Survey of Australian oral health practitioners and their smoking cessation practices

Attitudes and practices of health care providers towards improving adherence to smoking cessation medications in Australia: A descriptive study

ISSUE ADDRESSED

Adherence to smoking cessation medications is low and predicts the success of quit attempts. Health care providers (HCPs) role in delivering smoking cessation support is crucial. HCPs support to improve adherence to smoking cessation medication has not been evaluated in Australia. This study describes the attitudes and practices of HCPs in Australia towards adherence to smoking cessation medications (nicotine replacement therapies, varenicline and bupropion) and intervention options.

METHODS

A descriptive cross-sectional study was conducted using a convenience sample of 70 HCPs in Australia. Participants were recruited through the social media platforms of professional societies in Australia. Data was collected in the periods between November 2020 and September 2021. Descriptive statistics were performed using SPSS statistical software version 27.0 and data was presented using proportions and percentages.

RESULTS

The majority of participants were doctors, nurses and midwives (82.8%). Almost two-thirds of the participants (68.6%) self-reported that they provided adequate adherence support to individuals taking smoking cessation medications. The majority of participants (87.1%) identified adherence support service as part of their professional role. Only 11.1% of the participants who did not believe supporting medication adherence to be their role reported providing adherence support. The main perceived barriers to adherence support are lack of skill, knowledge, time and resources. HCPs believed that providing additional counselling and monitoring of adherence can improve adherence rates.

CONCLUSIONS

In an online survey conducted in Australia, HCPs indicated multiple barriers to providing adherence support and intervention strategies that should be considered for smoking cessation programs. A higher proportion of participants who perceived adherence support as their professional role reported supporting adherence to smoking cessation medications. SO WHAT?: Considerations should be given to improve HCPs attitudes and practices towards smoking cessation medications adherence support. Smoking cessation programs should consider the issue of adherence support. Further studies with a larger sample size across a broader range of HCPs are needed to extensively understand adherence service provision among HCPs in Australia.

Smoking cessation in dental setting: a narrative review on dental professionals' attitude, preparedness, practices and barriers

Integration of smoking cessation program into routine oral health care has been advocated by World Health Organization since it brings extensive benefits to oral health. By tobacco cessation, patients are less prone to progression of periodontal disease, have less future tooth loss, have reduced risks of oral mucosal lesions and head and neck cancers. Evidence indicates that dentists are in a favorable position to deliver effective smoking cessation advice to improve patients' oral health. This article aims to present the current situation of smoking cessation in dental setting, including dental management of smoking patients, perceptions of dentists and dental students towards smoking cessation, challenges dental professionals face when carrying out cessation interventions. Patients' perspectives are also evaluated to provide a clearer picture of smoking cessation practice in the dental field. Review of past surveys show most patients welcome smoking cessation advice from dental practitioners. Meanwhile dentists may have wrong assumption that patients would disapprove them if they advise patient to quit smoking. On top of that, main obstacles identified are lack of training, inadequate treatment time and insufficient knowledge towards smoking cessation guidelines and referral routes. With regard to the potential barriers, evidence demonstrates that more trainings on smoking cessation strategies are needed. Future research in this aspect is also indicated to further foster the practice of smoking cessation counselling in dental setting.

Teaching health promotion competencies in undergraduate dentistry training: A unique pedagogical approach

ISSUE ADDRESSED

Using appropriate pedagogical approaches in undergraduate dentistry training is important to develop student's health promotion knowledge, and to shape their attitude towards using these competencies in future dentistry practice. This brief report documents the signature pedagogical approach developed for an undergraduate health science subject at James Cook University, to teach dentistry students health promotion competencies.

PEDAGOGICAL APPROACH

The signature pedagogy involves three key approaches - experiential learning, cooperative learning and inquiry-based learning. Experiential learning "beyond the classroom" enables students to develop and deliver a school-based oral health promotion program. "Inside the classroom," role-plays encourage students to apply their health promotion skills to real-world dentistry scenarios. Cooperative learning techniques such as "think, pair, share" create a supportive environment for students to confidently exchange ideas; and inquiry-based learning engages students in thinking critically about health promotion strategies to address contemporary oral health challenges. These pedagogical approaches have developed student's understanding of the health promotion competencies required of a newly qualified dentist.

