Tobacco Quitlines: An Adjunct to Dental Interventions

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DESCRIPTION (provided by applicant): The proposed study will compare two methods for providing brief dental office-based interventions designed to help patients quit either cigarette smoking or smokeless tobacco use, and to compare these two dental office-based interventions with usual care. Although many dental practitioners now routinely incorporate the first two of the "5A's" (Ask and Advise) into their practice, and previous research indicates that brief office-based interventions are effective in producing modest tobacco quit rates for dental patients, dental practitioners continue to perceive a number of obstacles to routine provision of tobacco cessation services. Many dental practitioners still believe that counseling patients to quit an addictive behavior is beyond the scope of their training or comfort. Recent studies have shown that proactive phone counseling from State-sponsored telephone tobacco help lines has a positive effect on tobacco cessation. The use of these help lines offers a unique supplement to the dental professional that could reduce the burden on practitioner and enhance the likelihood of their patients' quitting. Referral to a specialist is within the common heuristic followed by dental and medical practitioners. Therefore, we believe referral to a telephone help line may be an innovative way of enabling dentists and dental hygienists to encourage and support their patients to quit tobacco. We propose to test two levels of intervention as compared to usual care in a randomized clinical trial in which 60 dental practices in Mississippi are randomized to one of three conditions. In one condition ("5A's"), the dental team will provide a brief office-based intervention that is modeled on the "5A' s" advocated by the Clinical Practice Guideline. In the second condition ("3A's" + THL), the dental team will provide the first three "A's" (Ask, Advise, Assess), and then refer patients to the State-supported telephone help line for provision of the cessation counseling and follow-up support. In the third condition (Usual Care), volunteering practices will ask their patients only to complete our study surveys. All consenting, tobacco-using patients aged 21 and older will be assessed at baseline, 6 weeks, 3 months, and 12 months following enrollment by mailed surveys and follow-up phone calls to non-responders. The primary outcome is self-reported consecutive quit at 3 and 12 months following intervention. Secondary outcomes are reduction in use, number of quit attempts at 3 and 12 months, and increases in readiness to quit. Dental practitioners will be assessed at baseline, and 3 and 12 months following the start of patient enrollment, to assess changes in tobacco cessation attitudes and behaviors. In addition, we will conduct an economic analysis to determine the relative cost effectiveness of each intervention.