Evaluation of a dental office tobacco cessation program: effects on smokeless tobacco use. Smokeless tobacco cessation intervention for college athletes: results after 1 year. Making the most of a teachable moment: a smokeless-tobacco cessation intervention in the dental office. Tobacco use quitline enrollment through dental practices: a pilot study. Smokeless tobacco cessation in military personnel: a randomized controlled trial. Using the hygiene visit to deliver a tobacco cessation program: results of a randomized clinical trial. Spit (Smokeless) Tobacco Intervention for High School Athletes: results after 1 year. Intensive smoking-cessation intervention in the dental setting. Tobacco cessation via public dental clinics: results of a randomized trial. Cluster-Randomized Controlled Trial of An Athletic Trainer-Directed Spit (Smokeless) Tobacco Intervention for Collegiate Baseball Athletes: Results After 1 Year. A randomised controlled trial of a smoking cessation intervention delivered by dental hygienists: a feasibility study. Do faxed quitline referrals add value to dental office-based tobacco-use cessation interventions? Comparison of a high and a low intensity smoking cessation intervention in a dentistry setting in Sweden: a randomized trial.
We describe a randomized trial designed to evaluate the effectiveness of a smokeless tobacco cessation intervention delivered by dental hygienists as part of a patient's regularly scheduled cleaning visit. Seventy-five practices were randomized to continue their usual care (n=25; 239 smokeless tobacco using patients enrolled) or to receive training to provide a tobacco cessation intervention (n=50; 394 smokeless tobacco using patients enrolled). Patient reports indicated that the training program was successful in getting hygienists to implement the intervention. The intervention produced a strong effect on sustained quitting for smokeless tobacco users but had no impact on secondary outcomes, including unsuccessful quit attempts, future intent to quit using smokeless tobacco, and change in readiness to quit using. Frequency of smokeless tobacco use and receipt of specific components of the intervention, including the video and written materials, predicted sustained cessation. Since this intervention was delivered by dental hygienists as part of a patient's regularly scheduled cleaning visit, it is easily disseminable. The purpose of this study was to determine the efficacy of a college-based smokeless tobacco cessation intervention targeting college athletes.
                Sixteen colleges were matched for prevalence of smokeless tobacco use in their combined baseball and football teams and randomly assigned within college pairs to the intervention or the control group. One-year prevalence of cessation among smokeless tobacco users was determined by self-report of abstinence for the previous 30 days. Differences between groups were analyzed in a weighted version of the Fisher 1-sided permutation test for paired samples after adjustment for significant predictors of quitting other than the intervention (i.e., smokeless tobacco uses per week and most frequently used brand).
                Cessation prevalences were 35% in the intervention colleges and 16% in the control colleges when subjects with unknown quit status were defined as nonquitters. After adjustment for other significant predictors of quitting, the difference of 19% increased to 21%. The intervention effect increased with level of smokeless tobacco use.
                This intervention was effective in promoting smokeless tobacco cessation, especially among those who were more frequent users. Primary care medical clinics are good settings for smoking interventions. This study extends this strategy with a smokeless tobacco intervention delivered by dentists and dental hygienists in the course of routine dental care.
                Male users of moist snuff and chewing tobacco (n = 518) were identified by questionnaire in clinic waiting rooms and then randomly assigned to either usual care or intervention. The intervention included a routine oral examination with special attention to the part of the mouth in which tobacco was kept and an explanation of the health risks of using smokeless tobacco. After receiving unequivocal advice to stop using tobacco, each patient viewed a 9-minute videotape, received a self-help manual, and was briefly counseled by the dental hygienist.
                Long-term success was defined as no smokeless tobacco use at both 3- and 12-month follow-ups, with those lost to follow-up counted as smokeless tobacco users. The intervention increased the proportion of patients who quit by about one half (12.5% vs 18.4%, P < .05).
                These results demonstrate the efficacy of a brief dental office intervention for the general population of smokeless tobacco users. Time and resource constraints limit the ability of oral health care professionals to help patients quit smoking. Opportunities exist for dental providers to help patients who smoke by enrolling them in tobacco use quitlines. The authors conducted a pilot study to investigate whether such referrals were feasible and effective.
                The authors randomly assigned eight general dental practices to provide either brief counseling regarding smoking cessation or brief counseling along with referrals to a tobacco use quitline for patients receiving routine dental hygiene care who reported that they were currently smoking cigarettes.
