Opinions of South Carolina dental students toward tobacco use interventions

Are Iranian graduating dental students prepared to act as future role models of good oral health behaviour? A 10-year study

INTRODUCTION

Dentists by their professional knowledge of prevention have a key role in providing a positive role model for oral health-promoting behaviours. We aimed to investigate the health behaviour of Iranian senior dental students in terms of oral self-care and tobacco use during a 10-year period to assess their preparedness to act as role models for health-promoting behaviours.

MATERIALS AND METHODS

The study was performed in six dental schools selected through stratified cluster random sampling to have a representative sample of all dental schools in Iran. Data were collected in four occasions in 2005, 2008, 2011 and 2015. Senior dental students (N = 1188) were invited to voluntarily complete a self-administered anonymous questionnaire about their oral self-care and tobacco use. Recommended tooth-brushing habit (RTH) was defined as at least twice a day brushing with fluoridated toothpaste. Three separate questions about cigarette, pipe and waterpipe use were applied to assess the students' reported use of tobacco.

RESULTS

The response rate was 81%. Female students reported more frequently RTH than males (p < .001). The reported RTH was more prevalent among nonsmokers. In 2005, 2008, 2011 and 2015, 22.5%, 26%, 28.5% and 24.6% of the students reported smoking, respectively. The trend of reported smoking had the least variation among female students. This was true also for male students regarding RTH.

CONCLUSION

The status and trend of oral self-care and tobacco use among Iranian dental students call for more emphasis on adopting health-promoting behaviours during dental education.

Counselling as a Tool for Tobacco Cessation in a Dental Institution: Insights from India

Background: Tobacco related mortality and morbidity is a growing public health problem world over. Counselling has emerged as an important arsenal in the battle against tobacco. Involving experts other than traditional medical health workers may be critical. Aim of the present study was to explore various aspects related to Tobacco cessation counselling among Indian dental students. Methods: Overall, 241 undergraduate students from Manipal College of Dental Sciences, Mangalore participated in the present investigation. A structured, pretested, self-administered questionnaire was used to ascertain knowledge, attitude, behavior, perceived effectiveness and barriers and socio-demographic details. Willingness to counsel patients and undergo further training counselling was also assessed. Results: Mean knowledge, attitude, behavior, perceived effectiveness and barrier scores were 2.94 (±2.08), 51.84 (±5.63), 19.25 (±8.79), 16.17 (±1.96) and 42.39 (±5.65) respectively. Age was significantly correlated with knowledge; while year of study revealed significant correlations with knowledge and behavior (p<0.05). Lack of motivation, poor attitude of patients; lack of knowledge and skills emerged as barriers. Multiple logistic regression analysis indicated that year of study, attitude, behavior and barrier scores were significant predictors for respondents ever counselled their patients (p<0.05). Conclusions: Knowledge and behavior scores of the respondents towards Tobacco cessation counselling were low, but a majority of the subjects were willing to counsel and undergo training. Year of study, attitude, behavior and barrier scores emerged as significant predictors of counselling for Tobacco use. The present study has important policy implications and highlights curriculum changes in making Tobacco cessation counselling more relevant and effective among Indian dental students.

Dental Students' Attitudes Toward Tobacco Cessation in the Dental Setting: A Systematic Review

Many dental schools have integrated tobacco cessation into their predoctoral curricula. However, dental students' perceptions should be taken into consideration when designing those curricula. The aim of this study was to systematically review the published literature on dental students' attitudes and perceptions regarding tobacco cessation. The research team conducted a search for articles through April 2016 using the following electronic databases: Medline, PsychInfo, Cochrane Library, and CINAHL. Each abstract and/or article was reviewed for inclusion. Data were extracted from all included articles. Each was rated for quality appraisal by two reviewers. The initial search identified 2,035 articles, and 38 of those were included in the review. The majority were cross-sectional and sampled students from one dental school. There was wide variation in the measurement of dental student attitudes. Overall, the majority of students in these studies reported believing it is within the scope of dental practice to address tobacco use with patients, but there was variability in terms of the practice of specific tobacco cessation strategies. The most common perceived barrier was patient resistance/lack of motivation. In most of the studies, the majority of students were interested in being trained in tobacco cessation. The findings suggest that dental students will respond positively to receiving tobacco cessation education while in dental school and that educators should include strategies to help future dentists deal with patient resistance. Future studies should focus on the development of a validated measure of dental student attitudes toward tobacco cessation and longitudinal, multi-institutional research that can provide more generalizable findings.

