title: Patterns and correlates of spit tobacco use among high school males in rural California.
abstract: OBJECTIVE
  To assess patterns and correlates of spit [smokeless tobacco (ST)] use among high school males in rural California.
  
  
  METHODS
  An 18-item, self-administered questionnaire was used to assess ST use among young males in 41 randomly selected high schools in 21 rural counties in California. To ensure confidentiality, students were instructed to seal their completed questionnaire in an attached envelope prior to returning it to the questionnaire administrator.
  
  
  RESULTS
  Overall prevalence of ST use was 9.8 percent, significantly increasing with year in school from 5 percent among freshmen to 15 percent among seniors. ST use was highest among rodeo athletes at 42 percent compared with <6 percent among nonathletes; ST use was significantly higher among smokers (32 percent) who were 2.5-30 times more likely to use ST compared with nonsmokers, depending on race/ethnicity as a result of a significant race/ethnicity x smoking interaction of degree/magnitude. In addition, students who believed there was no, or slight risk of, harm from ST use were significantly more likely to use ST than students perceiving moderate or great risk, depending on race/ethnicity (odds ratios 3.6-13). Among all ST users, 40 percent used ST on at least 5 days in the previous week, 80 percent of those reporting a brand used the brand Copenhagen, and 41 percent (189) used ST within 30 minutes of waking.
  
  
  CONCLUSIONS
  Dental public health practitioners, scholars, and policy-makers need to promote dental health through organized community efforts targeting high school male subgroups in rural areas that are at risk for ST-associated adverse health effects.
authors.affiliation: Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California, San Francisco, CA 94143-1361, USA.
authors.forename: Stuart A
authors.initials: SA
authors.lastname: Gansky
authors.forename: James A
authors.initials: JA
authors.lastname: Ellison
authors.forename: Catherine
authors.initials: C
authors.lastname: Kavanagh
authors.forename: Umo
authors.initials: U
authors.lastname: Isong
authors.forename: Margaret M
authors.initials: MM
authors.lastname: Walsh
mesh_terms: D000293:Adolescent; D002140:California; D003430:Cross-Sectional Studies; D006801:Humans; D012424:Rural Population; D011795:Surveys and Questionnaires; D014029:Tobacco Use Disorder / Q000523:psychology*; D014030:Tobacco, Smokeless