                The authors enrolled 82 patients (60 in the tobacco use quitline group, 22 in the brief counseling group). At six months, the self-reported, seven-day point prevalence tobacco use abstinence rates were 25.0 percent (15 of 60 patients) in the tobacco use quitline group and 27.3 percent (six of 22 patients) in the brief-counseling group (P approximately 1.0). Twenty-eight (47 percent) of 60 subjects in the tobacco use quitline group completed the initial tobacco use quitline consultation. Abstinence rates among subjects in the quitline group were higher if they completed more telephone consultations.
                Referral to a tobacco use quitline by dental practices is a feasible strategy for helping patients quit smoking if efficient links between the dental practice and the tobacco use quitline can be established. Research is needed to evaluate whether it is more effective than standard clinical interventions for tobacco use cessation.
                Dental practitioners with limited time and other resources can assist patients who smoke by referring them to a tobacco use quitline. Military personnel are twice as likely as civilians to use smokeless tobacco (ST). This study evaluated the efficacy of a minimal-contact ST cessation program in military personnel.
                Participants were recruited from 24 military dental clinics across the United States during annual dental examinations. Participants were 785 active-duty military personnel who were randomly assigned to receive a minimal-contact behavioral treatment (n = 392) or usual care (n = 393). The behavioral treatment included an ST cessation manual, a videotape cessation guide tailored for military personnel, and three 15-min telephone counseling sessions using motivational interviewing methods. Usual care consisted of standard procedures that are part of the annual dental examination, including recommendations to quit using ST and referral to extant local tobacco cessation programs. Participants were assessed at 3 and 6 months after enrollment.
                Participants in the ST cessation program were significantly more likely to be abstinent from all tobacco, as assessed by repeated point prevalence at both 3 and 6 months (25.0%), and were significantly more likely to be abstinent from ST use for 6 months, as assessed by prolonged abstinence (16.8%), compared with participants in usual care (7.6% and 6.4%, respectively).
                These results indicate that a minimal-contact behavioral treatment can significantly reduce ST use in military personnel and has the potential for widespread dissemination. If ST users were identified in dental visits and routinely referred to telephone counseling, this could have a substantial benefit for the health and well-being of military personnel. To examine the effectiveness of advising patients who use tobacco to quit, the authors conducted a randomized clinical trial to test a brief office-based intervention with all tobacco users in 75 fee-for-service dental practices in Oregon. The authors found that the dental hygienist-delivered intervention was effective in getting smokeless tobacco users to quit at three and 12 months and to sustain abstinence at both three and 12 months. They found that the program was not effective for cigarette smokers. The authors discuss the public health implications of program dissemination and widespread program adoption. To determine the efficacy of a spit tobacco (ST) intervention designed to promote ST cessation and discourage ST initiation among male high school baseball athletes.
                This study was a cluster-randomized controlled trial. Forty-four randomly selected high schools in rural California were randomized within strata (prevalence of ST use and number and size of baseball teams) to either the intervention or the control group. Ninety-three percent of eligible baseball athletes participated, yielding 516 subjects in 22 intervention schools and 568 subjects in 22 control schools. Prevalences of sustained ST cessation and ST use initiation over 1 year were assessed by self-report. Multivariate logistic regression models for clustered responses were used to test the null hypotheses of no association between group and the two outcomes, adjusted for the stratified design and baseline imbalances between groups in significant predictors of ST use.
                Prevalence of cessation was 27% in intervention high schools and 14% in control high schools (odds ratio (OR)=2.29; 95% confidence interval (CI), 1.36-3.87). The intervention was especially effective in promoting cessation among those who, at baseline, lacked confidence that they could quit (OR=6.4; 95% CI, 1.0-4.3), among freshmen (OR=15; 95% CI, 0.9-260), and among nonsmokers (OR=3.2; 95% CI, 0.9-11). There was no significant difference between groups in the prevalence of ST initiation.