Smoking Cessation Interventions Amongst New Zealand Dental Students: A Survey

Introduction:The NZ Government has set the goal of a smoke-free country by 2025. Research has shown that NZ dentists engage little in promotion of smoking cessation amongst their patients. The knowledge of, and attitudes towards, smoking cessation interventions of NZ dental students has not previously been reported.

Aims:To investigate smoking cessation intervention practices of clinical dental students and explore perceived barriers to their delivery.

Methods:A survey was conducted of all students in the three clinical years of the 5-year New Zealand dental training programme.

Results:The response rate was 73.7%. At least half of the participants did not recall the inclusion of smoking cessation intervention information in the curriculum. The majority (70.9%) used a routine protocol to identify smokers. Almost two-thirds felt that smoking cessation interventions are important, whilst two-fifths felt it is their duty as a health professional. Lack of knowledge and time were the most common barriers.

Conclusions:Although most dental students identify patients who smoke, the majority provide no cessation intervention services. This appears to be due to a lack of knowledge about available organisations and referral procedures. As future health professionals, dental students need better education in this area.

Opinions of dental students toward tobacco cessation intervention in the United Arab Emirates

OBJECTIVE

The objective of this study was to investigate the opinions of dental students, in one of the dental colleges in the United Arab Emirates (UAE), toward providing tobacco cessation interventions to their patients.

MATERIALS AND METHODS

Three-hundred-and-fifty students were administered a questionnaire including questions about tobacco cessation interventions (with a response rate of 77%). We generated descriptive statistics for all questions and examined the frequency distribution and percentages of all answers. Data were analysed using cross-tabulations and χ(2) -tests. The statistical significance was set at P < 0.05.

RESULTS

While 83.4% of students agreed that dentists should be trained in tobacco cessation, 56% of students disagreed that they are adequately trained to assist the patient in stopping tobacco use. As the year of study increased, the students' 'agree' responses increased to the statements that the dentist should be trained and that the dentist has a role in assisting patients to stop smoking. Non-Arab students were more confident than Emiratis in tobacco cessation counselling. The percentage of female students who felt greatly confident in assisting was double that of male students. There was a significant difference between tobacco-user students and non-users in response to the question about dentist's role in assisting tobacco cessation.

CONCLUSION

A comprehensive tobacco cessation education and training program should be included in dental schools' curriculum in the UAE to further improve student confidence in providing tobacco cessation services to their patients.

Educating Physical Therapist Students in Tobacco Cessation Counseling: Feasibility and Preliminary Outcomes

BACKGROUND

Smoking is the leading preventable cause of chronic disease and premature morbidity. People with physical disabilities experience elevated smoking prevalence when compared with their non-disabled peers. The physical therapy profession is dedicated to meeting needs of people with physical disabilities, yet most physical therapists (PT) do not typically provide tobacco cessation interventions. Similar deficits exist among other health professions, creating a demand for improved services to address smoking-related health burdens. Within other health professions, insufficient tobacco cessation counseling (TCC) education has been linked to a lack of interventions and may account for similar deficits in physical therapy practice.

STUDY PURPOSE

Goals were to assess feasibility, implementation, and results of a tailored TCC educational program for entry-level physical therapist (PT) students.

SUBJECTS

Two cohorts of entry-level physical therapist (PT) students (n = 12 and n = 17).