CONCLUSION

Pedagogical approaches that engage dentistry students in experiential, cooperative and inquiry-based learning are important considerations for undergraduate teaching, to strengthen understanding of health promotion and to help shape student's attitude towards using these competencies in future dentistry practice.

Tobacco Use and Oral Health

This review outlines the important oral implications of tobacco use. The lining of the mouth (oral mucosa), if exposed to tobacco and its products in a susceptible individual, can develop benign, potentially malignant, and malignant tumours. Treatment and prognosis depend on tumour type, how early it is detected, its size and site in the oral cavity and whether it has spread. Advanced oral squamous cell carcinoma (OSCC) has a 20% 5-year survival rate. Tobacco use also increases the risk of periodontitis, peri-implantitis, caries, alveolar osteitis and halitosis. Although less life threatening than OSCC, these tobacco related conditions create a substantial financial and health burden for individuals and society. Dental practitioners routinely examine the oral cavity for signs of mucosal and tooth changes, are experienced in recognising variations from normal and have established management and referral pathways. They are also ideally positioned to provide brief interventions to assist their patients to quit smoking.

Utilisation of a brief tobacco smoking cessation intervention tool in public dental services

ISSUE ADDRESSED

Dental practitioners have an important opportunity to promote smoking cessation. This study aimed to determine how many smokers attended West Moreton Oral Health Service (WMOHS), completion rates for the standardised Smoking Cessation Pathway, and smoking cessation practices, confidence levels and attitudes of dental practitioners in WMOHS.

METHODS

A mixed-methods approach collected clinical and demographic data from a retrospective audit of WMOHS reports from 1 August 2017 to 31 July 2019 and a cross-sectional survey of WMOHS dental practitioners. Logistic regression models determined factors associated with smoking status and delivery of the Pathway.

RESULTS

Over 24 months, 14,919 courses of care (COC) were completed. Twenty-five percent of patients identified as current smokers. The Pathway was delivered in 54% (n = 1999) of smokers' COC, which was significantly associated with patient age (aOR 0.99 [CI 0.99, 0.99; P < .001]), Indigenous status (aOR 1.47 [CI 1.05, 2.08; P =.02]) and high socio-economic status (aOR 1.41 [CI 1.06, 1.88; P =.02]). Practitioners identified lack of time and training as the main barriers to Pathway completion.

CONCLUSIONS

High-risk populations for tobacco use are frequently utilising WMOHS, however not all patients who smoke received smoking cessation support. Understanding and addressing barriers to smoking cessation promotion in oral health care settings may improve general and oral health outcomes for patients. SO WHAT?: Targeted training and utilisation of team-based models of care may better enhance delivery and uptake of the Pathway within the public dental setting, thus improving services to a high-need population and reducing smoking rates in priority populations.

Perception of Tobacco Counseling and Cessation among Dental Practitioners

Objective

To investigate the knowledge and practice of tobacco cessation and counseling (TCC) among dental practitioners and their attitude and perceived barriers.

Methods

A cross-sectional study targeted licensed dental practitioners in Jeddah, Saudi Arabia. Participants answered a pretested and validated self-administered questionnaire consisted of demographic data; smoking status; knowledge of tobacco hazards, attitude, and practice; and perceived barriers of tobacco cessation counseling.

Result

Among the total sample of 529, response rate was 72.2% (mean age (34.20 ± 9.38 years), males (42.4%), and current smokers (23.8%)). Only 13.2% received formal training on TCC. Around (57.1%) reported smoking of dental team as an obstacle for TCC. Half of the participants (49.9%) reported patient's resistance as barrier to TCC. Others (45%-48%) reported insufficient time, knowledge, or training for TCC. Professional responsibility and willingness to provide cessation services constituted the highest median.

Conclusion

The majority showed willingness to participate in TCC. Lack of training, smoking status of providers, females, inadequate materials, and patients' resistance were the most common barriers. Education and training on TCC are recommended and should be allowed as a routine practice in dentistry.