                This intervention was effective in promoting ST cessation, but was ineffective in preventing initiation of ST use by nonusers. Smoking exerts detrimental effects on dental treatment and oral health. Our goal was to evaluate effectiveness in terms of the abstinence rate in smoking-cessation intervention delivered by dental professionals. Individuals who were willing to quit smoking were randomly assigned to either an intervention or a non-intervention group. Intensive intervention was provided, consisting of 5 counseling sessions, including an additional nicotine replacement regimen. Reported abstinence was verified by the salivary cotinine level. Thirty-three persons in the intervention and 23 in the non-intervention group started the trial. On an intent-to-treat basis, 3-, 6- and 12-month continuous abstinence rates in the intervention group were 51.5%, 39.4%, and 36.4%, respectively, while the rates in the non-intervention group were consistent at 13.0%. Adjusted odds ratios (95% confidence interval) by logistic stepwise regression analyses were 7.1 (1.8, 28.5), 8.9 (1.7, 47.2), and 6.4 (1.3, 30.7), respectively. Intensive smoking-cessation intervention in the dental setting was therefore effective. We sought to compare the effectiveness of a dental practitioner advice and brief counseling intervention to quit tobacco use versus usual care for patients in community health centers on tobacco cessation, reduction in tobacco use, number of quit attempts, and change in readiness to quit.
                We randomized 14 federally funded community health center dental clinics that serve diverse racial/ethnic groups in 3 states (Mississippi, New York, and Oregon) to the intervention (brief advice and assistance, including nicotine replacement therapy) or usual care group.
                We enrolled 2549 smokers. Participants in the intervention group reported significantly higher abstinence rates at the 7.5-month follow-up, for both point prevalence (F(1,12) = 6.84; P < .05) and prolonged abstinence (F(1,12) = 14.62; P < .01) than did those in the usual care group.
                The results of our study suggest the viability and effectiveness of tobacco cessation services delivered to low-income smokers via their dental health care practitioner in community health centers. Tobacco cessation services delivered in public dental clinics have the potential to improve the health and well-being of millions of Americans. Context: Athletes in the United States are at high risk for using spit (smokeless) tobacco (ST) and incurring its associated adverse health effects.Objective: To examine whether an athletic trainer-directed ST intervention could decrease initiation and promote cessation of ST use among male collegiate baseball athletes.Design: Stratified, cluster-randomized controlled trial.Setting: Fifty-two California colleges.Patients or Other Participant(s): A total of 883 subjects in 27 intervention colleges and 702 subjects in 25 control colleges participated, as did 48 certified athletic trainers.Intervention(s): For college athletic trainers and associated dental professionals, a 3-hour video conference, and for collegiate athletes, an oral cancer screening with feedback and brief counseling during the preseason health screenings, athletic trainer support for cessation, and a peer-led educational baseball team meeting.Main Outcome Measure(s): The subjects' ST use over 1 year was assessed by self-report. At the end of the study, the certified athletic trainers were mailed a survey assessing their tobacco use and perceptions and behavior related to tobacco control in the athletic environment. We used multivariable logistic regression models for clustered responses (generalized estimating equations) to test the difference between groups in ST-use initiation and cessation and to identify significant overall predictors of noninitiation and cessation of ST use.Results: Of the 1585 athletes recruited, 1248 (78.7%) were followed up at 12 months. In addition, 48 of the 52 athletic trainers (92%) responded to the 1-year follow-up survey. The ST-use initiation (incidence) was 5.1% in intervention colleges and 8.4% in control colleges (generalized estimating equation odds ratio = 0.58, 95% confidence interval = 0.35-0.99). Predictors of ST noninitiation were low lifetime tobacco and monthly alcohol use (odds ratio = 1.98, 95% confidence interval = 1.40- 2.82) and athletic trainers' report that the baseball coach supported ST-use prevention activities (odds ratio = 1.43, 95% confidence interval = 1.11-1.83). Although at 1 year, cessation of ST use was relatively high in both groups (36%), we noted no significant difference between the groups (odd ratio = 0.94, 95% confidence interval = 0.70-1.27).Conclusions: The intervention was significantly effective in preventing incident ST use but did not significantly increase cessation beyond that seen in the control group. The latter finding is inconsistent with previous studies and may be explained by spillover of the intervention to control colleges, other anti-tobacco activity in control colleges, and/or the small sample of dependent ST users enrolled in the study. Tobacco use continues to be a global public health problem. Helping patients to quit is part of the preventive role of all health professionals. There is now increasing interest in the role that the dental team can play in helping their patients to quit smoking. The aim of this study was to determine the feasibility of undertaking a randomised controlled smoking cessation intervention, utilising dental hygienists to deliver tobacco cessation advice to a cohort of periodontal patients.
                One hundred and eighteen patients who attended consultant clinics in an outpatient dental hospital department (Periodontology) were recruited into a trial. Data were available for 116 participants, 59 intervention and 57 control, and were analysed on an intention-to-treat basis. The intervention group received smoking cessation advice based on the 5As (ask, advise, assess, assist, arrange follow-up) and were offered nicotine replacement therapy (NRT), whereas the control group received 'usual care'. Outcome measures included self-reported smoking cessation, verified by salivary cotinine measurement and CO measurements. Self-reported measures in those trial participants who did not quit included number and length of quit attempts and reduction in smoking.
