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National Collegiate Athletic Association Conferences Policies on Smokeless Tobacco Gregoz-/ N. Connolly, D.M.D., M.P.H. August 31, 1992 ack round There Snuff is a are two forms of smokeless tobacco, oral snuff f~nely ground tobacco which is held next to and chewing tobacco. the cheek and gum. Chewing tobacco is cut leaf tobacco that is chewed. ! Oral snuff is called "dip" and is sold under the brand names Skoal, Copenhagen and Hawken. Chewing tobacco is called "chew" and common brands include Red Man, and Levi Garrett.2 This report will review the health effects of smokeless tobacco industry marketing strategies to college students, prevalence of use among the National Collegiate Athletic.~ssociation (NCAA) athletes and NCAA 9onference policies restricting use. 1) Hea~th Effects of Oral Tobacco Oral Snuff, the most popular form of smokeless tobacco, causes mouth cancer, gum recession and other oral problems.3 A North Carolina study found that long term users of oral snuff were 50 times more likely to develop mouth cancer than nonusers. Mouth cancer is a devastating disease resulting in the loss of portions of the face and jaw. More than 40% of patients are dead within five years of diagnosis. Each year 30,000 Americans develop m~uth cancer and i0,000 die frum the disease. Cancer causing chemicals contained in oral tobacco include polonium 210 (a radioactive particle), benzopir~ene and nitrosamines. are potent carcinogens and are found at levels 20,000 times greater The later than that allo~ed in food or beverages. Cancers are often p~ b~ oral leukoplakia or

white patches caused by the irritation of the tobacco. Approximately, 3% to 6% of oral lerr]~oplakia exhibit precancerous cell changes.3 A 1988 study of 1,109 major and m~nor league baseball players who trained in Arizona found 40% of users have oral leukoplakia.4 Use of oral snuff also causes breakdown of the gum tissue next to where the tobacco is held a condition called gingival recession. Treatment of this problem can be painful and expensive. Snuff users in the Arizona study were far more likely to have gingiyal recession and loss of gum attachment than non users.4 Smokeless tobacco contains nicotine which is absorbed rapidly across the membranes of the mouth into the bloodstream and then enters the brain. According to the Surgeon General, nicotine is the drug in tobacco that makes it addictive. Use of smokeless tobacco is addictive.I'3 2) Marketin.~ of Smokeless Tobacco to....Colle~e Student,s The sharp increase in smokeless tobacco use among NC~A athletes is not accidental, but a direct result of a well organized tobacco industry marketing campaign that links use with sport and athletic performance. 5,6 During the early 1980s, US Tobacco (UST), representatives on over 200 Many were student athletes. the leading snuff manufacturer, hired student college campuses to encourage nonusers to use SPT. According to US Tobacco's College Marketing Manual, ~any college consumers have never had the opportunity to experience the enjoyment of smokeless tobacco. Success in reaching the college students today w~ll determine the continuing popularity and growth for our product :n our adult segment t~orrow."" Famous athletes including Walt Garrison, Nick Buonoconti, George Brett and Carlton Fisk advertised these products in the early 1980s. 7 Today, athletes like Brett and Fisk condemn use of these products and regret having ever appeared in the a~vertisements-7 According to the UST College Marketing manual the number 5 one responsibility of a student representative is s~pling low nicoti~ brande. 2

