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Holliday R, Hong B, McColl E, Livingstone-Banks J, Preshaw PM. Interventions for tobacco cessation delivered by dental professionals. Cochrane Database Syst Rev 2021; 2:CD005084. [PMID: 33605440 PMCID: PMC8095016 DOI: 10.1002/14651858.cd005084.pub4] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Dental professionals are well placed to help their patients stop using tobacco products. Large proportions of the population visit the dentist regularly. In addition, the adverse effects of tobacco use on oral health provide a context that dental professionals can use to motivate a quit attempt. OBJECTIVES To assess the effectiveness, adverse events and oral health effects of tobacco cessation interventions offered by dental professionals. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group's Specialised Register up to February 2020. SELECTION CRITERIA We included randomised and quasi-randomised clinical trials assessing tobacco cessation interventions conducted by dental professionals in the dental practice or community setting, with at least six months of follow-up. DATA COLLECTION AND ANALYSIS Two review authors independently reviewed abstracts for potential inclusion and extracted data from included trials. We resolved disagreements by consensus. The primary outcome was abstinence from all tobacco use (e.g. cigarettes, smokeless tobacco) at the longest follow-up, using the strictest definition of abstinence reported. Individual study effects and pooled effects were summarised as risk ratios (RR) and 95% confidence intervals (CI), using Mantel-Haenszel random-effects models to combine studies where appropriate. We assessed statistical heterogeneity with the I2 statistic. We summarised secondary outcomes narratively. MAIN RESULTS Twenty clinical trials involving 14,897 participants met the criteria for inclusion in this review. Sixteen studies assessed the effectiveness of interventions for tobacco-use cessation in dental clinics and four assessed this in community (school or college) settings. Five studies included only smokeless tobacco users, and the remaining studies included either smoked tobacco users only, or a combination of both smoked and smokeless tobacco users. All studies employed behavioural interventions, with four offering nicotine treatment (nicotine replacement therapy (NRT) or e-cigarettes) as part of the intervention. We judged three studies to be at low risk of bias, one to be at unclear risk of bias, and the remaining 16 studies to be at high risk of bias. Compared with usual care, brief advice, very brief advice, or less active treatment, we found very low-certainty evidence of benefit from behavioural support provided by dental professionals, comprising either one session (RR 1.86, 95% CI 1.01 to 3.41; I2 = 66%; four studies, n = 6328), or more than one session (RR 1.90, 95% CI 1.17 to 3.11; I2 = 61%; seven studies, n = 2639), on abstinence from tobacco use at least six months from baseline. We found moderate-certainty evidence of benefit from behavioural interventions provided by dental professionals combined with the provision of NRT or e-cigarettes, compared with no intervention, usual care, brief, or very brief advice only (RR 2.76, 95% CI 1.58 to 4.82; I2 = 0%; four studies, n = 1221). We did not detect a benefit from multiple-session behavioural support provided by dental professionals delivered in a high school or college, instead of a dental setting (RR 1.51, 95% CI 0.86 to 2.65; I2 = 83%; three studies, n = 1020; very low-certainty evidence). Only one study reported adverse events or oral health outcomes, making it difficult to draw any conclusions. AUTHORS' CONCLUSIONS There is very low-certainty evidence that quit rates increase when dental professionals offer behavioural support to promote tobacco cessation. There is moderate-certainty evidence that tobacco abstinence rates increase in cigarette smokers if dental professionals offer behavioural support combined with pharmacotherapy. Further evidence is required to be certain of the size of the benefit and whether adding pharmacological interventions is more effective than behavioural support alone. Future studies should use biochemical validation of abstinence so as to preclude the risk of detection bias. There is insufficient evidence on whether these interventions lead to adverse effects, but no reasons to suspect that these effects would be specific to interventions delivered by dental professionals. There was insufficient evidence that interventions affected oral health.
