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Virginia L. Ernster, PhD; Deborah G. Grady, MD, MPH; John C. Greene, DMD, MPH; Margaret Walsh, EdD; Paul Robertson, DDS; Troy E. Daniels, DDS; Neal Benowitz, MD; David Siegel, MD; Barbara Gerbert, PhD; Walter W. Hauck, PhD

JAMA. 1990;264(2):218-224.

Abstract
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.

(JAMA. 1990;264:218-224)

Author Affiliations
From the Departments of Epidemiology and Biostatistics (Drs Ernster, Grady, Siegel, and Hauck) and Medicine (Drs Grady, Benowitz, and Siegel), School of Medicine, and Departments of Dental Public Health and Hygiene (Drs Ernster, Grady, Greene, Walsh, and Gerbert) and Stomatology (Dr Daniels), School of Dentistry, University of California, San Francisco; and Department of Clinical Dental Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, Canada (Dr Robertson).

Footnotes
Reprint requests to Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, CA 94143-0560 (Dr Ernster, c/o Editor).

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