The impact of a brief tobacco-use cessation intervention in public health dental clinics.
ABSTRACT Public health dental clinic patients use tobacco at disproportionately high rates. The purpose of this study was to evaluate a tobacco-use cessation program delivered via public health dental practitioners.
Two public health dental clinics participated in this quasiexperimental design study. First, all patients in one clinic who used tobacco (n = 178) received usual care. Next, the authors trained all practitioners to conduct a tobacco-use assessment and provide a brief cessation intervention. Subsequently, all patients in both clinics who used tobacco (N = 190) received the intervention. All enrolled patients had an income at or below the federal poverty level. The authors conducted follow-up assessments at six weeks and three and six months after enrollment.
Differences in self-reported quitting by condition between participants in the two groups were significant across all endpoints. Patients in the intervention group were more likely to quit than those receiving usual care (15.5 versus 4.3 percent) and after 12 months (18.8 versus 4.6 percent). Controlling for enrollment differences between patients in the two groups (age, race/ethnicity, time to first cigarette after waking), the authors found that differences between groups were significant for quitting at three months (P < .05; odds ratio [OR] = 4.85; 95 percent confidence interval [CI] = 1.20, 19.60), and six months (P < . 01; OR = 5.25; 95 percent CI = 1.35, 20.36).
The results of this study suggest the viability and effectiveness of delivering a tobacco intervention to low-income smokers via public dental practitioners. A randomized clinical trial is warranted.
The potential reach of public health dental clinics is great. Because of the high percentage of tobacco-using patients in these clinics, the public health impact of a program such as the one reported here would be significant.
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ABSTRACT: Although dental care settings provide an exceptional opportunity to reach smokers and provide brief cessation advice and treatment to reduce oral and other tobacco-related health conditions, dental care providers demonstrate limited adherence to evidence-based guidelines for treatment of tobacco use and dependence. Guided by a multi-level, conceptual framework that emphasizes changes in provider beliefs and organizational characteristics as drivers of improvement in tobacco treatment delivery, the current protocol will use a cluster, randomized design and multiple data sources (patient exit interviews, provider surveys, site observations, chart audits, and semi-structured provider interviews) to study the process of implementing clinical practice guidelines for treating tobacco dependence in 18 public dental care clinics in New York City. The specific aims of this comparative-effectiveness research trial are to: compare the effectiveness of three promising strategies for implementation of tobacco use treatment guidelines--staff training and current best practices (CBP), CBP + provider performance feedback (PF), and CBP + PF + provider reimbursement for delivery of tobacco cessation treatment (pay-for-performance, or P4P); examine potential theory-driven mechanisms hypothesized to explain the comparative effectiveness of three strategies for implementation; and identify baseline organizational factors that influence the implementation of evidence-based tobacco use treatment practices in dental clinics. The primary outcome is change in providers' tobacco treatment practices and the secondary outcomes are cost per quit, use of tobacco cessation treatments, quit attempts, and smoking abstinence. We hypothesize that the value of these promising implementation strategies is additive and that incorporating all three strategies (CBP, PF, and P4P) will be superior to CBP alone and CBP + PF in improving delivery of cessation assistance to smokers. The findings will improve knowledge pertinent to the implementation, dissemination, and sustained utilization of evidence-based tobacco use treatment in dental practices.Trial registration: NCT01615237.Implementation Science 02/2014; 9(1):25. · 3.47 Impact Factor
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ABSTRACT: Tobacco use is a modifiable risk factor for oral disease. Dental professionals are able to reduce the burden of oral and overall health by influencing tobacco use. Results of electronic searches for literature indicated progress in tobacco interventions in dentistry. Patients believed that dentists should routinely offer smoking cessation services, and those interested in quitting felt comfortable receiving advice about quitting. Dental professionals were aware of the importance of tobacco interventions. However, tobacco intervention practices were limited or restricted, and dental professionals have not fully embraced opportunities for tobacco intervention. A consistently reported barrier was the lack of training. Although various factors were identified as barriers and facilitators, few study assessed structure for the implementation of tobacco interventions. Tobacco-related education of undergraduate students has been recognized as an important issue. Globally, the majority of dental students recognized themselves as role models in society and believed they should receive training. However, few reported receiving such formal training. Dental researchers and educators around the world should explore new knowledge and exchange experiences to make full use of the unique opportunity of providing dental interventions against tobacco use.Japanese Dental Science Review 02/2013; 49(1):47–56.
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ABSTRACT: Objectives. We examined the association of smoke-free laws with dentists' advice to quit smoking and referral to a quit line, among smokers who reported visiting the dentist in the past 12 months. Methods. We used the 2006 to 2007 Tobacco Use Supplement of the Current Population Survey merged with the American Nonsmokers' Rights Foundation Local Ordinance Database of smoke-free laws. The dependent variables were advice from a dentist to quit smoking and referral to a quit line, and the independent variable of interest was 100% smoke-free law coverage. We controlled for respondent demographics and an index of state-level smoking ban attitudes (included to ensure that the effect detected was not the result of social attitudes). Results. Smoke-free law coverage was associated with dental advice to quit smoking (odds ratio [OR] = 1.27; 95% confidence interval [CI] = 1.01, 1.59; P = .041), but not with referral to a quit line (OR = 1.33; 95% CI = 0.79, 2.25; P = .283). Conclusions. Interventions with dentists are needed to increase referrals to quit lines and other smoking cessation efforts. (Am J Public Health. Published online ahead of print February 13, 2014: e1-e7. doi:10.2105/AJPH.2013.301714).American Journal of Public Health 02/2014; · 3.93 Impact Factor