Impact of tobacco control auxiliary resources on the 5As behavior in nursing interns: Self-reports from students

INTRODUCTION

The help of healthcare professionals for smokers to quit is critically important to increase quit rates. In the future, internship nursing students will potentially become the largest population of medical professionals. This study explored the impact of the use and awareness of universal tobacco control auxiliary resources on nursing students’ 5As behavior in helping patients to quit smoking during a 40-week clinical internship in the last year of nursing school in Chongqing, China.

METHODS

A survey was conducted in 13 teaching hospitals selected from 29 in Chongqing, China, in 2019, by a random cluster sampling method. It investigated, by self-reported questionnaires, student 5As behavior in helping patients to quit smoking and use and knowledge of tobacco cessation auxiliary resources (tobacco cessation self-education manual, tobacco cessation guidelines, tobacco cessation drugs, tobacco cessation websites, and hotline). The relationship between tobacco cessation auxiliary resources and 5As behavior in helping patients to quit smoking was analyzed with a multivariate linear mixed-effect model.

RESULTS

In all, 534 (39.3%) students, of a total of 1358, reported that the majority of internship units provided a tobacco control self-education manual; 674 (49.6%) ever skimmed through tobacco cessation guidelines; 641 (47.2%) browsed tobacco cessation websites; 738 (54.3%) knew some cessation-assistance drugs; and 93 (6.8%) knew of and could recall the tobacco cessation hotline. Except for tobacco cessation websites, tobacco cessation auxiliary resources affected nursing interns’ 5As behavior in helping patients to quit (p<0.05).

CONCLUSIONS

Tobacco cessation auxiliary resources influenced students’ 5As behavior in helping patients to quit smoking. Students knew a little of tobacco cessation auxiliary resources. To improve students’ 5As behavior for helping patients to quit, more tobacco cessation resources need to be developed and more students need to become acquainted with them.

Facilitating smoking cessation in patients who smoke: a large-scale cross-sectional comparison of fourteen groups of healthcare providers

Background

Although healthcare providers are well placed to help smokers quit, implementation of smoking cessation care is still suboptimal. The Ask-Advise-Refer tasks are important aspects of smoking cessation care. We examined to which extent a large and diverse sample of healthcare providers expressed the intention to implement smoking cessation care and which barriers they encountered. We moreover examined to which extent the Ask-Advise-Refer tasks were implemented as intended, and which determinants (in interaction) influenced intentions and the implementation of Ask-Advise-Refer.

Methods

Cross-sectional survey among addiction specialists, anaesthesiologists, cardiologists, general practitioners, internists, neurologists, paediatricians, pulmonologists, ophthalmologists, surgeons, youth specialists, dental hygienists, dentists, and midwives (N = 883). Data were analysed using multivariate linear and logistic regression analyses and regression tree analyses.

Results

The Ask-Advice-Refer tasks were best implemented among general practitioners, pulmonologists, midwives, and addiction specialists. Overall we found a large discrepancy between asking patients about smoking status and advising smokers to quit. Participants mentioned lack of time, lack of training, lack of motivation to quit in patients, and smoking being a sensitive subject as barriers to smoking cessation care. Regression analyses showed that the most important determinants of intentions and implementation of Ask-Advise-Refer were profession, role identity, skills, guideline familiarity and collaboration agreements for smoking cessation care with primary care. Determinants interacted in explaining outcomes.

Conclusions

There is much to be gained in smoking cessation care, given that implementation of Ask-Advise-Refer is still relatively low. In order to improve smoking cessation care, changes are needed at the level of the healthcare provider (i.e., facilitate role identity and skills) and the organization (i.e., facilitate collaboration agreements and guideline familiarity). Change efforts should be directed towards the specific barriers encountered by healthcare providers, the contexts that they work in, and the patients that they work with.

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.

Mental health nurses' attitudes, experience, and knowledge regarding routine physical healthcare: systematic, integrative review of studies involving 7,549 nurses working in mental health settings

Background

There has been a recent growth in research addressing mental health nurses’ routine physical healthcare knowledge and attitudes. We aimed to systematically review the empirical evidence about i) mental health nurses’ knowledge, attitudes, and experiences of physical healthcare for mental health patients, and ii) the effectiveness of any interventions to improve these aspects of their work.

