GOAL I: RESEARCH AND INFORMATION SYSTEM A comprehensive, integrated, and coordinated statewide research and information system will provide the framework for developing, implementing, evaluating, and disseminating spit tobacco programs, policies, and services. Objective A: Develop and implement a comprehensive, integrated, and coordinated research system for the collection and analysis of spit tobacco data that is responsive to the needs of Texas citizens, public and community educators, and health care professionals. Little research and data exist regarding the impact of spit tobacco use in Texas. A comprehensive, integrated, and coordinated research system is essential in providing the scientifically sound framework for an effective spit tobacco education, prevention, and cessation campaign in Texas. Desired Results: A coordinated, unified, and systematic approach to data collection and analysis. Development of baseline spit tobacco data. Creation of a functional, coordinating body to provide oversight for the development, implementation, and evaluation of an information resource center. Strategy 1: Assess the knowledge, attitudes, and practices of Texas citizens, especially youth, related to spit tobacco epidemiology, health effects, prevention, cessation, and personal spit tobacco use. Strategy 2: Assess the knowledge, attitudes, and practices of Texas public and community educators related to spit tobacco epidemiology, health effects, prevention, cessation, and personal spit tobacco use. Although the ill effects of cigarettes and the addictive properties of nicotine are well-known to most educators in Texas, their depth of knowledge and awareness of the health hazards of spit tobacco are unknown. Most educational materials on tobacco address the harmful effects of cigarettes alone. Materials available on spit tobacco have not yet received widespread circulation. Statewide surveys could be conducted by a number of entities, including but not limited to: The Texas Department of Health Office of Tobacco Prevention and Control, the Texas Commission on Alcohol and Drug Abuse, the Texas Education Agency, the Texas A&M University Public Policy Research Institute, and the Parents and Teachers Association. Strategy 3: Assess the knowledge, attitudes, and practices of Texas health care professionals related to spit tobacco epidemiology, health effects, prevention, cessation, and personal spit tobacco use. Recent literature has documented the importance of health care professionals' knowledge of the harmful effects of smoking. Clinicians report a lack of knowledge as a significant barrier to intervening with patients who smoke.[1-3] Their awareness of the harmful effects of spit tobacco is unknown. The Dental Oncology Education Program has conducted and published a survey of the knowledge, attitudes, and behaviors of Texas practicing dentists in regard to the prevention, detection, diagnosis, and management of oral cancer.[4] A similar format would not only provide guidance for the structuring of continuing education programs on spit tobacco for dental personnel, but also serve as a reminder for those who have appropriate knowledge and skills but fail to utilize them. The Physician Oncology Education Program conducts surveys to assess the knowledge and practices of physicians related to various cancer prevention and early detection topics. This statewide survey, subcontracted through Baylor College of Medicine's Center for Cancer Control Research, is conducted two or three times annually and represents Texas' practicing physicians. Similar means would be appropriate to assess the knowledge, attitudes, and practices of physicians regarding spit tobacco. The Nurse Oncology Education Program assesses the knowledge and practices of a representative sample of nurses every three years. This survey would aid in identifying the educational needs of nurses regarding spit tobacco. In 1993, nurses reported a strong need for tobacco cessation training.[5] Strategy 4: Develop profiles of spit tobacco initiators, adult influencers, and spit tobacco users. Strategy 5: Identify the success factors of effective spit tobacco prevention and cessation interventions and develop scientifically-based intervention guidelines accordingly. Spit tobacco use is a different behavior from smoking. Attempts to use interventions designed for smoking cessation and prevention have proven unsuccessful. Sound scientific research is necessary to identify the parameters which influence spit tobacco use and incorporate these into spit tobacco appropriate guidelines. Strategy 6: Assess the effectiveness of education delivered via public and community educators, health care professionals, and media. Objective B: Implement a comprehensive and accessible information resource center responsive to the needs of Texas citizens, public and community educators, and health care professionals. In conjunction with the comprehensive, integrated, and coordinated research system, this resource center will act as the cornerstone for all spit tobacco-related activities in Texas and provide baseline spit tobacco data and educational materials. Desired Results: Creation of a functional spit tobacco information resource center. Strategy 1: Identify and evaluate media and educational resources. Strategy 2: Develop a comprehensive and accessible information resource center which maintains and disseminates scientific data and resources on spit tobacco education, epidemiology, health effects, user identification, risk groups, and prevention and cessation strategies and services. Information and resources on spit tobacco are available free of charge or at a nominal fee from such organizations as the American Cancer Society, American Lung Association, American Heart Association, the National Cancer Institute, the Centers for Disease Control, and from tobacco control programs in most states. Unfortunately, materials on spit tobacco are limited, difficult to locate, and often outdated. Collaborative efforts to evaluate, develop, and disseminate spit tobacco materials through a Texas spit tobacco resource center would identify weaknesses and more effectively reach Texans.