METHODS

Educational objectives were established based on prior review of the literature, a survey of national PT education programs, and clinical guidelines for TCC established by the United States Public Health Service (USPHS). Based on these objectives, the team designed a 3-hour workshop involving didactic content and problem-based skills practice. A pre- and post-test survey was used to measure 6 dimensions: knowledge, perceived barriers, perceived facilitators, self-efficacy, outcome expectations, and self-rated skill in TCC. Within each cohort, changes in score were compared using a paired t test. The ability to apply clinical guidelines for TCC was assessed using case scenarios and structured observation. These outcomes were selected based on the Theory of Reasoned Action, which states that future behavior is determined by intention to act. Intention to act is a product of knowledge, a positive balance between perceived barriers and facilitators, strong self-efficacy, favorable outcome expectations, and necessary skills. Student satisfaction with training was assessed through anonymous written feedback. Feasibility was based on cost analysis, including material resources, as well as faculty time and effort.

RESULTS

Following participation, both cohorts improved in knowledge, perceived facilitators, outcome expectations, and self-rated skill. Cohort 2 also showed an increase in self-efficacy (P < .01). Structured observation revealed competencies in application of clinical guidelines for case-based scenarios. Mean student satisfaction ratings for the educational experience were 5/5, and cost-estimate for delivery of the 3-hour educational intervention was approximately $32 per student.

CONCLUSIONS

This research study demonstrated feasibility and impact of an evidence-based curricular model designed to increase likelihood of TCC by future PTs by enhancing factors known to promote TCC behaviors. The program was well-received by students, and objectives were achieved through efficient use of faculty time and resources. Subsequent research should examine the effects of training on the provision of TCC within clinical settings, as well as the impact of TCC on smoking quit rates for patients who have received this intervention as a component of their physical therapy plan of care.

Tobacco cessation in India: how can oral health professionals contribute?

Tobacco use is described as the single most preventable cause of morbidity and mortality globally, with the World Bank predicting over 450 million tobacco-related deaths in the next fifty years. In India, the proportion of all deaths that can be attributed to tobacco use is expected to rise from 1.4% in 1990 to 13.3% in 2020 of which smoking alone will cause about 930,000 adult deaths by 2010. Many studies have shown that counseling from a health professional is an effective method of helping patients quit the tobacco habit. Tobacco cessation needs to be urgently expanded by training health professionals in providing routine clinical interventions, increasing availability and subsidies of pharmacotherapy, developing wide-reaching strategies such as quitlines, and cost- effective strategies, including group interventions. The WHO Framework Convention on Tobacco Control (FCTC) emphasizes the vital contribution of participation of health professional bodies, as well as training and healthcare institutions in tobacco control efforts. Dentists can play an important role in helping patients quit using tobacco. One of the key strategies to reduce tobacco-related morbidity and mortality is to encourage the involvement of health professionals in tobacco-use prevention and cessation counselling. The dental office is an ideal setting for tobacco cessation services since preventive treatment services, oral screening, and patient education have always been a large part of the dental practice.

Insights into the tobacco cessation scenario among dental graduates: an Indian perspective

INTRODUCTION

To curb the ever growing menace of tobacco and its ill effects, it is essential to prevent its usage. Dental professionals' contributions can be invaluable in this venture.

OBJECTIVES

To assess Indian dental graduates' knowledge, attitude and practices towards tobacco cessation; perceived effectiveness in pursuing tobacco cessation activities; perception of factors that interfere in tobacco cessation as barriers; and willingness to participate in tobacco cessation. Further, to determine associations among the aforementioned variables.

METHODOLOGY

All house surgeons in Manipal College of Dental Sciences, Manipal University, Mangalore were included in the study. A structured, pre-tested and self-administered questionnaire was employed to assess participants' knowledge, attitude, behavior, perceived effectiveness, perceived barriers and willingness to participate in tobacco cessation. Information regarding respondents' age, gender and residence was collected.

RESULTS

A total of 100 out of 103 respondents participated in the study. Mean knowledge, attitude, behavior, perceived effectiveness, perceived barrier scores were 17.6 ± 2.53 (73.2%), 72.1 ± 6.59 (90.2%), 28.3 ± 5.12 (67.4%), 13.3 ± 5.36 (53.16%) and 35.0 ± 3.79 (89.8%) respectively. Overall, 97% respondents were willing to participate in tobacco cessation activities. Correlation analysis revealed that knowledge was associated with attitude (r=0.36, p=0.00) and perceived barriers (r=0.34, p=0.00) and behavior was associated with perceived barriers (r=0.22, p=0.03).