Methods

Systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Multiple electronic databases were searched using comprehensive terms. Inclusion criteria: English language papers recounting empirical studies about: i) mental health nurses’ routine physical healthcare-related knowledge, skills, experience, attitudes, or training needs; and ii) the effectiveness of interventions to improve any outcome related to mental health nurses’ delivery of routine physical health care for mental health patients. Effect sizes from intervention studies were extracted or calculated where there was sufficient information. An integrative, narrative synthesis of study findings was conducted.

Results

Fifty-one papers covering studies from 41 unique samples including 7549 mental health nurses in 14 countries met inclusion criteria. Forty-two (82.4%) papers were published since 2010. Eleven were intervention studies; 40 were cross-sectional. Observational and qualitative studies were generally of good quality and establish a baseline picture of the issue. Intervention studies were prone to bias due to lack of randomisation and control groups but produced some large effect sizes for targeted education innovations. Comparisons of international data from studies using the Physical Health Attitudes Scale for Mental Health Nursing revealed differences across the world which may have implications for different models of student nurse preparation.

Conclusions

Mental health nurses’ ability and increasing enthusiasm for routine physical healthcare has been highlighted in recent years. Contemporary literature provides a base for future research which must now concentrate on determining the effectiveness of nurse preparation for providing physical health care for people with mental disorder, determining the appropriate content for such preparation, and evaluating the effectiveness both in terms of nurse and patient- related outcomes. At the same time, developments are needed which are congruent with the needs and wants of patients.

Electronic supplementary material

The online version of this article (10.1186/s12912-019-0339-x) contains supplementary material, which is available to authorized users.

Tobacco Cessation Counseling: Attitudes and Practices among Yemeni Dental Professionals

Tobacco use is a significant health problem in Yemen and worldwide. Dental practitioners can play a pivotal role in educating their patients on the risk of smoking and motivating them to quit. This study aimed to assess the attitudes towards and practices of tobacco cessation counseling (TCC) among Yemeni dental professionals and to evaluate whether such attitudes and practices are associated with gender, smoking status, and years since graduation. In this cross-sectional study, a self-administered questionnaire containing questions regarding the practice and attitudes towards TCC in dental clinic was used. SPSS version 20 was used for data analysis. For statistical analysis, Chi-square test was used with a significance level of P < 0.05. Of the 400 distributed questionnaires, 182 were completed and analyzed. 53.3% of the respondents were males and 46.7% were females. Around one fifth of the respondents were smokers. The majority reported that they routinely ask their patients about their tobacco habits (83.5%), and advise against tobacco use (85%). Around half of the respondents believed that tobacco cessation intervention may affect their clinical practice and their income negatively through decreasing number of attending patients and believed that provision of dental treatment is more important than TCC. The majority (92%) believe that health professionals should refrain from tobacco, and 83% agree that TCC should be included in dental school curricula. Recent graduates and non-smokers showed relatively better attitudes and practices. There is an urgent need for continuing educational programs in TCC. Also, inclusion of TCC to dental curriculum is highly required.

Addressing smoking among people living with HIV: a cross-sectional survey of Australian HIV health practitioners' practices and attitudes

People living with HIV (PLHIV) have high rates of tobacco smoking, and smoking is a leading cause of premature mortality and morbidity. It is important to understand HIV healthcare providers' practices and attitudes towards addressing smoking with their patients. An online survey that measured: (i) use of the 5A framework for addressing smoking (Ask, Assess, Advise, Assist, Arrange) and (ii) attitudes and barriers to addressing smoking cessation was distributed by relevant professional bodies. Eligible participants were Australian health practitioners providing healthcare to PLHIV. Of the 179 respondents, most reported practising at least one of the 5As: Ask (94%); Assess (78%); Advise (82%); Assist (89%); and Arrange (73%). Practising the full 5A framework (completing at least one activity from each A) was less common (62%) and associated with having undertaken smoking cessation training (OR 2.1, CI 1.1-3.9), being a medical practitioner (OR 6.0, CI 3.1-11.6), having greater perceived knowledge and resources (OR 1.7, CI 1.3-2.4) and more positive attitudes (OR 1.5, CI 1.1-2.0). Common barriers to delivering cessation assistance related to knowledge and availability of resources. Development and greater dissemination of effective smoking cessation training and resources may be required to ensure healthcare practitioners have the capacity to complete all aspects of the 5A framework for smoking cessation and support their patients with HIV who smoke.