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Affiliation(s)
- Richard Holliday
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Bosun Hong
- Oral Surgery Department, Birmingham Dental Hospital, Birmingham, UK
| | - Elaine McColl
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | - Philip M Preshaw
- School of Dental Sciences, Newcastle University, Newcastle upon Tyne, UK
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Neumann AS, Kumar SV, Bangar S, Kookal KK, Spallek H, Tokede B, Simmons K, Even J, Mullins J, Mertz E, Yansane A, Obadan-Udoh E, White JM, Walji MF, Kalenderian E. Tobacco screening and cessation efforts by dental providers: A quality measure evaluation. J Public Health Dent 2019; 79:93-101. [PMID: 30566752 PMCID: PMC6570416 DOI: 10.1111/jphd.12298] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 09/12/2018] [Accepted: 10/22/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVES The purpose of this study was to adapt, test, and evaluate the implementation of a primary care "Preventive care and Screening" meaningful use quality measure for tobacco use, in dental institutions. We determined the percentage of dental patients screened for tobacco use, and the percentage of tobacco users who received cessation counseling. METHODS We implemented the dental quality measure (DQM), in three dental schools and a large dental accountable care organization. An automated electronic health record (EHR) query identified patients 18 years and older who were screened for tobacco use one or more times within 24 months, and who received cessation counseling intervention if identified as a tobacco user. We evaluated EHR query performance with a manual review of a subsample of charts. RESULTS Across all four sites, in the reporting calendar year of 2015, a total of 143,675 patients met the inclusion criteria for the study. Within 24 months, including 2014 and 2015 calendar years, percentages of tobacco screening ranged from 79.7 to 99.9 percent, while cessation intervention percentages varied from 1 to 81 percent among sites. By employing DQM research methodology, we identified intervention gaps in clinical practice. CONCLUSIONS We demonstrated the successful implementation of a DQM to evaluate screening rates for tobacco use and cessation intervention. There is substantial variation in the cessation intervention rates across sites, and these results are a call for action for the dental profession to employ tobacco evidence-based cessation strategies to improve oral health and general health outcomes.
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Affiliation(s)
- Ana S Neumann
- Department of General Dentistry and Dental Public Health. University of Texas Health Science Center, School of Dentistry at Houston, 7500 Cambridge, Houston, TX, 77054
| | - Shwetha V Kumar
- Department of Diagnostic and Biomedical Sciences, Technology Services and Informatics. University of Texas Health Science Center, School of Dentistry at Houston, 7500 Cambridge, Houston, TX, 77054
| | - Suhasini Bangar
- Department of Diagnostic and Biomedical Sciences, Technology Services and Informatics. University of Texas Health Science Center, School of Dentistry at Houston, 7500 Cambridge, Houston, TX, 77054
| | - Krishna K Kookal
- Technology Services and Informatics. University of Texas Health Science Center, School of Dentistry at Houston, 7500 Cambridge, Houston, TX, 77054
| | - Heiko Spallek
- The University of Sydney. Faculty of Dentistry. 1 Mons Road, Westmead, NSW, 2145 Australia
| | - Bunmi Tokede
- Department of Oral Health Policy and Epidemiology. Harvard School of Dental Medicine. 188 Longwood Avenue, Boston, MA 02115
| | - Kristen Simmons
- Willamette Dental Group. 6950 NE Campus Way. Hillsboro, OR 97124
| | - Joshua Even
- Willamette Dental Group. 6950 NE Campus Way. Hillsboro, OR 97124
| | - Joanna Mullins
- Willamette Dental Group. 6950 NE Campus Way. Hillsboro, OR 97124
| | - Elizabeth Mertz
- Department of Preventive & Restorative Dental Sciences University of California San Francisco School of Dentistry. 707 Parnassus Ave., San Francisco, CA 94143
| | - Alfa Yansane
- Department of Preventive & Restorative Dental Sciences University of California San Francisco School of Dentistry. 707 Parnassus Ave., San Francisco, CA 94143
| | - Enihomo Obadan-Udoh
- Department of Preventive & Restorative Dental Sciences University of California San Francisco School of Dentistry. 707 Parnassus Ave., San Francisco, CA 94143
| | - Joel M White
- Department of Preventive & Restorative Dental Sciences University of California San Francisco School of Dentistry. 707 Parnassus Ave., San Francisco, CA 94143
| | - Muhammad F Walji
- Department of Diagnostic and Biomedical Sciences, Technology Services and Informatics. University of Texas Health Science Center, School of Dentistry at Houston, 7500 Cambridge, Houston, TX, 77054
| | - Elsbeth Kalenderian
- Department of Preventive & Restorative Dental Sciences University of California San Francisco School of Dentistry. 707 Parnassus Ave., San Francisco, CA 94143
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McIsaac JL, Warner G, Lawrence L, Urquhart R, Price S, Gahagan J, McNally M, Jackson LA. The application of implementation science theories for population health: A critical interpretive synthesis. AIMS Public Health 2018; 5:13-30. [PMID: 30083567 PMCID: PMC6070464 DOI: 10.3934/publichealth.2018.1.13] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Accepted: 02/07/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND AND PURPOSE Over the last decade, the field of implementation science (IS) has yielded an array of theoretical approaches to clarify and understand how factors influence the application and scaling-up of evidence-based practice in health care. These developments have led to questions about whether IS theories and frameworks might be of value to population health researchers and decision makers. The purpose of this research was to conduct a critical interpretive synthesis to explore, if, and how, key IS theories and frameworks might inform population health interventions aimed at reducing the burden of illness across populations. METHODS An initial list of theories and frameworks was developed based on previous published research and narrowed to focus on theories considered as formative for the field of IS. A standardized data extraction form was used to gather key features of the theories and critically appraise their relevance to population health interventions. RESULTS Ten theories were included in the review and six deemed most applicable to population health based on their consideration of broader contextual and system-level factors. The remaining four were determined to have less relevant components for population health due to their limited consideration of macro-level factors, often focusing on micro (individual) and meso (organizational) level factors. CONCLUSIONS Theories and frameworks are important to guide the implementation and sustainability of population health interventions. The articulation of meso level factors common in IS theories may be of value to interventions targeted at the population level. However, some of the reviewed theories were limited in their consideration of broader contextual factors at the macro level (community, policy or societal). This critical interpretive synthesis also found that some theories lacked provision of practical guidance to address interventions targeting structural factors such as key social determinants of health (e.g., housing, income).
