The National Spit Tobacco Education Program

The 1986 Surgeon General's report on the Health Consequences of Smokeless Tobacco Use focused attention on oral cancer and other diseases caused by "smokeless" or "spit" tobacco. At that time, the smokeless or "chewing" tobacco industry was in the midst of a campaign, begun in the late 1970s, to change attitudes toward its products while ramping up efforts to reach a more youthful audience. The industry, which used celebrity baseball players as models in its advertisements, attempted to convey a message that smokeless was synonymous with harmless.

The marketing strategy was successful. Sales of moist snuff—commonly referred to as "dip—rose by 55 percent between 1978 and 1985. Baseball players, particularly, took to spit tobacco. A 1985 survey of male college baseball players found that 40 percent used spit tobacco regularly. A survey taken two years later revealed that over half of professional baseball players had a history of spit tobacco use and that 34 percent were current users.

Staff members at the Robert Wood Johnson Foundation were involved with early efforts—led mainly by the National Cancer Institute—to reverse the trends and decrease the use of spit tobacco. One strategy was to form partnerships with Major League Baseball to break the link between spit tobacco use and the game of baseball. Star players, league officials, and public health leaders were actively engaged in the program, which also had the support of the Major League Teams Physicians Association and the Professional Baseball Athletic Trainers Society.

In 1990, the NCAA banned the use of tobacco in all tournament play. In 1992, Major League Baseball banned spit tobacco for all minor league players in its Rookie and Class A leagues. The Los Angeles Dodgers and the Oakland A's were among the first teams to address the problem of spit tobacco. Los Angeles banned players from carrying snuff or chewing tobacco while in uniform, and Oakland banned tobacco advertising in its program.

In the fall of 1995, the Robert Wood Johnson Foundation held discussions with Oral Health America to develop a program aimed at increasing the level of engagement by major league players. This new program built on the work of Joe Garagiola—former major leaguer, television broadcaster, and recognized ambassador for baseball. Named the National Spit Tobacco Education Program (NSTEP), the initiative involved all 28 major league teams. The Foundation's initial support of $800,000 included community outreach in six major-league cities to build bridges between the team and the local tobacco control and public health community. In its first year the campaign generated more than $30 million worth of media publicity, including national broadcast and print advertising and in-stadium and player promotions. In 1997, support for NSTEP was renewed for three years at a level of $3.5 million in 1997.

In this chapter, Leonard Koppett, a baseball Hall of Fame sportswriter, chronicles how Joe Garagiola led an effort that changed the way Major League Baseball viewed and responded to the problems of spit tobacco.