Public health authorities, including the Surgeon General and the National Cancer Institute, have found that smokeless tobacco use is hazardous to health and can easily lead to nicotine addiction. The National Cancer Institute states that chewing tobacco and snuff contain 28 cancer-causing agents and the U.S. National Toxicology Program has established smokeless tobacco as a "known human carcinogen."
The National Cancer Institute and the International Agency for Research on Cancer report that use of smokeless tobacco causes oral, pancreatic, and esophageal cancer; and may also cause heart disease, gum disease, and oral lesions other than cancer, such as leukoplakia (precancerous white patches in the mouth).
Youth participation in sports has many health benefits including the development of positive fitness habits, reducing obesity, and combating the epidemic of early onset diabetes. 45 percent of all American youth play in an agency-sponsored sports league such as Little League baseball or Pop Warner football – that figure represents 22 million children each year who are influenced by actively participating in organized sporting events.
But youth players and spectators are also vulnerable to developing a potentially deadly habit, the use of smokeless tobacco. Smokeless tobacco is strongly associated with playing sports particularly with a legacy of decades of association with baseball through marketing tie-ins and regular use of the product by players. In a 2012 report, the Centers for Disease Control and Prevention (CDC) concluded that "Athletes serve as role models for youth, and smokeless tobacco manufacturers have used advertising, images, and testimonials featuring athletes and sports to make smokeless tobacco products appear attractive to youth. Children and teens closely observe athletes' actions, including their use of tobacco products, and are influenced by what they see. Adolescents tend to mimic the behaviors of those they look up to and identify with, including baseball players and other athletes."
In a letter to former Major League Baseball Commissioner Bud Selig following the 2014 death of baseball icon Tony Gwynn due to salivary gland cancer, nine leading health care organizations, including the American Medical Association, American Cancer Society, American Lung Association, American Heart Association, Campaign for Tobacco-Free Kids, and American Dental Association, stated that, "Use of smokeless tobacco endangers the health of major league ballplayers. It also sets a terrible example for the millions of young people who watch baseball at the ballpark or on TV and often see players and managers using tobacco."
Professional and college football players as well as those participating in wrestling, ice hockey, and lacrosse also have been shown to use smokeless tobacco products at high rates.
The CDC Youth Risk Behavioral Surveillance Report found that nationally 14.7% of high-school boys and 8.8 % of all high-school students reported using smokeless products in 2013. In San Francisco, 3.3% of high-school students reported current use of smokeless tobacco in 2013. Each year, about 415,000 kids nationally ages 12-17 use smokeless tobacco for the first time.
Smokeless tobacco products are heavily advertised and promoted, with the top five smokeless tobacco companies in the U.S. more than tripling their total advertising and marketing expenditures from 1998 to 2011. The Federal Trade Commission reports that in 2011, these smokeless tobacco companies spent $451.7 million to advertise and promote their products.
Flavored tobacco products are known to be attractive to youth and flavored smokeless tobacco products have increased in the market 72% between 2005 and 2011, and contributed to 59.4% of total growth of the smokeless tobacco market. Smokeless tobacco products are viewed by young adults positively because they come in flavors and in attractive packaging, and are promoted as recreational, convenient, concealed, modern, and fun.
Tobacco use has been prohibited in minor league baseball games since 1993 and in the National Collegiate Athletic Association since 1994 (which also adopted a zero-tolerance policy in 2002); the Little League World Series is tobacco-free, and the San Francisco Unified School District policies prohibit use of tobacco, including smokeless tobacco, during athletic events by players and coaches since 1996. Nearly 1,000 college campuses nationwide are tobacco-free. Research shows that students, faculty, and staff looking to stop their nicotine habits are more likely to do so in an environment that prohibits all tobacco use.
The entire University of California system (10 campuses) is tobacco-free and smoke-free, including athletic fields and stadiums. Sacramento State University, Santa Clara University, and San Jose State University all have plans in place to become tobacco-free during 2015.
The following Major League Baseball stadiums have instituted various forms of tobacco-free policies: the Milwaukee Brewers at Miller Park, Saint Louis Cardinals at Busch Stadium, the Seattle Mariners at Safeco Field, and the Cleveland Indians at Progressive Field. AT&T Park in San Francisco is a smoke-free facility in accordance with Article 19F of the Health Code, which prohibits smoking anywhere in the ballpark, including vaporized e-cigarette smoking. Major League Baseball publically supports banning the use of smokeless tobacco products as a means of protecting the health of their players and youth.
Use of smokeless tobacco can also interfere with the enjoyment of spectators and others using sports fields. Users of two forms of smokeless tobacco, snuff and chewing tobacco, let the tobacco sit in their mouth while they suck on the tobacco juices, spitting often to get rid of the saliva that builds up, creating unsightly and offensive conditions for others.
Research supports that changing policy, environment, and social norms regarding smokeless tobacco use can positively influence young people and reduce use. Coaches and players at all levels, especially professionals, can become positive role-models to young players by reducing and/or ceasing their use, reinforcing existing smokeless tobacco bans, and participating in educating youth on the health risks of smokeless tobacco.