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Affiliation(s)
- Jessie-Lee McIsaac
- Healthy Populations Institute, Dalhousie University, Canada
- Faculty of Education, Mount Saint Vincent University, Canada
| | - Grace Warner
- Healthy Populations Institute, Dalhousie University, Canada
- Faculty of Health, Dalhousie University, Canada
| | - Logan Lawrence
- Healthy Populations Institute, Dalhousie University, Canada
- Faculty of Health, Dalhousie University, Canada
| | - Robin Urquhart
- Healthy Populations Institute, Dalhousie University, Canada
- Faculty of Medicine, Dalhousie University, Canada
| | - Sheri Price
- Healthy Populations Institute, Dalhousie University, Canada
- Faculty of Health, Dalhousie University, Canada
| | - Jacqueline Gahagan
- Healthy Populations Institute, Dalhousie University, Canada
- Faculty of Health, Dalhousie University, Canada
| | - Mary McNally
- Healthy Populations Institute, Dalhousie University, Canada
- Faculty of Medicine, Dalhousie University, Canada
- Faculty of Dentistry, Dalhousie University, Canada
| | - Lois A Jackson
- Healthy Populations Institute, Dalhousie University, Canada
- Faculty of Health, Dalhousie University, Canada
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Diniz-Freitas M, Insua A, Keat R, Fricain JC, Catros S, Monteiro L, Silva L, Lodi G, Pispero A, Albuquerque R. Web-Based Information on the Treatment of Tobacco Dependence for Oral Health Professionals: Analysis of English-Written Websites. J Med Internet Res 2017; 19:e349. [PMID: 29054831 PMCID: PMC5670309 DOI: 10.2196/jmir.8174] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 08/09/2017] [Accepted: 09/07/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Studies have been conducted on the content and quality of Web-based information for patients who are interested in smoking cessation advice and for health care practitioners regarding the content of e-learning programs about tobacco cessation. However, to the best of our knowledge, there is no such information about the quality of Web-based learning resources regarding smoking cessation dedicated to oral health professionals. OBJECTIVE The aim of this study was to identify and evaluate the quality of the content of webpages providing information about smoking cessation for oral health care professionals. METHODS Websites were identified using Google and Health on Net (HON) search engines using the terms: smoking cessation OR quit smoking OR stop smoking OR 3As OR 5As OR tobacco counselling AND dentistry OR dental clinic OR dentist OR dental hygienist OR oral health professionals. The first 100 consecutive results of the 2 search engines were considered for the study. Quality assessment was rated using the DISCERN questionnaire, the Journal of the American Medical Association (JAMA) benchmarks, and the HON seal. In addition, smoking cessation content on each site was assessed using an abbreviated version of the Smoke Treatment Scale (STS-C) and the Smoking Treatment Scale-Rating (STS-R). To assess legibility of the selected websites, the Flesch Reading Ease (FRES) and the Flesch-Kinkaid Reading Grade Level (FKRGL) were used. Websites were also classified into multimedia and nonmultimedia and friendly and nonfriendly usability. RESULTS Of the first 200 sites selected (100 of Google and 100 of HON), only 11 met the inclusion criteria and mainly belonged to governmental institutions (n=8), with the others being prepared by Professional Associations (n=2) and nonprofit organizations (n=1). Only 3 were exclusively dedicated to smoking cessation. The average score obtained with the DISCERN was 3.0, and the average score in the FKRGL and FRES was 13.31 (standard deviation, SD 3.34) and 40.73 (SD 15.46), respectively. Of the 11 websites evaluated, none achieved all the four JAMA benchmarks. The mean score of STS-R among all the websites was 2.81 (SD 0.95) out of 5. A significant strong positive correlation was obtained between the DISCERN mean values and the STS-R (R=.89, P=.01). CONCLUSIONS The mean quality of webpages with information for oral health care professionals about smoking cessation is low and displayed a high heterogeneity. These webpages are also difficult to read and often lack multimedia resources, which further limits their usefulness.
