Use of smokeless tobacco (ST) is increasing in prevalence among young
American males and is especially prevalent among those residing in rural
areas and those who play baseball. Users typically take up the habit as
adolescents, and long-term use puts them at risk of oral cancer. Those
who give up the ST habit may exchange it for smoking cigarettes, putting
them at risk of lung and other cancers. The goal of the proposed
research is to increase ST cessation and abstention among baseball
athletes attending rural high schools in California. It will implement
and evaluate an innovative team-based intervention that will use dental
health care providers and peer team members in its delivery. The
intervention is based on Cognitive Social Learning Theory and Diffusion
of Innovation Theory and applies a public health perspective by
approaching ST users in their environment and attempting to change social
norms to effect behavioral change. Thirty rural high schools in
California with baseball teams will be randomized to receive the
intervention or serve as controls. Briefly, the intervention will
consist of a 1-hour interactive group session for each team to discuss
harmful effects of ST and face-saving ways to refuse it, a strong peer
opinion leader component to endorse behavioral change and an educational
session for parents and coaches to gain their support. In addition, ST
users will be offered an oral exam and cessation advice from a dentist,
a self-help guide for quitting, behavioral counseling by a dental
hygienist, and booster sessions to prevent relapse or deal with slips.
The specific aims are (1) to tailor ST intervention components to rural
high school baseball athletes by conducting structured interviews and
focus groups among rural athletes and their parents and coaches and by
pilot testing the intervention in a rural high school; (2) to assess the
prevalence, patterns and correlates of ST use among rural high school
baseball athletes via a questionnaire administered to athletes in both
intervention and control schools; (3) to determine the efficacy of the
intervention by comparing quit rates, changes in motivation to quit, and
changes in ST use behavior at the end of the intervention and 1 and 2
years after the intervention, and (4) to identify the characteristics of
rural high school baseball athletes that are associated with quitting use
of ST. We expect that the intervention tested in this study will be
effective in reducing the prevalence of use of ST among high school
athletes and will be applicable to other groups of athletes involved in
team sports at the high school and junior high school levels.
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