Australian mental health care practitioners' practices and attitudes for encouraging smoking cessation and tobacco harm reduction in smokers with severe mental illness

Reducing the burden of physical illness among people living with severe mental illnesses (SMI) is a key priority. Smoking is strongly associated with SMIs resulting in excessive smoking related morbidity and mortality in smokers with SMI. Smoking cessation advice and assistance from mental health practitioners would assist with reducing smoking and smoking-related harms in this group. This study examined the attitudes and practices of Australian mental health practitioners towards smoking cessation and tobacco harm reduction for smokers with SMI, including adherence to the 5As (ask, assess, advise, assist and arrange follow up) of smoking cessation. We surveyed 267 Australian mental health practitioners using a cross-sectional, online survey. Most practitioners (77.5%) asked their clients about smoking and provided health education (66.7%) but fewer provided direct assistance (31.1-39.7%). Most believed that tobacco harm reduction strategies are effective for reducing smoking related risks (88.4%) and that abstinence from all nicotine should not be the only goal discussed with smokers with SMI (77.9%). Many respondents were unsure about the safety (56.9%) and efficacy (39.3%) of e-cigarettes. Practitioners trained in smoking cessation were more likely (OR: 2.9, CI: 1.5-5.9) to help their clients to stop smoking. Community mental health practitioners (OR: 0.3, CI: 0.1-0.9) and practitioners who were current smokers (OR: 0.3, CI: 0.1-0.9) were less likely to adhere to the 5As of smoking cessation intervention. The results of this study emphasize the importance and need for providing smoking cessation training to mental health practitioners especially community mental health practitioners.

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.

Vaporised nicotine and tobacco harm reduction for addressing smoking among people living with HIV: A cross-sectional survey of Australian HIV health practitioners' attitudes

BACKGROUND

Tobacco smoking is a major cause of morbidity and mortality among people living with HIV (PLHIV). Due to the limited success of standard abstinence-focused smoking cessation strategies in this population, there is growing interest in tobacco harm reduction (THR) approaches as an additional strategy to address these high smoking rates. This study explored the attitudes of health practitioners who provide healthcare to PLHIV towards THR.

METHODS

179 Australian health practitioners who provide healthcare to PLHIV completed an online survey that measured their attitudes towards THR approaches, including switching from cigarettes to e-cigarettes or vaporised nicotine products (VNPs).

RESULTS

Respondents supported the concept of THR but were undecided on the role of VNPs. Respondents most commonly reported 'don't know' or 'undecided' responses to statements regarding VNPs. More respondents, however, agreed than disagreed that switching from smoking to long-term vaping could reduce risk (36% and 22% respectively) and be an effective strategy to help PLHIV to quit smoking (37% agree and 17% disagree). Only a minority of respondents (20%) agreed that VNPs are too harmful to recommend to patients, however around half (53%) were undecided.

CONCLUSIONS

Despite supporting the principle of THR, health practitioners may require more evidence and knowledge about VNPs before being willing to consider them as a suitable intervention strategy.

Tobacco cessation support among dentists: A cross-sectional survey in Saudi Arabia and Kuwait

INTRODUCTION

This study aims to explore the smoking prevalence among a sample of dentists working in two Gulf countries, and to assess the association between smoking habit and socio-professional factors affecting their attitude towards tobacco cessation activities, including barriers that prevent them from practicing such activities.

METHODS

This was a cross-sectional, online questionnaire-based, survey among dentists from Saudi Arabia and Kuwait, during summer 2016. The questionnaire consisted of questions on socio-professional characteristics, tobacco use and attitudes towards the adoption of tobacco cessation programs in dental practices. The questionnaire also enquired about the barriers to adoption of tobacco cessation. Descriptive statistics were used to describe demographic and smoking characteristics while cross tabulation with chi-square test was used to find out statistical significance of association between the groups (P≤0.05).

RESULTS

A total number of 466 responses were included in statistical analysis with 286 males (61.4%) and 180 females (38.6%), age ranged from 23 to 79 years (mean=32.7± 9.32). Most of the sample (N=437, 93.8%) indicated that the dentist has a vital role in educating patients on the health hazards of smoking. A positive attitude toward adoption of tobacco cessation campaigns was associated with older, more experienced, medically compromised, non-smoker dentists. The most frequently cited barrier to tobacco cessation was lack of time (39.2%).

