Interventions for tobacco cessation in the dental setting.
Interventions for tobacco cessation in the dental setting.
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DOI：
10.1002/14651858.cd005084.pub3
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发表时间：
2012-06-13
影响因子：
8.4
通讯作者：
Ebbert, Jon
中科院分区：
文献类型：
--
作者：
Carr, Alan B.;Ebbert, Jon
关键词：
吸烟对口腔健康有很大的不良影响。牙科诊所或社区的口腔健康专业人员有一个独特的机会来提高烟草使用者的戒烟率。这项审查评估了由口腔健康专业人员提供的戒烟干预措施的有效性，并在牙科诊所或社区环境中向吸烟者和无烟烟草使用者提供干预。计算机检索Cochrane烟草成瘾组专门注册库(中央)、MEDLINE(1966-2011年11月)、EMBASE(1988-2011年11月)、CINAHL(1982-2011年11月)、Healthstar(1975-2011年11月)、Eric(1967-2011年11月)、QicINFO(1984-2011年11月)、国家技术信息服务数据库(NTIS，1964-2011年11月)、在线论文摘要(1861-2011年11月)、有效性评价摘要数据库(DARE，1995-2011年11月)和科学网(1993-2011年11月)。我们纳入了随机和伪随机临床试验，评估由口腔健康专业人员在牙科办公室或社区环境中进行的戒烟干预措施，并进行至少6个月的随访。两位作者独立审查了潜在纳入的摘要，并从纳入的试验中提取了数据。分歧通过协商一致得到解决。根据已报道的最严格的戒烟定义，主要结果是戒烟或所有烟草使用(对于无烟烟草使用者)在最长的随访时间内。这种影响被总结为赔率比，并在适当的情况下对集群进行了修正。使用I2统计量评估异质性，并在适当的情况下使用逆方差固定效应模型估计集合效应。14项临床试验符合纳入本综述的标准。包括评估牙科办公室或社区学校或大学环境中干预措施的有效性的研究。6项研究评估了无烟烟草(ST)使用者中干预措施的有效性，8项研究评估了吸烟者中的干预措施，其中6项涉及在牙科诊所环境中的成年吸烟者。所有的研究都采用了行为干预，只有一项研究需要药物治疗作为干预的组成部分。所有研究都包括口试部分。综合所有14项研究表明，口腔健康专业人员进行的干预可以在6个月或更长时间内增加戒烟率(优势比[OR]1.71，95%可信区间[CI]1.44至2.03)，但有证据表明存在异质性(I2=61%)。在针对吸烟者的干预分组中，异质性较小(I2=51%)，但主要归因于一项大型研究显示没有益处的证据。在这一小组中，有五项研究涉及成年吸烟者在牙科实践环境中。合并这些研究显示出明显的益处和最小的异质性(OR 2.38，95%CI 1.70至3.35，5项研究，I2=3%)，但这是一项后分组分析。在对无烟烟草使用者的研究中，异质性也归因于一项大型研究没有显示出受益的迹象，可能是由于干预溢出到对照大学；其他五项研究表明，对ST使用者的干预是有效的(OR 1.70；95%CI 1.36至2.11)。现有证据表明，由口腔健康专业人员在牙科办公室或社区环境中结合口腔检查部分进行的戒烟行为干预可能会增加吸烟者和无烟烟草使用者的戒烟率。研究之间的差异限制了就应该纳入临床实践的干预成分提出结论性建议的能力，然而，行为咨询(通常是简短的)与口头检查相结合是一种始终如一的干预成分，也在一些对照组中提供。
Tobacco use has significant adverse effects on oral health. Oral health professionals in the dental office or community setting have a unique opportunity to increase tobacco abstinence rates among tobacco users. This review assesses the effectiveness of interventions for tobacco cessation delivered by oral health professionals and offered to cigarette smokers and smokeless tobacco users in the dental office or community setting. We searched the Cochrane Tobacco Addiction Group Specialized Register (CENTRAL), MEDLINE (1966-November 2011), EMBASE (1988-November 2011), CINAHL (1982-November 2011), Healthstar (1975-November 2011), ERIC (1967-November 2011), PsycINFO (1984-November 2011), National Technical Information Service database (NTIS, 1964-November 2011), Dissertation Abstracts Online (1861-November 2011), Database of Abstract of Reviews of Effectiveness (DARE, 1995-November 2011), and Web of Science (1993-November 2011). We included randomized and pseudo-randomized clinical trials assessing tobacco cessation interventions conducted by oral health professionals in the dental office or community setting with at least six months of follow-up. Two authors independently reviewed abstracts for potential inclusion and abstracted data from included trials. Disagreements were resolved by consensus. The primary outcome was abstinence from smoking or all tobacco use (for users of smokeless tobacco) at the longest follow-up, using the strictest definition of abstinence reported. The effect was summarised as an odds ratio, with correction for clustering where appropriate. Heterogeneity was assessed using the I2 statistic and where appropriate a pooled effect was estimated using an inverse variance fixed-effect model. Fourteen clinical trials met the criteria for inclusion in this review. Included studies assessed the efficacy of interventions in the dental office or in a community school or college setting. Six studies evaluated the effectiveness of interventions among smokeless tobacco (ST) users, and eight studies evaluated interventions among cigarette smokers, six of which involved adult smokers in dental practice settings. All studies employed behavioral interventions and only one required pharmacotherapy as an interventional component. All studies included an oral examination component. Pooling all 14 studies suggested that interventions conducted by oral health professionals can increase tobacco abstinence rates (odds ratio [OR] 1.71, 95% confidence interval [CI] 1.44 to 2.03) at six months or longer, but there was evidence of heterogeneity (I2 = 61%). Within the subgroup of interventions for smokers, heterogeneity was smaller (I2 = 51%), but was largely attributable to a large study showing no evidence of benefit. Within this subgroup there were five studies which involved adult smokers in dental practice settings. Pooling these showed clear evidence of benefit and minimal heterogeneity (OR 2.38, 95% CI 1.70 to 3.35, 5 studies, I2 = 3%) but this was a posthoc subgroup analysis. Amongst the studies in smokeless tobacco users the heterogeneity was also attributable to a large study showing no sign of benefit, possibly due to intervention spillover to control colleges; the other five studies indicated that interventions for ST users were effective (OR 1.70; 95% CI 1.36 to 2.11). 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.