Dental Professionals' Engagement in Tobacco, Electronic Cigarette, and Cannabis Patient Counseling

OBJECTIVES

California features low smoking prevalence, cautionary electronic cigarette (e-cigarette) public messaging, and legal recreational cannabis: a unique landscape for dental professionals to navigate tobacco cessation promotion. This cross-sectional study assessed California dental professionals' self-reported tobacco patient counseling behaviors and the correlates of providing such assistance.

METHODS

Statewide surveys of dental hygienists (n = 701) and dentists (n = 725) were distributed electronically. The dentist survey was weighted for sampling and nonresponse. Prevalence of asking patients about use was compared for cigarette and noncigarette products (e.g., e-cigarettes, cannabis). Multivariable models identified independent correlates of providing cessation assistance to tobacco-using patients.

RESULTS

Respondents reported frequently (often/always) documenting patient tobacco use (hygienists: 80%; dentists: 73%) but less commonly provided forms of assistance (hygienists: 27%-49%; dentists: 10%-31%). Most respondents asked patients about cigarette smoking, but noncigarette product use (cigar, hookah, pipe, e-cigarette, or cannabis) was not commonly assessed. Greater confidence and willingness to assist were positively associated with providing assistance in multivariable models, but perceived barriers (e.g., lack of time and remuneration) were not. Results were robust to model specifications.

CONCLUSIONS

California dental professionals often ask about smoking but lag in providing cessation assistance and inquiring about noncigarette products. Successful efforts to encourage dental professionals' engagement in tobacco prevention and cessation must enhance providers' self-efficacy and motivation and likely will require system and organizational change.

KNOWLEDGE TRANSFER STATEMENT

Study findings identify substantial gaps in dental professionals' engagement in patient tobacco cessation. The results identify correlates of providing assistance and of dental professionals' willingness and confidence to do so, which could serve to inform interventions to support and enhance engagement.

Using an extended theory of planned behaviour to predict smoking cessation counsellors' intentions to offer smoking cessation support in the Taiwanese military: a cross-sectional study

OBJECTIVES

To use the extended theory of planned behaviour (TPB) to predict smoking cessation counsellors' intentions to offer smoking cessation support.

DESIGN

Cross-sectional study SETTING: Taiwanese military PARTICIPANTS: A survey of 432 smoking cessation counsellors was conducted in 2017.

PRIMARY AND SECONDARY OUTCOME MEASURES

All participants completed a self-administered questionnaire that solicited information concerning demographics, smoking behaviour, self-rated suitability for being a counsellor, the knowledge and skills learnt from training courses and the TPB construct.

RESULTS

The factors of perceived behavioural control (β=0.590, p<0.001), self-rated suitability for being a counsellor (acceptable vs not suitable, β=0.436, p=0.001; suitable vs not suitable, β=0.510, p<0.001), knowledge (β=0.298, p=0.020) and professional specialty (military doctor vs non-military doctor, β=0.198, p=0.034) were found to be correlated with intention. However, attitude, subjective norms and descriptive norms were determined to be non-significant correlates. The model explained 59.7% of the variance for the intention to offer smoking cessation support (F[12,343]=44.864, p<0.001).

CONCLUSIONS

To encourage smoking cessation counsellors to offer cessation support to smokers, policies should aim to increase their perceived behavioural control, knowledge and self-rated suitability for being a counsellor.

Survey of dental clinic patients: smoking and preferences for cessation support

BACKGROUND

Smoking cessation interventions delivered by dental practitioners can be as effective as those delivered by general medical practitioners. However, concern that addressing smoking may cause offence to their patients is a reason cited by dental practitioners for not regularly addressing patient smoking behaviours, despite believing they should play a role in smoking cessation. This study aimed to elicit the smoking behaviour and smoking cessation preferences of dental patients to determine if these concerns accurately reflect patient attitudes.

METHODS

We surveyed 726 adult dental patients attending The University of Queensland's School of Dentistry dental clinics, Brisbane Dental Hospital and four private dental practices in South-East Queensland.

RESULTS

Most (80%) current daily smokers had tried to quit smoking. Smokers and non-smokers both agreed that dentists should screen for smoking behaviour and are qualified to offer smoking cessation advice (99% and 96% respectively). Almost all participants (96%) said they would be comfortable with their dentist asking about their smoking and that if their smoking was affecting their oral health their dentist should advise them to quit.

CONCLUSIONS

Patients are receptive to dental practitioners inquiring about smoking behaviour and offering advice on quitting. Smoking patients showed considerable motivation and interest in quitting smoking, particularly in the context of health problems related to smoking being identified. These results should encourage dentists to raise the issue with their patients.

Factors that influence delivery of tobacco cessation support in general dental practice: a narrative review

OBJECTIVES

To review the literature reporting factors that are associated with the delivery of lifestyle support in general dental practice.

METHODS

A systematic review of the quantitative observational studies describing activities to promote the general health of adults in primary care general dental practice. Behavior change included tobacco cessation, alcohol reduction, diet, weight management, and physical activity. Tooth brushing and oral hygiene behaviors were excluded as the focus of this review was on the common risk factors that affect general health as well as oral health.

RESULTS

Six cross sectional studies met the inclusion criteria. Five studies only reported activities to support tobacco cessation. As well as tobacco cessation one study also reported activities related to alcohol usage, physical activity, and Body Mass Index. Perceptions of time availability consistently correlated with activities and beliefs about tobacco cessation, alongside the smoking status of the dental professional. Dentists who perceive having more available time were more likely to discuss smoking with patients, prescribe smoking cessation treatments and direct patients toward (signpost to) lifestyle support services. Dental professionals who smoke were less likely to give smoking cessation advice and counselling than nonsmokers. Finally, the data showed that professional support may be relevant. Professionals who work in solo practices or those who felt a lack of support from the wider professional team (peer support) were more likely to report barriers to delivering lifestyle support.

CONCLUSION

Organizational changes in dental practices to encourage more team working and professional time for lifestyle support may influence delivery. Dental professionals who are smokers may require training to develop their beliefs about the effectiveness of smoking cessation interventions.

Survey of Australian oral health practitioners and their smoking cessation practices

BACKGROUND

Smoking is a significant health and economic burden in Australia. Studies of smoking cessation practices in dental settings have primarily concentrated on dentists rather than other oral health practitioner (OHP) groups (dental hygienists, dental therapists and oral health therapists). The aim of this study was to measure Australian OHPs' attitudes, behaviours, interest and barriers to delivering smoking cessation interventions.

METHODS

Members of the two peak professional bodies representing Australian OHPs were invited to participate in an anonymous online questionnaire.

RESULTS

There were discrepancies between practitioner attitudes and current smoking cessation practices. While the majority of practitioners (90.1%) frequently screened for smoking behaviour, fewer (51.1%) assisted patients to quit smoking. The principal form of assistance was referral to Quitline (45.7%) or to a general medical practitioner (44.4%). The most prevalent barriers identified were lack of knowledge of pharmacological treatments (45.8%) and lack of access to smoking cessation resources (44.2%). Contrary to international studies, time and financial incentive were not commonly cited barriers to delivering smoking cessation interventions.

CONCLUSIONS

This survey identifies a need for continuing education in smoking cessation practice. Dissemination of policies, guidelines and resources may assist OHPs to become more engaged and confident in delivering smoking cessation interventions as part of their routine practice.