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Affiliation(s)
- Márcio Diniz-Freitas
- School of Medicine and Dentistry, University of Santiago de Compostela, Santiago de Compostela, Spain.,Medical-Surgical Dentistry Research Group (OMEQUI), Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Angel Insua
- School of Medicine and Dentistry, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Ross Keat
- Birmingham Dental Hospital, School of Dentistry, University of Birmingham, Birmingham, United Kingdom
| | | | - Sylvain Catros
- Department of Dentistry, University of Bordeaux, Bordeaux, France
| | - Luis Monteiro
- Department of Medicine and Oral Surgery, University Institute of Health Sciences (IUCS), CESPU, Gandra, Portugal.,Institute of Research and Advanced Training in Health Sciences and Technologies (IINFACTS), CESPU, Gandra, Portugal
| | - Luis Silva
- Institute of Research and Advanced Training in Health Sciences and Technologies (IINFACTS), CESPU, Gandra, Portugal
| | - Giovanni Lodi
- Dipartimento di Scienze Biomediche Chirurgiche e Odontoiatriche, University of Milan, Milan, Italy
| | - Alberto Pispero
- Dipartimento di Scienze Biomediche Chirurgiche e Odontoiatriche, University of Milan, Milan, Italy
| | - Rui Albuquerque
- Birmingham Dental Hospital, School of Dentistry, University of Birmingham, Birmingham, United Kingdom
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Beyond intention-to-treat: The effect of brief counseling for tobacco cessation in secondary analyses of a cluster randomized controlled trial in Swedish dental clinics. Contemp Clin Trials Commun 2017; 5:92-99. [PMID: 29740626 PMCID: PMC5936699 DOI: 10.1016/j.conctc.2017.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 11/04/2016] [Accepted: 01/14/2017] [Indexed: 11/22/2022] Open
Abstract
In experimental studies the assigned intervention measures the received intervention if full protocol adherence is achieved, but this is rarely the case in public health. The objective of this study was to estimate the effect of a brief counseling intervention delivered in Swedish dental clinics on tobacco use cessation, taking non-adherence into account. We conducted three secondary analyses. In a per-protocol analysis the experimental counseling delivered as intended was contrasted to usual care (control). In an as-treated analysis individuals were compared according to the counseling components actually received, disregarding randomization. In an instrumental variable analysis the effect of the intervention among those who would always be treated as assigned was estimated. Logistic regression was used to examine the association between tobacco cessation outcomes (seven-day abstinence, three-month abstinence, half-reduction, quit attempts) and the defined exposure to the intervention. Protocol adherence in the intervention group was 73.4%. The per-protocol analysis closely replicated the results of the intention-to-treat analysis, showing a statistically significant effect of the brief counseling on the reduction in tobacco consumption OR = 1.81, 95% CI [1.06, 3.07], but no significant effect for other outcomes. In the as-treated analysis, receiving more counseling components compared with no tobacco counseling increased the likelihood of half-reduction. The instrumental variable yielded biased results. We conclude that despite application problems, conducting per-protocol, as-treated and instrumental variable analyses in randomized trials where experimental conditions are not strictly standardized strengthens and puts in context the inference based on intention-to-treat analysis.
