Texas Demographics
The Texas State Data Center estimated that the state¹s population in 1995 was nearly 19 million people. By the year 2000, it predicts that Texas' population will have grown to over 20 million people and will be comprised of 58% white, 12% black, and 28% Hispanic individuals.[39]
Despite the fact that females comprised 50% of the Texas population in 1995, males comprise the vast majority of spit tobacco users. Therefore, spit tobacco user data often represents only the male gender. The U.S. Census Bureau estimated that 25% of the male population in 1995 was under the age of 15, the age group most likely to be targeted with spit tobacco prevention programs. Almost one-third of all Texas males were 15-34 years old, the age group reportedly with the highest tobacco use rate. Approximately 35% of the Texas male population was 40 years or older, the age group in which oral cancers are most likely to manifest.[40]
Spit Tobacco Cessation
Few studies have assessed spit tobacco cessation programs.[41] Programs developed to date have been mostly small-scale efforts using support groups, counseling to strengthen coping behavior, buddy systems', and nicotine-replacement therapy. Reported quit rates range from 2.3% to 43%.[42,43]
Barriers to Implementing Spit Tobacco Programs
There are several barriers to implementing programs to reduce spit tobacco use. First, spit tobacco is generally considered by the public as a safe alternative to smoking.[30] Secondly, spit tobacco use is widely accepted as suitable behavior in the eyes of the public, especially when compared to smoking. Unlike smoking which raises concerns over the environmental dangers of second-hand smoke, the spit habit from smokeless tobacco is largely considered only to be unsightly and otherwise not a threat. Thirdly, the use of spit tobacco is gaining popularity, especially among young people. Peer pressure and latent health effects may make programs aimed at spit tobacco prevention and cessation difficult to implement within this age group.
Spit Tobacco Programs in Texas
Although some organizations are making efforts to educate the public on the hazards of spit tobacco, no organized statewide program presently exists.
Baylor College of Dentistry/TAMUS currently administers the National Spit Tobacco Education Program (NSTEP) Initiative for Texas, a collaborative effort of Oral Health America, Major League Baseball, Major League Baseball Players Association, American Baseball Coaches Association, and Little League Baseball. Its goal is to inform the public of the dangers of spit tobacco use. Activities to date have been high profile media events and national public service announcements coordinated with Major League Baseball games. In addition, the Richardson Independent School District in north Texas has trained high school students to educate elementary and middle school students about the dangers of spit tobacco use, using a program developed independently by one of its counselor/health educators and a local dentist.
The Texas Agricultural Extension Service has also made efforts to educate the public on spit tobacco. The Spit Tobacco Peer Education Program was a pilot program in four Texas counties from September 1995 through August 1996. Video skits were developed by youth to teach their peers about spit tobacco use. The pilot projects in Deaf Smith, Fort Bend, Polk, and Tarrant Counties promoted the prevention of spit tobacco use. Spit tobacco exhibits are available in each of the twelve district extension offices for county extension agents in the 254 counties to check out and use in their educational efforts. Both the Dental Oncology Education Program (DOEP) and the Nurse Oncology Education Program (NOEP) have conducted seminars to educate health care providers about spit tobacco use. In 1995 and 1996, the DOEP and NOEP sponsored workshops for dentists, hygienists, and nurses which contained current information on spit tobacco. In addition, the DOEP distributes video tapes for health care professionals which provide education on oral cancer and techniques for complete intraoral and extraoral examinations.
Some information and resources on spit tobacco are available free of charge or at a nominal fee from such organizations as the American Cancer Society, American Lung Association, American Heart Association, the National Cancer Institute, the National Spit Tobacco Education Program, and the Texas Department of Health Office of Tobacco Prevention and Control. Unfortunately, materials on spit tobacco are often outdated or in limited supply.
Significance
There is growing concern among the health care community over the use of spit tobacco by Texas youth. These concerns are justified by the increase in spit tobacco sales since the 1960s and the rates of spit tobacco use by young males. Given these factors, the next two decades have the potential to yield an increase in oral cancers, cancers of the esophagus and upper gastrointestinal tract, and other health conditions related to the use of spit tobacco.
At present, data on spit tobacco use in Texas is insufficient. Most research conducted so far has focused on prevalence, health effects, and addiction. Inconsistencies in the data collection processes make comparisons between data sources unreliable. Few programs aimed at reducing spit tobacco use have been developed. Those that do exist generally focus on prevention and have not been adequately evaluated to determine their effectiveness. No programs have been developed which adequately address the issue of spit tobacco cessation.
A coordinated effort is needed to establish an effective spit tobacco campaign in Texas. Although this effort should focus on the prevention of spit tobacco use among our youth, an aggressive effort should be initiated to help those already addicted to spit tobacco.
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