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Blasi PR, Krakauer C, Anderson ML, Nelson J, Bush T, Catz SL, McClure JB. Factors associated with future dental care utilization among low-income smokers overdue for dental visits. BMC Oral Health 2018; 18:183. [PMID: 30382910 PMCID: PMC6211575 DOI: 10.1186/s12903-018-0646-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 10/18/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Smokers are at increased risk of oral disease. While routine dental care can help prevent and treat oral health problems, smokers have far lower rates of dental care utilization compared with non-smokers. We sought to better understand which factors may facilitate or hinder dental care utilization among low-income smokers participating in a randomized intervention trial in order to inform future intervention planning. METHODS This is a secondary analysis of data collected between 2015 and 2017 as part of the OralHealth4Life trial. Participants were eligible callers to the Louisiana, Nebraska, and Oregon state tobacco quitlines who had no dental appointment in the prior or upcoming six months. We examined the association between participants' baseline characteristics and their receiving professional dental care between baseline and the 6-month follow-up survey. RESULTS Participants were racially diverse (42% non-White) and two-thirds had an annual household income under $20,000. Most (86.7%) had not had a dental cleaning in more than one year. Commonly cited barriers to dental care included cost (83.7%) and no dental insurance (78.1%). Those with dental insurance were more likely to see a dentist at follow-up (RR 1.66). Similarly, those reporting a dental insurance barrier to care were less likely to see a dentist at follow-up (RR 0.69); however, there was no significant utilization difference between those reporting a cost barrier vs. those who did not. After controlling for these financial factors, the following baseline characteristics were significantly associated with a higher likelihood of dental care utilization at 6 months: higher motivation (RR 2.16) and self-efficacy (RR 1.80) to visit the dentist, having a disability (RR 1.63), having a higher education level (RR 1.52), and having perceived gum disease (RR 1.49). Factors significantly associated with a lower likelihood of dental care utilization included being married (RR 0.68) and not having a last dental cleaning within the past year (RR 0.47). CONCLUSIONS Our findings provide important insight into factors that may facilitate or deter use of professional dental care among low-income smokers. This information could inform the development of future interventions to promote dental care utilization. TRIAL REGISTRATION ClinicalTrials.gov : NCT02347124 ; registered 27 January 2015.
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Affiliation(s)
- Paula R. Blasi
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101 USA
| | - Chloe Krakauer
- Department of Biostatistics, University of Washington, F-600, Health Sciences Building 1705 NE Pacific Street, Seattle, WA 98195 USA
| | - Melissa L. Anderson
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101 USA
| | - Jennifer Nelson
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101 USA
| | - Terry Bush
- Optum Center for Wellbeing Research, 999 3rd Ave., Suite 2000, Seattle, Washington, 98104 USA
| | - Sheryl L. Catz
- Betty Irene Moore School of Nursing, University of California-Davis, 2450 48th Street, Suite 2600, Sacramento, CA 95817 USA
| | - Jennifer B. McClure
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101 USA
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McClure JB, Bush T, Anderson ML, Blasi P, Thompson E, Nelson J, Catz SL. Oral Health Promotion and Smoking Cessation Program Delivered via Tobacco Quitlines: The Oral Health 4 Life Trial. Am J Public Health 2018; 108:689-695. [PMID: 29565660 DOI: 10.2105/ajph.2017.304279] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To assess the effects of a novel oral health promotion program (Oral Health 4 Life; OH4L) delivered through state-funded tobacco quitlines. METHODS Using a semipragmatic design to balance experimental control and generalizability, we randomized US quitline callers (n = 718) to standard care or standard care plus OH4L. We followed participants for 6 months to assess effects on professional dental care and smoking abstinence. We collected data between 2015 and 2017. RESULTS Participants were racially diverse (42% non-White) and socioeconomically disadvantaged. Most (71%) reported fair or poor oral health, and all were overdue for routine dental care. At 6 months, professional dental care and abstinence did not significantly differ between arms, but abstinence favored the experimental arm and was significantly higher among experimental participants at 2 months in a complete case sensitivity analysis. CONCLUSIONS OH4L was not effective for promoting dental care, but integrating oral health counseling with quitline counseling may offer some advantage for smoking cessation. Public Health Implications. We offer a model for conducting semipragmatic trials and partnering with tobacco quitlines to evaluate population-level public health interventions.
