of two groups and compared: continuous smokeless tobacco users (n = 10), and deprivation plus no nicotine gum (n = 10). In the second experiment, subjects were assigned randomly and in a double-blind fashion to one of three groups and compared: (1) deprivation plus 0 mg nicotine gum (n = 20); (2) deprivation plus 2 mg nicotine gum (n = 20); and (3) deprivation plus 4 mg nicotine gum (n = 20). The first experiment showed significant increases upon abstinence for the following variables: (1) craving; (2) difficulty concentrating; (3) restlessness; (4) excessive hunger; (5) eating; (6) reaction time; (7) variability of reaction time and (8) total withdrawal scores for both the self-rated and the observer-rated forms. The second experiment showed that nicotine gum failed to significantly reduce smokeless tobacco abstinence effects, although those with high cotinine levels may receive some benefit from nicotine gum.
The effects of smokeless tobacco (ST) use were studied in 1109 members of major and minor league professional baseball teams during spring training in 1988. The prevalence of current ST use was 39%. The median age at initiation among users was 18 years, and the median duration of use was 5 years. Among users, 75% cited a snuff brand as their usual ST product. Oral leukoplakia was present in 46% (196/423) of current-week ST users and 1.4% (7/493) of nonusers (odds ratio, 60; 95% confidence interval, 28 to 130). Prevalence of oral leukoplakia among ST users increased with hours used per day and decreased with time lapsed since last use, and was higher in snuff users than in chewing tobacco users. Of the subjects with oral leukoplakia who underwent punch biopsy, 91 had benign hyperkeratosis and one had mild dysplasia. Overall prevalence of dental caries, gingivitis, and plaque did not differ between ST users and nonusers. In analyses confined to facial surfaces of mandibular incisor teeth, where ST is most commonly used, there were significant increases among users in both gingival recession and attachment loss. Users of ST did not differ from nonusers in blood pressure, pulse, total or high-density lipoprotein cholesterol level, or white blood cell count, but among users high-density lipoprotein cholesterol levels were inversely associated with serum cotinine levels. The major health effects of ST use among professional baseball players are oral leukoplakia and localized periodontal disease. The study population was young, physically fit, and characterized by relatively moderate short-term ST use.
The risk for oral mucosal lesions associated with use of smokeless tobacco among 1,109 professional baseball players during spring training in 1988 was investigated. Leukoplakia was very strongly associated with use of smokeless tobacco in this population of healthy young men. Of the 423 current smokeless tobacco users, 196 had leukoplakia compared to seven of the 493 nonusers (OR = 60.0, 95% CI = 40.5-88.8). The amount of smokeless tobacco used (in hours per day that smokeless tobacco was held in the mouth), recency of smokeless tobacco use (hours since last use), type (snuff versus chewing tobacco), and brand of snuff used were significantly associated with risk for leukoplakic lesions among smokeless tobacco users. Ninety-eight leukoplakic areas in 92 subjects were biopsied and examined microscopically. All lesions were benign, but one specimen had mild epithelial dysplasia. The long-term significance of leukoplakia in smokeless tobacco users and their relation to oral cancer is not clear.
This report describes periodontal findings from a comprehensive study of smokeless tobacco use in professional baseball players. Subjects consisted of 1,094 players, coaches, and training staff of seven major league and their associated minor league teams. Before being examined, subjects completed questionnaires on patterns of smokeless tobacco use (validated by blood chemistry studies), rinsed their mouths under supervision, and were cautioned not to discuss their use of tobacco with the dental examiners. They then received a complete oral examination that included recording of all mucosal abnormalities, missing teeth, caries, extrinsic stain, attrition, Plaque Index, Gingival Index, pocket depth, attachment loss, and gingival recession. More than 50% of team members reported using smokeless tobacco, and 39% reported use during the current week. Among current week users, 46% had oral mucosal lesions, located primarily in the mandible at sites where the smokeless tobacco quid was placed. The use of smokeless tobacco was not necessarily associated with severe forms of periodontal disease, and the presence of poor oral hygiene and gingivitis in these users was not related to the development of oral lesions. However, sites adjacent to mucosal lesions in smokeless tobacco users showed significantly greater recession and attachment loss than in sites not adjacent to lesions in users or comparable sites in non-users.