The UST college marketing manual instructed students to obtain a sports schedule and campus calendar and free sample low nicotine brands. The UST college student representatives created their own events and free sampled tens of thousands of students each year. Free sampling was the cornerstone of the company marketing program which called for new users to begin with low nicotine brands such as Sknal Bandits and to graduate up to higher nicotine brands overtime (Copenhagen)8 as tolerance to the toxic effects of nicotine deweloped. as Copenhagen have four timesthe nicotine yield as Skoal Bandits. by older athletes influences younger students and adolescents professional Bnd NCAAbaseball on television. Mainline brands such Use of SPT who. watch Sponsorship of sporting events with names such as .Copenhagen and Skoal links SPT use with the thrill and excitement of athlete competition. One study reported 22 minutes of televised use of oral tobacco by major league baseball players during the 5th game of the advertising value to be worth $36 million.9 1986 world series and estimated the 3) Use of 0ral Tobacco by NCAAAthletes The College Marketing Campaign and other industry.promotions have been extremely effective. A 1989 survey done by the Michigan State University found an a]_a~m~ng 40% increase in the use of smokeless/spitting tobacco (SPT) by NCAA athletes frum 1985 to 1989.10 No other social drug showed such an increase. Not surprisingly, highest use rates were among baseball playeEs (57%), yet, 40% of football players reported current use of SLT as well as 24% of male tennis players. Seventy-five Percent of student athletes reported using o~i tobacco before c~ning to college and 15% began during their freshman year. Use of smokeless tobacco varied little b~ NUAA Division hut did var~ b~ NCAA Region with highest rate in the midwest (33%) and lowest in ~e South (23%). Use by black athletes was only 11% and among whites, 31%. Only 1.3% of the athletes reported using oral tobacco to improve performance and 62% reported dipping or chewing for 3

social or recreational reasons. There are anecdotal reports these products to keep weight down and that some football steroids, use oral tobacco to encourage salivation associated with steroid use. 4) NCAA Conferences Policies In March of 1992, NCAA conference c~m~issioners were and programs to curb use of SPT and on attitudes toward policies that would curb use. Conferences whose students were using SPT (w~men's conferences) were dropped from the analysis. that wrestlers use players, who take to cut down bloating surveyed on policies the adoption of new at low risk of As of May 15, 1992, 50 conferences responded to the survey. A follow-up mailing was done and a total of 65 cc~nissioners responded 67% of those 97 NCAA conferences surveyed. Coem~issionars were asked about current Policies that restrict use of smokeless tobacco by student athletes. Twenty-four (34%) reported policies that ban use. Eleven conferences (17%) ban use during games, ten (15%) during both games and practices and three (5%) in all sport related activities. Two co~erences reported a ~ban on free sampling in clubhouses. commented that they followed the NCAA policy of banning use only and six stated that Policies Three commissioners~ in post season play on use were set by member schools. What are Your Current Policies on Smokeless Tobacco Use by Student Athletes? Ba, UseDuzingGames 0nly Ban UseDuri~4Game and Practice Ba, Use in AllSportRelatedA~tivities N ii I0 3 41 65 % (17) (15) (100) 4

Eight~n (28%) conferences reported that they were considering adopting new policies. Of this group twelve were considering a ban during games and practice and five during games only. Sixteen ccumissioners commented that future policies were under discussion and five stated that there had been no discussion to date. Fourty--nine conferences (75%) were amenable to NCAA adopting a policy that Two opposed would ban use during games and practice within the next two years. this idea. Of the 24 with conferences with rules prohibiting use, abided by the rules and only two felt that students sometimes. Six didn ' t respond. Two 16 felt that students adhered to the bans cc~nissioners co~ented that it was up to individual coaches to monitor a~herence to the ban. Of the I0 conferences with policies, eleven reported that coaches enforced them, three that both coaches and a~ninistrators did and two that umpires were responsible for enforcement. Of those 24 with policies, thirteen (54%} reported penalties for violators including warnings or removal from competition. Seven remaining conferences had either nd penalties or were developing penalties and four did not respond. Nine respondents reported no resistance to ~mplementing the policies and twelve reported sume resistance. Six cc~nissioners cc~ented that coaches were reluctant to implement the policy and two stated that all the coaches unanimously voted for the new policy before it was a~opted. 0nly two conferences reported lectures dedicated to the dangers of smokeless tobacco. Twelve had smokeless covered in their drug e~ucation programs, nine distributed posters and other education materials and 19 had no educational activity. Five omm~issioners reported that athletes were screened for SPT oral lesions during routine physical exams, six that they were not and 38 didn't kno~. The team physician was cited most often as the person responsible for the screening. Three om--issioners stated that any ban should include coaches as well as students. One c~m~issioD~r 5

