Background: Tobacco dependence treatment efforts have focused on primary care physicians (PCPs), but evidence suggests that they are insufficient to help most smokers quit. Other health professionals also frequently encounter smokers, but their smoking prevalence, cessation practices, and beliefs are less well known. Methods: The study included 2,804 subjects from seven health professional groups: PCPs, emergency medicine physicians, psychiatrists, registered nurses, dentists, dental hygienists, and pharmacists. Outcomes included self-reported smoking status, smoking cessation practices, and beliefs. Multivariate regression was used to examine factors associated with health professionals (except pharmacists) self-reportedly performing the "5 A's": asking, advising, assessing, assisting, or arranging follow-up about tobacco. Results: Health professionals have a low smoking prevalence (<6%), except nurses (13%). Many health professionals report asking (87.3%-99.5%) and advising (65.6%-94.9%) about smoking but much less assessing smokers' interest (38.7%-84.8%), assisting (16.4%―63.7%), and arranging follow-up (1.3%-23.1%). Controlling for health professional and practice demographics, factors positively associated in the multivariate analyses with self-reportedly performing multiple components of the 5 A's include awareness of the Public Health Service guidelines, having had cessation training, and believing that treatment was an important professional responsibility. Negative associations include the health professional being a current smoker, not being a PCP, being uncomfortable asking patients if they smoke, believing counseling was not an appropriate service, and reporting competing priorities. Conclusion: U.S. health professionals report not fully performing the 5 A's. The common barriers and facilitators identified may help inform strategies for increasing the involvement of all health professionals in conducting tobacco dependence treatments.

/pdf/national-survey-of-u-s-health-professionals-smoking-11euhw7o04.pdf

National survey of U.S. health professionals’ smoking prevalence, cessation practices, and beliefs

Background Results of previous studies demonstrated the effectiveness of chairside medical screening by dentists to identify patients at increased risk of experiencing cardiovascular-associated events. In this study, the authors assessed dentists' attitudes, willingness and perceived barriers regarding chairside medical screening in the dental office. Methods A national, random sample of U.S. general dentists was surveyed by mail by means of an anonymous questionnaire that involved a five-point Likert scale (1 = very important/very willing; 5 = very unimportant/very unwilling). Friedman nonparametric analysis of variance was used to compare response items within each question. Results Of 1,945 respondents, most were male (82.3 percent), white (85.7 percent) and 40 to 60 years old (59.4 percent) and had practiced for more than 10 years (84.5 percent). The majority thought it was important for dentists to conduct screening for hypertension (85.8 percent), cardiovascular disease (76.8 percent), diabetes mellitus (76.6 percent), hepatitis (71.5 percent) and human immunodeficiency virus infection (68.8 percent). Respondents were willing to refer patients for consultation with physicians (96.4 percent), collect oral fluids for salivary diagnostics (87.7 percent), conduct medical screenings that yield immediate results (83.4 percent) and collect blood via finger stick (55.9 percent). Respondents were significantly more willing ( P P Conclusions Dentists considered medical screening important and were willing to incorporate it into their practices. Additional education and practical implementation strategies are necessary to address perceived barriers. Clinical Implications The findings of this study regarding chairside medical screening may lead to changes in our approach to dental education and may help define the practice of dentistry in the future.

https://jada.ada.org/article/S0002-8177(14)62216-9/pdf

Dentists' attitudes toward chairside screening for medical conditions

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World Journal of Pharmaceutical Sciences

Rationale Relative to other regions in the USA, Mississippi has a high prevalence of tobacco use and tobacco-related disease. This study assessed the tobacco-related knowledge, attitudes and intervention behaviours of family doctors, dentists and nurse practitioners in the state of Mississippi.



Methods  The Provider Attitude Survey, an 85-item measure of tobacco-related knowledge, attitudes and intervention behaviours was mailed to all members of Mississippi's Family Medicine, Dentistry and Nurse Practitioner professional organizations (N = 2043).