The use of smokeless tobacco (ST) within the United States has increased greatly in recent years, especially among adolescent boys and young men. Recent national data completed from several large scale studies indicate that 10-12 million Americans use some form of ST. Representing a significant systemic and oral health risk, ST usage can produce a wide range of negative effects on both soft and hard oral tissues. These oral conditions include bad breath, discolored teeth and restorative materials, excessive tooth surface wear (abrasion), decreased ability to taste and smell, gingival (gum) recession, advanced periodontal soft and hard tissue destruction, tooth loss, soft tissue erythema and leukoplakia. Long-term ST usage is directly correlated to an increased risk of cancer of the mouth, larynx, throat and esophagus. Much of the destruction of oral tissues is related to the localization of the tobacco quid; i.e., it is habitually held in only one spot in the mouth. Nicotine from ST can activate the sympathetic nervous system thereby significantly increasing heart rate, blood pressure, cardiac stroke volume and output and coronary blood flow. A common misconception is that ST is a 'safe' alternative to smoking cigarettes. Several recent Surgeon General's Reports list ST as being addictive. It is highly possible that ST users will 'graduate' to cigarettes if they eventually conclude that these products are socially unacceptable, inconvenient or out of vogue. Health professionals, educators, parents and schoolchildren need to be informed about the significant health risks associated with ST use.
On March 25, 1986, the Surgeon General of the Public Health Service released a report that detailed the results of the first comprehensive, indepth review of the relationship between smokeless tobacco use and health. This review, prepared under the auspices of the Surgeon General's Advisory Committee on the Health Consequences of Using Smokeless Tobacco, is summarized in this article. In the United States, smokeless tobacco is used predominantly in the forms of chewing tobacco and snuff. During the past 20 years, the production and consumption of these products have risen significantly in marked contrast to the decline in smokeless tobacco use during the first half of the century. National estimates indicate that more than 12 million persons age 12 and older in the United States used some form of smokeless tobacco in 1985, and half of these were regular users. The highest rates of smokeless tobacco use occurred among adolescent and young adult males. Examination of the relevant epidemiologic, experimental, and clinical data revealed that oral use of smokeless tobacco is a significant health risk. This behavior can cause cancer in humans, and the evidence is strongest for cancer of the oral cavity, particularly at the site of tobacco placement. Smokeless tobacco use can also lead to the development of noncancerous oral conditions, particularly, oral leukoplakias and gingival recession. Further, the levels of nicotine in the body resulting from smokeless tobacco can lead to nicotine addiction and dependence.
Epidemiologic studies often compare several groups of subjects for the presence or absence of a specified biological trait, where each subject in a group contributes two or more observations to the analysis. Examples occur in ophthalmologic studies, where each subject contributes observations on each of two eyes, and dental studies, where observations on each of several teeth may be contributed. Application of the standard Pearson chi-square test to such data is not valid, since the resulting sample observations are not statistically independent. In this paper we show how simple adjustments can be made to the Pearson chi-square statistic that adjust for the within-subject clustering. Application to other types of investigations involving clustered data is also discussed.
The use of smokeless tobacco appears to be finding its way onto middle school, high school and college campuses as a socially acceptable and popular habit. Numerous reports in the literature have described the oral changes that appear to be associated with the use of smokeless tobacco in adults. Such information is unavailable for the lower age groups. A study was therefore undertaken to determine the prevalence and frequency of oral hard- and soft-tissue alterations associated with the use of smokeless tobacco in a teen-age population. High school students in grades 9 to 12 were evaluated on a random basis. From a total sample of 1,119 students, 117 users of smokeless tobacco were identified. Four distinct lesions associated with smokeless tobacco use were identified clinically: (1) hyperkeratotic or erythroplakic lesions of the oral mucosa, (2) gingival or periodontal inflammation, (3) a combination of oral mucosal lesions and periodontal inflammation, and (4) cervical erosion of the teeth. Among the smokeless tobacco users, 113 were boys and 4 were girls. Fifty-seven (48.7 percent) of the users had soft-tissue lesions and/or periodontal inflammation or erosion of dental hard tissues. Ninety-nine of the 117 users were Caucasian, 6 were Hispanic, 1 was black, 1 was Asian, 1 was an American Indian, and 6 failed to identify an ethnic origin. Use ranged from one to twenty "dips" per day, with an average time per dip of 30 minutes. Most users had been dipping for an average of 2 years, and twelve different tobacco brands were identified.