                At 3 months, 9/59 (15%) of the intervention group had quit compared to 5/57 (9%) of the controls. At 6 months, 6/59 (10%) of the intervention group quit compared to 3/57 (5%) of the controls. At one year, there were 4/59 (7%) intervention quitters, compared to 2/59 (4%) control quitters. In participants who described themselves as smokers, at 3 and 6 months, a statistically higher percentage of intervention participants reported that they had had a quit attempt of at least one week in the preceding 3 months (37% and 47%, for the intervention group respectively, compared with 18% and 16% for the control group).
                This study has shown the potential that trained dental hygienists could have in delivering smoking cessation advice. While success may be modest, public health gain would indicate that the dental team should participate in this activity. However, to add to the knowledge-base, a multi-centred randomised controlled trial, utilising biochemical verification would be required to be undertaken. The Ask, Advise, Refer (AAR) model of intervening with patients who use tobacco promotes a brief office-based intervention plus referral to a tobacco quitline. However, there is little evidence that this model is effective. The primary aim of this study was to evaluate the effects on patients' tobacco use of two levels of a dental office-based intervention compared with usual care.
                The authors randomly assigned 68 private dental clinics to one of three conditions: 5 As (Ask, Advise, Assess, Assist, Arrange); 3 As (AAR model); or usual care, and they enrolled 2,160 participants.
                At the 12-month assessment, compared with those in usual care, participants in the two intervention conditions combined were more likely to report cessation of tobacco use, as measured by nine-month prolonged abstinence (3 percent versus 2 percent; F(1,66) = 3.97, P < .10) and 12-month point prevalence (12 percent versus 8 percent; F(1,66) = 7.32, P < .01). There were no significant differences between participants in the clinics using the 5 As and 3 As strategies.
                The results of this study are inconclusive as to whether referrals to a quitline add value to brief dental office-based interventions. Patients receiving telephone counseling quit tobacco use at higher rates, but only a small percentage of those proactively referred actually received counseling.
                The results confirm those of previous research: that training dental practitioners to provide brief tobacco-use cessation advice and assistance results in a change in their behavior, and that these practitioners are effective in helping their patients to quit using tobacco. Tobacco is still the number one life style risk factor for ill health and premature death and also one of the major contributors to oral problems and diseases. Dentistry may be a potential setting for several aspects of clinical public health interventions and there is a growing interest in several countries to develop tobacco cessation support in dentistry setting. The aim of the present study was to assess the relative effectiveness of a high intensity intervention compared with a low intensity intervention for smoking cessation support in a dental clinic setting.
                300 smokers attending dental or general health care were randomly assigned to two arms and referred to the local dental clinic for smoking cessation support. One arm received support with low intensity treatment (LIT), whereas the other group was assigned to high intensity treatment (HIT) support. The main outcome measures included self-reported point prevalence and continuous abstinence (> or = 183 days) at the 12-month follow-up.
                Follow-up questionnaires were returned from 86% of the participants. People in the HIT-arm were twice as likely to report continuous abstinence compared with the LIT-arm (18% vs. 9%, p = 0.02). There was a difference (not significant) between the arms in point prevalence abstinence in favour of the HIT-protocol (23% vs. 16%). However, point prevalence cessation rates in the LIT-arm reporting additional support were relatively high (23%) compared with available data assessing abstinence in smokers trying to quit without professional support.
                Screening for willingness to quit smoking within the health care system and offering smoking cessation support within dentistry may be an effective model for smoking cessation support in Sweden. The LIT approach is less expensive and time consuming and may be appropriate as a first treatment option, but should be integrated with other forms of available support in the community. The more extensive and expensive HIT-protocol should be offered to those who are unable to quit with the LIT approach in combination with other support.
                Trial registration number: NCT00670514.
Available evidence suggests that behavioral interventions for tobacco cessation conducted by oral health professionals incorporating an oral examination component in the dental office or community setting may increase tobacco abstinence rates among both cigarette smokers and smokeless tobacco users. Differences between the studies limit the ability to make conclusive recommendations regarding the intervention components that should be incorporated into clinical practice, however, behavioral counselling (typically brief) in conjunction with an oral examination was a consistent intervention component that was also provided in some control groups.