Summer 2000 Issue
MVP in the fight against oral cancer, John Greene challenges tradition, helping baseball players kick the spit tobacco habit
Shortly after completing his assignment in the Epidemic Intelligence Service (EIS) in 1957, John Greene, spent two months studying periodontal disease in India. He remembers his reaction to the devastating effects of smokeless tobacco use among Indians: “Thank goodness we don’t have this problem in the States.”
Then he wondered: Or do we?
Over time, Greene would come to understand further the hazards of smokeless tobacco, a product that poses a health risk to the 10 to 16 million Americans who use it each year, according to the American Cancer Institute. Smokeless tobacco has been linked to gum recession, periodontal disease and chronic hypertension. Many of those who are addicted to it are men in the prime of their lives and careers – namely, professional baseball players.
In 1986, while heading the University of California School of Dentistry, Greene witnessed two events that prompted him to fight statistics. “The Surgeon General’s Report urged more research on smokeless tobacco use,” he says. “Then, while watching the World Series, I saw a pitcher chewing and spitting tobacco. I thought, ‘Here’s a high-profile, high-risk group that ought to be studied.’” Greene’s University of California colleagues agreed.
Starting in his own backyard, Greene pitched the idea to Al Rosen, then general manager of the San Francisco Giants. Rosen’s receptivity encouraged Greene to contact Peter Ueberroth, then Commissioner of Major League Baseball. When Ueberroth requested a proposal, the door to a once closed society opened.
Aided by a grant, Greene and colleagues headed to spring training in Arizona to study players in the Cactus League. “Prevalence of use was around 40 percent, higher than I expected,” Greene recalls. “About half the players had mouth lesions.”
The visiting physicians encountered obstacles because spit tobacco is a baseball ritual. Large quantities of free samples were stashed in clubhouses. The practice is now banned, thanks to Greene’s team.
After their initial foray into the dugouts, Greene and colleagues received another grant, this one for approximately $1.5 million from the National Institute of Dental Research. They organized the National Spit Tobacco Education Program (NSTEP), chaired by former Major League player and network broadcaster Joe Garagiola.“‘Smokeless’ became ‘spit’ to connote a negative, harmful image,” says Elizabeth Rogers, creative director of programs and education at Oral Health America, a non-profit group working to promote the importance of good oral health.
Greene explains the program’s approach: “We meet the team in the clubhouse and explain why we’re there. Someone who has had oral cancer gives a talk. After the presentation, I examine players to personalize the issue. I hand them a mirror, saying, ‘Your body is telling you it doesn’t want this substance anymore.’ Then they’re sent to an addiction cessation counselor. Ultimately, it’s their decision.”
Often, the presentations are charged with emotion. Greene recalls how one player, who has since died, spoke movingly about his condition. His wife talked about the impact on their family. Greene has also examined players and coaches on the field, listening to their emotional confessions, counseling them on ways to quit. “One coach was so addicted, if he ran out of tobacco during a game, he’d put a handful of dirt in his mouth. He said he just had to quit.”
Evidence suggests that EIS alumnus Greene and the NSTEP are making progress: Spit tobacco use among major league ballplayers is down to around 30 to 35 percent. “Players once asked, ‘Why didn’t somebody tell me before I got hooked?’ Now they’re saying, ‘Thank you, Doc, for providing this service.’”
According to Greene, 2000 is a breakthrough year. The Commissioner’s Office and the Major League Baseball Players Association made the program part of the annual physical, Greene says, and the NSTEP has expanded to the Grapefruit League in Florida. Like a ball hit out of the park, the momentum is spreading to other sports. “With CDC’s help, we’re going beyond baseball, studying other sporting events to see where spit tobacco use is prevalent,” Greene says.
- Nancy Moreland