The use of smokeless tobacco (ST) products is associated with mucosal lesions, gingival recession, and attachment loss at the site of tobacco placement. Monocytes/macrophages are primary producers of PGE2 and IL-1 beta, inflammatory mediators which are thought to play a role in the destruction of the periodontium. The purpose of this study was to determine the effect of ST alone and in combination with a major stimulator of inflammation, bacterial lipopolysaccharide (LPS), on monocyte secretion of these mediators. Peripheral blood monocytes (PBM) were isolated by counterflow centrifugal elutriation from 15 healthy donors who were non-ST users. PBM were incubated for 24 hours in RPMI 1640 containing various concentrations of ST (0%, 0.005%, 0.01%, 1%) with or without 10 micrograms/ml LPS (Porphyromonas gingivalis LPS or Escherichia coli LPS). Of the ST preparations, only 1% ST resulted in PBM mediator secretion (7.7 +/- 2.0 ng/ml for PGE2 and 1.3 +/- 0.2 ng/ml for IL-1 beta) above that of control (unstimulated) cultures. Furthermore, the combination of 1% ST and LPS resulted in a potentiation of PGE2 release (5-fold for E. coli LPS + 1% ST and 10-fold for P. gingivalis LPS + 1% ST; P < 0.0001, one-way ANOVA) relative to the LPS preparations alone. In contrast, PBM IL-1 beta release decreased more than 2-fold upon E. coli LPS and 1% ST exposure, relative to treatment with E. coli LPS alone (P < 0.0001, one-way ANOVA).(ABSTRACT TRUNCATED AT 250 WORDS)
We surveyed varsity athletes (N = 1,328) in 16 California colleges about their patterns of spit (smokeless) tobacco (ST) use, related habits, reasons for use, and preferred methods for quitting. Prevalence of use was analyzed by sport and demographic characteristics, and patterns of use in players using snuff exclusively, using chewing tobacco exclusively, and those using both were compared. Odds ratios and 95% confidence intervals were calculated, adjusting for ethnic group. Prevalence was highest in Whites (44%) and Native Americans (48%) and lowest in African Americans (11%), and higher in varsity baseball (52%) than varsity football players (26%), in players attending rural colleges, and among those who ever smoked cigarettes or used alcohol. Forty-one percent of ST users initiated regular use during their high school years. Athletes who used snuff exclusively used it more intensively and for more years than those who used chewing tobacco exclusively. Snuff users indicated a greater perceived need for ST, but also were more ready to quit. These data suggest ST programs with prevention and cessation components are appropriate for high school as well as college athletes. Such interventions should focus on baseball players, distinguish snuff from chewing tobacco users in planning quit strategies, integrate intervention programs for cigarette smoking and alcohol consumption, provide training in refusal skills, and attempt to change social norms in support of ST use by integrating popular peers and significant others (e.g., wives/girlfriends) to endorse nonuse of ST.
Smokeless tobacco usage, particularly by young men and boys, has increased dramatically in the United States. To assess their possible risk, we reviewed the records of 128 patients with oral carcinoma who had used smokeless tobacco exclusive of other carcinogens. Most were elderly white women (average age, 78 years), 78% of whom had used smokeless tobacco for 40 or more years. The median duration of symptoms before presentation was only 3 months, yet initially 42% of these patients had T3 or T4 lesions and 30% had nodal metastases. Forty-two percent had posttreatment recurrence at the presenting site (average, 8.2 months); 26% had a second oral-cavity tumor at a new site more than 24 months after treatment (average, 49.3 months), indicative of a field cancerization phenomenon. Forty-seven percent were alive after 3 years and 37% after 5 years. These findings emphasize that strong preventive programs are needed if today's young users of smokeless tobacco are not to form future oral cancer patient populations.