Smokeless tobacco, which includes both oral moist snuff and chewing tobacco, imbues substantial health risks, not limited to increased chances of oral and pancreatic cancer, gum disease, nicotine addiction, and, among adolescents, increased likelihood of smoking initiation. There is little evidence that use of smokeless tobacco enhances athletic performance; yet, sporting events and athletic participation are consistently identified as key contexts associated with smokeless tobacco use. The tobacco industry has long marketed smokeless tobacco products at sporting events and targeted elite athletes for product endorsements in order to integrate smokeless tobacco into the sporting culture. Young males, whether striving to gain the acceptance of admired peers or to emulate respected athletes and coaches, often engage in smokeless tobacco experimentation and continued use during sports participation or attendance at sporting events. In the United States, male high school athletes are significantly more likely to use smokeless tobacco than their non-athlete counterparts. The same holds true for female high school athletes, although smokeless tobacco use is much less common among females overall. In contrast, cigarette smoking is less prevalent among high school athletes than non-athletes. Baseball, in particular, is one of several sports, including rodeo, wrestling, ice hockey, and football, that are associated with high levels of smokeless tobacco use among its participants, extending across the high school, college, and professional ranks. Smokeless tobacco use is prohibited on the field of play in college baseball and in the minor leagues. Major League Baseball bars its players from carrying smokeless tobacco products in their uniforms but does not ban use during play, which results in the broadcast of implicit product endorsements to millions of viewers worldwide.