East Region is equal to that in the SoUth Region (25% to 23%). is unprecedented in the history of NCAA and of major concern. stated that NCAA should limit its involvement to education and policies for postseason play. Two felt that additional educational programs were needed. Ninety-one percent wanted a copy of the survey results. Conclusions Tobacco manufacturers targeted college students during the 1980s with a sophisticated college marketing campaign employing student representatives on over 200 college campuses. In direct response to this campaign use of SPT has risen sharply among college students in particular those involved with sports. From 1986 to 1989, use among NCAA athletes rose at an alarming 40% rate. Among baseball players use is 57%. The problem is not limited to baseball or certain conferences where use has been popular for years. Among male college athletes 4% of football, 20% of track and 29% of tennis players use SPT. Use in the NCAA This level of use Smokeless tobacco use causes mouth cancer, nicotine addiction and other oral health problems. -" Many conferences are addressing .this problem. The I~ League and the South Eastern Conference (SEC)Ii ban SPT and the Big South and Patriot League will do so next year.12"13 Thirty-seven percent of conferences already prohibit use of SPT during games. Of all conferences seventy-five percent are amenable to a NC~A ban on use during games and .practices. NC~A already bans use in post season 14 play. Policies establish a positive environment that makes no tobacco use the norm and complement other policies on abuse of alcohol and illicit drugs. Policies also reinforce cessation and prevention programs that are being conducted. Other sport associations have adopted policies restricting SPT use including Major League Baseball which prohibits use by three fourths of minor league players15 and National Junior College Athletic Association which prohibits use by students, coaches and officials ~uring games.16 United States Oly~pic baseball also 6

prohibits tobacco chewing and dipping. 15 These have been adopted with minimal resistance and have resulted in some players quitting and more importantly manM not starting- If the health of student athletes is to be protected policies are needed throughout NCAA prohibiting use by students, coaches, umpires and others involved with sport. These policies must be part of a larger program that educates students about the dangers and helps users quit. S~ecial Thanks: Richard Armacher, Ellen Hanley, Sherry Mills, M.D. and Craig Stotts for their assistance in carrying out this study. This study was ~supported through Contract No.I-CN-05275 from the National Cancer Institute.

1) Connolly et al. 1986; 3 14:1020-7. The Reemergence of Smokeless Tobacco. N. Engl J Med. 2) Maxwell JC. The Maxwell Consumer Report, the Smokeless Tobacco Industry in 1991- Whest First Securities, Richmond, VA. Pub. No. WFB5-6529. April 1992. 3) H.S. Department of Health and Human Services. The Health Effects of Smokeless Tobacco, A Report of the Advisory Committee to the Surgeon General. U.S. Department of Health and Human Services. Public Health Service. NIH Pub. No. 86-2874. April 1986. 4) Ernster V., et, al. Smokeless tobacco use and health effects among baseball players. JAMA. 1990; 264: 218-224. 5) 6) 7) 8) 9) 10) 11) 12) 13) 14) 15) 16) US Tobacco C~mpany. Greenwich, CT. July 1, 1985. College Representative Manual. US Tobacco Company. Ernster .V. Advertising and promotions of smokeless tobacco products. Monographs. 1989; 8: 87-94. Snuffing Tobacco Out of Sport. NCI" Connolly GN, Orleans T, Blum A. Pub. Hlth. 1992;82:351-354. Feigelson J. Skoal Bandits blitz kicks off N.Y. entrM. August 8, 1983. Jones RB. Use of Smokeless 1987; 316: 952. (Letters). Advertising Age, Tobacco in the 1986 World Series. College of. Human Medicine Michigan State University,~ National Study of the Substance Use and Abuse Habits Athletes. College of Human Medicine Michigan State Lansing. October 1989. Walker C. SEC bans use of tobacco in league baseball Advertiser. January 27, 1992. 5B. Anonymous Minutes of the Council of Athletic Directors. Conference News. June 1992. P. ii. Replication of the of College Student University. East games. Montgomery UllrichCF. Executive Director, PatriotLeague to Chapman C. ECAC (letter) May 18, 1992. Anonymous. Executive c~mnittee approves offs- NCAANews. 1990;27. The Big South Commmission ban on tobacco products at play Baseball and Smokeless Tobacco. USA Today. June ii, 1992. Baseball American College Notebook. September i, 1990. 8