CONCLUSIONS

Respondents reported high knowledge and attitude scores, along with high perceived barriers scores and willingness to participate in tobacco cessation activities. Present study highlights the need for a more meaningful involvement of dental professionals in tobacco cessation and has policy implications for curriculum changes regarding the same.

Impact of educational intervention on implementation of tobacco counselling among oral health professionals: a cluster-randomized community trial

OBJECTIVES

Tobacco use adversely affects oral health. Clinical guidelines recommend that oral health professionals promote tobacco abstinence and provide patients who use tobacco with brief tobacco use cessation counselling. Research shows that these guidelines are seldom implemented successfully. This study aimed to evaluate two interventions to enhance tobacco use prevention and cessation (TUPAC) counselling among oral health professionals in Finland.

METHODS

We used a cluster-randomized community trial to test educational and fee-for-service interventions in enhancing TUPAC counselling among a sample of dentists (n=73) and dental hygienists (n=22) in Finland. Educational intervention consisted of 1 day of training, including lectures, interactive sessions, multimedia demonstrations and a role play session with standard patient cases. Fee-for-service intervention consisted of monetary compensation for providing tobacco use prevention or cessation counselling. TUPAC counselling procedures provided were reported and measured using an electronic dental records system. In data analysis, intent-to-treat principles were followed at both individual and cluster levels. Descriptive analysis included chi-square and t-tests. A general linear model for repeated measures was used to compare the outcome measures by intervention group.

RESULTS

Of 95 providers, 73 participated (76.8%). In preventive counselling, there was no statistically significant time effect or group-by-time interaction. In cessation counselling, statistically significant group-by-time interaction was found after a 6-month follow-up (F=2.31; P=0.007), indicating that counselling activity increased significantly in intervention groups. On average, dental hygienists showed greater activity in tobacco prevention (F=12.13; P=0.001) and cessation counselling (F=30.19; P<0.001) than did dentists. In addition, cessation counselling showed a statistically significant provider-by-group-by-time interaction (F=5.95; P<0.001), indicating that interventions to enhance cessation counselling were more effective among dental hygienists.

CONCLUSIONS

Educational intervention yielded positive short-term effects on cessation counselling, but not on preventive counselling. Adding a fee-for-service to education failed to significantly improve TUPAC counselling performance. Other approaches than monetary incentives may be needed to enhance the effectiveness of educational intervention. Further studies with focus on how to achieve long-term changes in TUPAC counselling activity among oral health professionals are needed.

Tobacco cessation practices of senior dental students in Iran

OBJECTIVE

Tobacco use is prevalent in Iran, especially among men. The aim was to assess cessation practices and identify perceived barriers to delivery of tobacco cessation services by Iranian senior dental students.

DESIGN

Descriptive, cross-sectional study.

SETTING

Iran, Schools of Dentistry, 2009-2010.

PARTICIPANTS

370 (response rate 82%) officially registered senior dental students selected through stratified random sampling.

INTERVENTION

Students at 11 dental schools throughout the country completed the survey.

MAIN OUTCOME MEASURE

Students' practice of the US Clinical Practice Guideline 5 As (ask, advise, assess, assist, arrange); interest in training; intention and barriers addressing tobacco use in dental settings.

RESULTS AND CONCLUSIONS

Respondents were primarily female (67.8%). The students were far more likely to be actively involved in asking, advising and assessing patients to quit than in assisting and arranging. Most respondents (68.5%) agreed that it is within the scope of dental practice to help smokers quit. The most important barriers to providing cessation services included perceived patient resistance (44%) and lack of a supportive organisation (36%). This was the first assessment of approaches to tobacco users by dental students in Iran. Although there clearly is room for improvement, the interest of the students toward tobacco cessation is encouraging.

Oral cancer awareness among undergraduate dental students in Iran

The aim of this study was to assess undergraduate dental students' knowledge about prevention and detection of oral cancer in Tehran University of Medical Sciences (TUMS). A validated questionnaire which tested oral cancer awareness and procedure was given to 3rd to 6th year students of the dental faculty of TUMS. A total of 165 students participated in this survey. As expected, students of the final years showed greater knowledge of risk factors and clinical features of the disease. This study highlights for consideration regarding improvement to undergraduate dental education.

