title: A 10-yr study of smokeless tobacco use in a professional baseball organization.
abstract: OBJECTIVE
  Professional baseball players frequently use smokeless tobacco and are at risk of oral leukoplakia. There are limited long-term data on current trends in tobacco use and resultant oral health in this high-risk group. The purpose of this study was to monitor the prevalence of smokeless tobacco use in a professional baseball organization over a 10-yr period, looking for changes in the patterns of use and resultant changes in the incidence of oral leukoplakia.
  
  
  METHODS
  During 10 successive spring training camps (1991-2000), players and management personnel were surveyed on their use of smokeless tobacco. A detailed mouth examination of each participant was performed by an examiner blinded to the questionnaire results. The main outcome measures were trends in self-reported tobacco use and the presence of oral leukoplakia on examination.
  
  
  RESULTS
  We performed 2266 mouth examinations on participants with a completed questionnaire, with the yearly sample size ranging from 190 to 259. The prevalence of smokeless tobacco use declined, falling from 41.1% in year 1 to 25.6% in year 10 (P=0.029). Tobacco use was strongly associated with the prevalence of oral leukoplakia. As the overall prevalence of smokeless tobacco use fell, the prevalence of oral leukoplakia in the entire population declined; falling from 22.6% of all participants in year 1 to only 9.4% in year 10 (P<0.001).
  
  
  CONCLUSIONS
  The prevalence of smokeless tobacco use showed a steady decline in this professional baseball organization over the 10 yr of the study, with a concomitant decline in the prevalence of oral leukoplakia in this population. We postulate that changes in league rules regarding tobacco use and regular education and support for tobacco cessation might explain the declining use.
authors.affiliation: Middlesex Hospital Family Medicine Residency Program, Middletown, CT 06457, USA. ksinusas@midhosp.org
authors.forename: Keith
authors.initials: K
authors.lastname: Sinusas
authors.forename: Joseph G
authors.initials: JG
authors.lastname: Coroso
mesh_terms: D001484:Baseball; D005431:Florida; D006801:Humans; D007972:Leukoplakia, Oral / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D011795:Surveys and Questionnaires; D014030:Tobacco, Smokeless / Q000009:adverse effects*; D014481:United States / Q000453:epidemiology