CONCLUSIONS

Dentists who smoke are less likely to adopt smoking cessation campaigns in their clinics. More experienced dentists and those older than 40 years are more likely to engage in smoking cessation activities.

Free smoking cessation mobile apps available in Australia: a quality review and content analysis

OBJECTIVES

This review aimed to identify free, high-quality, smoking cessation mobile applications (apps) that adhere to Australian smoking cessation treatment guidelines.

METHODS

A systematic search of smoking cessation apps was conducted using Google. The technical quality of relevant apps was rated using the Mobile Application Rating Scale. The content of apps identified as high quality was assessed for adherence to smoking cessation treatment guidelines.

RESULTS

112 relevant apps were identified. The majority were of poor technical quality and only six 'high-quality' apps were identified. These apps adhered to Australian treatment guidelines in part. The efficacy of two apps had been previously evaluated.

CONCLUSIONS

In lieu of more substantial research in this area, it is suggested that the high-quality apps identified in this review may be more likely than other available apps to encourage smoking cessation. Implications for public health: Smoking cessation apps have the potential to address many barriers that prevent smoking cessation support being provided; however few high-quality smoking cessation apps are currently available in Australia, very few have been evaluated and the app market is extremely volatile. More research to evaluate smoking cessation apps, and sustained funding for evidence-based apps, is needed.

Effectiveness of Non-Primary Care-Based Smoking Cessation Interventions for Adults with Diabetes: A Systematic Literature Review

Diabetes is a chronic disease that affects over 25 million adults, many of whom are smokers. The negative health impact of diabetes and comorbid smoking is significant and requires comprehensive interdisciplinary management. The National Diabetes Education Program has identified specific providers, known as PPOD, who include pharmacists, podiatrists, optometrists, and dentists, as key individuals to improve diabetes-related clinical outcomes. These providers are encouraged to work together through interdisciplinary collaboration and to implement evidence-based strategies as outlined in the PPOD toolkit. The toolkit encourages healthcare providers to ask, advise, and assist patients in their efforts to engage in risk reduction and healthy behaviors, including smoking cessation as an important risk factor. While individual PPOD providers have demonstrated effective smoking cessation interventions in adults with other acute and chronic systemic diseases, they lack specific application and focus on adults with diabetes. This literature review examines the current role of PPOD providers in smoking cessation interventions delivered to adults with diabetes.

General Practitioners and Dentists: A Call for Action Against Tobacco

INTRODUCTION

To investigate the frequency of advice to quit smoking received by the Italian population from general practitioners (GP) and dentists, we analyzed a cross-sectional study.

METHODS

A face-to-face survey was conducted in 2014 on 3052 individuals, representative of the general Italian population aged 15 years or more.

RESULTS

During the previous year, 89% of individuals (82% of smokers) reported that they had visited a GP while 71% (67% of smokers) had visited a dentist. Among smokers, 25% reported that they had received advice to quit smoking from their GP, and 26% from their dentist. Advice by GPs was less frequently received by smokers with higher education (multivariate odds ratios (OR) were 0.48 for intermediate and 0.38 for high as compared to low education), and more frequently by heavy smokers (≥15 cigarettes/day; OR = 1.78), those with intention to quit (OR = 2.59), with previous quit attempts (OR = 2.09), and those aware of the existence of smoking cessation services (OR = 1.59). Advice by dentists was more frequently received by smokers aged 25-44 years (OR = 3.55 compared to those aged 15-24) and those with an intention to quit (OR = 2.46). Among Italian current smokers, 32% reported that their GP and 17% that their dentist was a current smoker. The corresponding figures among young smokers were 40% and 26%, respectively.

CONCLUSION

Healthcare providers have the potential to become a key reference point in the fight against smoking. However, before acting, GPs and dentists should set a good example: those who smoke should urgently quit or at least refrain from smoking during working hours.

IMPLICATIONS

GPs and dentists, reaching the large majority of Italian smokers, can make a major contribution in the fight against tobacco. Future studies are needed to investigate possible reasons of the apparently high smoking prevalence among GPs, in order to develop tailored smoking cessation interventions for healthcare providers.