Results  Over one-third (n = 802, 39.2%) of eligible providers responded. Just 24.3% had received training in tobacco cessation and 33.7% were aware of the Public Health Service clinical practice guideline. Over 90% indicated that it was their role to prevent tobacco use; felt rewarded when they helped patients quit; and were bothered and upset by the health effects of tobacco. Doctors assisted more patients than nurses or dentists. Doctors and nurses reported more self-efficacy, motivation and preparedness for treating tobacco use than dentists. Providers with training performed more interventions and reported more self-efficacy, preparedness and fewer barriers than those without training. Training was associated with greater increases in self-efficacy, preparedness and intervention behaviours for dentists than for the other groups.



Conclusions  Despite a high prevalence of tobacco use and tobacco-related disease in Mississippi, primary care providers in Mississippi provide tobacco cessation interventions at an unacceptably low frequency relative to other regions. Training is likely to increase the frequency of intervention behaviours.

A survey of tobacco-related knowledge, attitudes and behaviours of primary care providers in Mississippi.

Author(s): Prakash, Preeti; Belek, Marilynn G; Grimes, Barbara; Silverstein, Steven; Meckstroth, Richard; Heckman, Barbara; Weintraub, Jane A; Gansky, Stuart A; Walsh, Margaret M | Abstract: ObjectiveThis study assessed attitudes, behaviors, and barriers among general dentists in California, Pennsylvania, and West Virginia, related to patient tobacco cessation counseling.MethodsFrom 2004 to 2008, a baseline survey was mailed to 271 study dentists randomly selected from a master Delta Dental Insurance Company provider list in each state who had agreed to participate in a tobacco cessation randomized clinical trial. Four backward logistic regression models assessed correlates of the five As related to tobacco cessation: Asking about tobacco use, Advising users to quit, Assessing readiness to quit, Assisting with quitting, and Arranging follow-up.ResultsMost respondents (n=265) were male, had practiced dentistry for over 15 years, asked about tobacco use (74%), and advised tobacco users to quit (78%). Only 19% assessed readiness to quit; 39% assisted with quitting; 4% arranged follow-up; and 42% had formal training in tobacco cessation. Believing that tobacco cessation counseling was an important professional responsibility, practicing l15 years, and asking about tobacco use significantly related to advising users to quit. Providing cessation advice and feeling effective intervening related to assessing readiness to quit. Advising users to quit, assessing readiness to quit, feeling effective intervening, and having had formal tobacco cessation training related to assisting with quitting. Barriers to cessation counseling were perceived patient resistance (66%), lack of insurance reimbursement (56%), not knowing where to refer (49%), and lack of time (32%).ConclusionStudy dentists reported not fully performing the five As. Advising, assessing, having formal training, and feeling effective increased the likelihood of cessation counseling.

/pdf/dentists-attitudes-behaviors-and-barriers-related-to-tobacco-2811jvyzwo.pdf

Dentists’ attitudes, behaviors, and barriers related to tobacco-use cessation in the dental setting

Tobacco cessation knowledge, attitudes, and behaviors of dentists participating in a large national managed care dental plan were assessed using a mailed survey. The survey was administered to dentists recruited to participate in an evaluation of a CD-ROM and supportive electronic detailing to promote increased tobacco cessation activities. General dentists who met specific technological criteria, had an active E-mail account, and at least 200 adult patients were eligible to participate in this study. A total of 184 dentists, located in 29 states, agreed to participate. The survey instrument included questions that addressed (a) Ask, Advise, Assess, Assist, and Arrange behaviors, (b) self-efficacy including knowledge, confidence, and success regarding tobacco cessation, (c) success of various tobacco cessation strategies, (d) barriers to tobacco cessation, and (e) demographics including year of graduation, gender, and race/ethnicity. Self-reported baseline tobacco intervention-related behaviors were low, with 28% of dentists reporting that they asked their patients about tobacco or recorded tobacco use in their patients' charts at least 41% of the time. For Advise behavior, approximately half of the dentists advised tobacco-using patients to quit at least 41% of the time. Although self-reported lack of knowledge was high, 71% of respondents indicated that their lack of knowledge was either not a barrier or a slight barrier to incorporating tobacco cessation into their practices. The survey revealed that dentists do not routinely incorporate tobacco cessation into their practices. Newer information-transfer technologies may serve as vehicles for increased smoking cessation activities by dentists.

Tobacco attitudes, practices, and behaviors: a survey of dentists participating in managed care

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Tobacco attitudes, practices, and behaviors: a survey of dentists participating in managed care