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Sohanpal R, Rivas C, Steed L, MacNeill V, Kuan V, Edwards E, Griffiths C, Eldridge S, Taylor S, Walton R. Understanding recruitment and retention in the NHS community pharmacy stop smoking service: perceptions of smoking cessation advisers. BMJ Open 2016; 6:e010921. [PMID: 27388355 PMCID: PMC4947750 DOI: 10.1136/bmjopen-2015-010921] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To understand views of pharmacy advisers about smoker recruitment and retention in the National Health Service community pharmacy stop smoking programme. DESIGN Thematic framework analysis of semistructured, in-depth interviews applying the Theoretical Domains Framework and COM-B behaviour change model. We aimed to identify aspects of adviser behaviour that might be modified to increase numbers joining and completing the programme. PARTICIPANTS 25 stop smoking advisers (13 pharmacists and 12 support staff). SETTING 29 community pharmacies in 3 inner east London boroughs. RESULTS Advisers had preconceived ideas about smokers likely to join or drop out and made judgements about smokers' readiness to quit. Actively recruiting smokers was accorded low priority due in part to perceived insufficient remuneration to the pharmacy and anticipated challenging interactions with smokers. Suggestions to improve smoker recruitment and retention included developing a more holistic and supportive approach using patient-centred communication. Training counter assistants were seen to be important as was flexibility to extend the programme duration to fit better with smokers' needs. CONCLUSIONS Cessation advisers feel they lack the interpersonal skills necessary to engage well with smokers and help them to quit. Addressing advisers' behaviours about active engagement and follow-up of clients, together with regular skills training including staff not formally trained as cessation advisers, could potentially boost numbers recruited and retained in the stop smoking programme. Adjustments to the pharmacy remuneration structure to incentivise recruitment and to allow personalisation of the programme for individual smokers should also be considered.
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Affiliation(s)
- Ratna Sohanpal
- Asthma UK Centre for Applied Research, Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Carol Rivas
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Liz Steed
- Asthma UK Centre for Applied Research, Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | | | - Valerie Kuan
- Asthma UK Centre for Applied Research, Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Elizabeth Edwards
- Asthma UK Centre for Applied Research, Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Chris Griffiths
- Asthma UK Centre for Applied Research, Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Sandra Eldridge
- Asthma UK Centre for Applied Research, Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Stephanie Taylor
- Asthma UK Centre for Applied Research, Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Robert Walton
- Asthma UK Centre for Applied Research, Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Virtanen SE, Zeebari Z, Rohyo I, Galanti MR. Evaluation of a brief counseling for tobacco cessation in dental clinics among Swedish smokers and snus users. A cluster randomized controlled trial (the FRITT study). Prev Med 2015; 70:26-32. [PMID: 25445335 DOI: 10.1016/j.ypmed.2014.11.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 11/02/2014] [Accepted: 11/10/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The aim of this study is to assess the effectiveness of a very brief structured counseling for tobacco cessation in dentistry clinics. METHOD A cluster randomized trial was conducted in Sweden in 2012-2013. Twenty-seven dentistry clinics in two Swedish counties were randomized to provide either a structured brief advice based on the 5 A's model or usual care. Participants were 467 patients currently using tobacco daily (225 in the intervention group and 242 in usual care), of which 97% were retained at follow-up, six months after enrolment. Study outcomes were: 7-day abstinence (primary outcome); 3-month sustained abstinence; 50% reduction of the amount tobacco used; quit attempts lasting at least 24h. RESULTS Compared to usual care, brief counseling was not associated to statistically significant increase in the proportion abstinent from tobacco use after 6months. However, there was a statistically significant association with reduction of tobacco consumption (OR=2.07 95% CI 1.28-3.35). Changes in the expected direction for all outcomes were more frequent in the intervention than in the usual care group, and larger among exclusive snus users than among smokers. CONCLUSIONS Very brief and structured counseling in dentistry may achieve positive behavioral modifications among tobacco users, with significant reduction of tobacco consumption, particularly among smokeless tobacco users.
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Affiliation(s)
- Suvi E Virtanen
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
| | - Zangin Zeebari
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; Centre for Epidemiology and Community Medicine, Stockholm Health Care District, Sweden.
| | - Izla Rohyo
- Dentistry Clinic Solvändan, Sörmland Health Care Region, Mariefred, Sweden.
| | - Maria R Galanti
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; Centre for Epidemiology and Community Medicine, Stockholm Health Care District, Sweden.
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Ostroff JS, Li Y, Shelley DR. Dentists United to Extinguish Tobacco (DUET): a study protocol for a cluster randomized, controlled trial for enhancing implementation of clinical practice guidelines for treating tobacco dependence in dental care settings. Implement Sci 2014; 9:25. [PMID: 24559178 PMCID: PMC3936874 DOI: 10.1186/1748-5908-9-25] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 02/12/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND 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. METHODS/DESIGN 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. DISCUSSION 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.
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Affiliation(s)
- Jamie S Ostroff
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10022, USA
| | - Yuelin Li
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10022, USA
| | - Donna R Shelley
- Department of Population Health, New York University School of Medicine, 227 East 30th Street, 7th floor, New York, NY 10016, USA
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