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Affiliation(s)
- Jennifer B McClure
- Jennifer B. McClure, Melissa L. Anderson, Paula Blasi, Ella Thompson, and Jennifer Nelson are with the Kaiser Permanente Washington Health Research Institute, Seattle, WA. Terry Bush is with the Optum Center for Wellbeing Research, Seattle. Sheryl L. Catz is with the Betty Irene Moore School of Nursing, University of California, Davis
| | - Terry Bush
- Jennifer B. McClure, Melissa L. Anderson, Paula Blasi, Ella Thompson, and Jennifer Nelson are with the Kaiser Permanente Washington Health Research Institute, Seattle, WA. Terry Bush is with the Optum Center for Wellbeing Research, Seattle. Sheryl L. Catz is with the Betty Irene Moore School of Nursing, University of California, Davis
| | - Melissa L Anderson
- Jennifer B. McClure, Melissa L. Anderson, Paula Blasi, Ella Thompson, and Jennifer Nelson are with the Kaiser Permanente Washington Health Research Institute, Seattle, WA. Terry Bush is with the Optum Center for Wellbeing Research, Seattle. Sheryl L. Catz is with the Betty Irene Moore School of Nursing, University of California, Davis
| | - Paula Blasi
- Jennifer B. McClure, Melissa L. Anderson, Paula Blasi, Ella Thompson, and Jennifer Nelson are with the Kaiser Permanente Washington Health Research Institute, Seattle, WA. Terry Bush is with the Optum Center for Wellbeing Research, Seattle. Sheryl L. Catz is with the Betty Irene Moore School of Nursing, University of California, Davis
| | - Ella Thompson
- Jennifer B. McClure, Melissa L. Anderson, Paula Blasi, Ella Thompson, and Jennifer Nelson are with the Kaiser Permanente Washington Health Research Institute, Seattle, WA. Terry Bush is with the Optum Center for Wellbeing Research, Seattle. Sheryl L. Catz is with the Betty Irene Moore School of Nursing, University of California, Davis
| | - Jennifer Nelson
- Jennifer B. McClure, Melissa L. Anderson, Paula Blasi, Ella Thompson, and Jennifer Nelson are with the Kaiser Permanente Washington Health Research Institute, Seattle, WA. Terry Bush is with the Optum Center for Wellbeing Research, Seattle. Sheryl L. Catz is with the Betty Irene Moore School of Nursing, University of California, Davis
| | - Sheryl L Catz
- Jennifer B. McClure, Melissa L. Anderson, Paula Blasi, Ella Thompson, and Jennifer Nelson are with the Kaiser Permanente Washington Health Research Institute, Seattle, WA. Terry Bush is with the Optum Center for Wellbeing Research, Seattle. Sheryl L. Catz is with the Betty Irene Moore School of Nursing, University of California, Davis
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McClure JB, Blasi PR, Cook A, Bush T, Fishman P, Nelson J, Anderson ML, Catz SL. Oral health 4 life: Design and methods of a semi-pragmatic randomized trial to promote oral health care and smoking abstinence among tobacco quitline callers. Contemp Clin Trials 2017; 57:90-97. [PMID: 28412230 DOI: 10.1016/j.cct.2017.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 04/07/2017] [Accepted: 04/10/2017] [Indexed: 10/19/2022]
Abstract
Smokers are at high risk for oral disease. As a result, they represent an important target group for population-level, public oral health promotion efforts. While dental health professionals often address smoking with their patients, no systematic efforts have been made to offer smokers an intervention to improve their use of oral health care. This paper details the rationale, design, and methods of a large, semi-pragmatic, randomized clinical trial designed to address this gap. Participants are recruited via the Oregon, Nebraska and Louisiana state-sponsored tobacco quitlines and randomized to receive standard quitline care versus standard care plus a multi-modal oral health promotion program (Oral Health 4 Life) integrated within the quitline services. All participants are followed for 6months to assess the impact of the intervention on smoking abstinence and utilization of professional dental care. In addition, the study will assess the cost of the intervention and provide practical guidance to states on whether the intervention is financially feasible to implement, should the intervention be effective. This study protocol may be useful to others interested in promoting oral health among smokers, those interested in partnering with tobacco quitlines to extend standard services to address other high risk health behaviors among smokers, or those interested in semi-pragmatic trial design.
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Affiliation(s)
- Jennifer B McClure
- Kaiser Permanente Washington Health Research Institute (formerly, Group Health Research Institute), 1730 Minor Ave, Suite 1600, Seattle, WA 98101, USA.
| | - Paula R Blasi
- Kaiser Permanente Washington Health Research Institute (formerly, Group Health Research Institute), 1730 Minor Ave, Suite 1600, Seattle, WA 98101, USA.
| | - Andrea Cook
- Kaiser Permanente Washington Health Research Institute (formerly, Group Health Research Institute), 1730 Minor Ave, Suite 1600, Seattle, WA 98101, USA.
| | - Terry Bush
- Alere Wellbeing, Optum Center for Wellbeing Research, 999 3rd Ave., Suite 2000, Seattle, WA 98104, USA.
| | - Paul Fishman
- Kaiser Permanente Washington Health Research Institute (formerly, Group Health Research Institute), 1730 Minor Ave, Suite 1600, Seattle, WA 98101, USA; University of Washington, Department of Health Services, 1959 NE Pacific St., Box 357660, Seattle, WA 98195-7660, USA.
| | - Jennifer Nelson
- Kaiser Permanente Washington Health Research Institute (formerly, Group Health Research Institute), 1730 Minor Ave, Suite 1600, Seattle, WA 98101, USA.
| | - Melissa L Anderson
- Kaiser Permanente Washington Health Research Institute (formerly, Group Health Research Institute), 1730 Minor Ave, Suite 1600, Seattle, WA 98101, USA.
| | - Sheryl L Catz
- University of California, Davis, Betty Irene Moore School of Nursing, 4610 X St., Suite 4202, Sacramento, CA 95817, USA.
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