Smoking cessation advice: knowledge, attitude and practice among clinical dental students

OBJECTIVE

To examine knowledge, attitude and current practice among clinical dental students in giving smoking cessation advice (SCA) and to explore the barriers to this activity.

DESIGN AND SETTING

A self-administered questionnaire survey of clinical dental students at Cardiff University School of Dentistry.

MATERIALS AND METHODS

In 2008, clinical dental students were surveyed (n = 181). Information on smoking cessation practices, students' attitude, potential barriers and level of preparedness to deliver SCA, knowledge of association between tobacco use and various pathological conditions and demographics and tobacco use by clinical dental students were gathered.

RESULTS

One hundred and sixty-one (89%) students responded. All students enquired about patient smoking habits in the previous three months but were inconsistent in providing SCA--only one third of students gave SCA all or nearly all the time. Students had good knowledge of the associated health risks with tobacco use. A majority of students perceived barriers in providing patients with SCA. Those who provided advice were more likely to have positive attitudes and reported feeling adequately prepared.

CONCLUSIONS

Dental educators should address students' perceived barriers towards providing SCA when designing smoking cessation curricula in order to produce dentists who are confident and competent to provide this important health care intervention.

Oral cancer preventive practices of South Carolina dentists and physicians

The purpose of this study was to assess the South Carolina (SC) dentists' and physicians' oral cancer knowledge and practices and interest in training in oral cancer screening and tobacco cessation counseling. Method used was a cross-sectional survey of SC dentists and selected physician specialties with responses to mailed questionnaires summarized by descriptive statistics and chi-square tests for comparisons. Overall response rates were 58%for dentists and 44% for physicians. Dentists (81%) and 13% of the physicians reported conduct of oral cancer examinations at least half of the time over the past 12 months. Dentists (41%) and 83% of physicians assisted patients to quit smoking. Few dentists (19%) and 53% of physicians were aware of SC tobacco cessation resources. Dentists (40%) and physicians (37%) were interested in receiving training in oral cancer screening, and 36% and 49%, respectively, in training in tobacco cessation counseling. Results support the development of tailored education for SC dentists and physicians to achieve Healthy People 2010 Oral Health Objectives for Oral Cancer.

An international review of tobacco smoking among dental students in 19 countries

This study was conducted as a systematic review of all modern literature describing the prevalence of tobacco smoking among dental students. An electronic keyword search of appropriate terms was initially undertaken to identify relevant material, after which the reference lists of manuscripts were also examined to locate additional publications. A total of 27 studies from 19 countries were identified. The earliest manuscripts appeared in 1970, with the most recent being published in 2006. From a global perspective, our review suggests that tobacco smoking is relatively uncommon among contemporary dental students in Australia, Brazil, Canada, Great Britain and the United States. This is not surprising however, as it has previously been noted that dentists generally smoke at one of the lowest rates among all health professionals, and much lower than that of the communities in which they live. Somewhat discouragingly, we did find that smoking remains quite common among dental students in countries such as Greece, Serbia, Romania and Hungary. Given the fact that some of the student body continue to smoke tobacco, it is clear that more aggressive tobacco-specific measures should become a mandatory component of global dental education in future years.

Oral cancer prevention and early detection: using the PRECEDE-PROCEED framework to guide the training of health professional students

BACKGROUND

Teaching cancer prevention and detection is important in health professional education. It is desirable to select a comprehensive framework for teaching oral cancer (OC) prevention and detection skills.

METHODS

The PRECEDE-PROCEED model was used to design a randomized pretest and posttest study of the OC prevention and detection skills of dental students (n = 104). OC knowledge, opinions, and competencies were evaluated.

RESULTS

Second year students in the intervention group were more competent than those in the control group.

CONCLUSIONS

The novel use of PRECEDE-PROCEED sets a precedent for designing a standardized OC curriculum for a wide range of health professional disciplines.