Although multiple risk factors influence the initiation of tobacco use, participation in sports is an important contributor to the use of smokeless tobacco. Interest in sports activities occurs at the critical time that coincides with when young people are also likely to initiate tobacco use. In Africa and Middle East, smokeless tobacco dipping or chewing is rarely found among athletes. However, there are other forms of plants dipping “Kat” that are used among some populations in Yemen and other countries. So, More studies need to be done to further substantiate the relationship between Tobacco, Kat and Sports activities in Africa and Middle East. In USA in 1997 survey of 1200 high school athletes disclosed that those students who engaged in high-intensity sports were more likely to use smokeless tobacco prod­ucts, and participants in any athletic activity had a 1.5 times greater use rate than nonathletes. The manufacturers promoted their products as a safer or less harmful alternative to smoking, but recent studies on the use of smokeless tobacco proved that it could lead to:

• Addiction from the nicotine.

• Gums to pull away from the teeth in the place where the tobacco is held.

• The gums do not grow back.

• Dental decay in exposed tooth roots due to the presence of sugar in spit tobacco.

• Leathery white patches, called leukoplakia, and red sores are common in dippers and chewers and can turn into cancer.