Tobacco 7 First Year

7/27/2019 Tobacco 7 First Year

1/6


2/6


3/6

May 2004 Journal of Dental Education 565

a member of their close family had used tobacco regu-

larly. The majority of respondents (94 percent) had

not received prior training in tobacco cessation pro-

motion.

Responses to items related to professional re-

sponsibility are shown in Table 1. Nearly all respon-

dents strongly agreed (80 percent) or agreed (19 per-cent) that it is the dental professionals responsibility

to educate patients about the oral health risks of to-

bacco use. A total of 81 percent of respondents

strongly agreed (42 percent) or agreed (39 percent)

that it is the dental professionals responsibility to

encourage patients to quit using tobacco. Nineteen

percent of respondents were neutral or disagreed that

it is the dental professionals responsibility to encour-

age patients to quit using tobacco.

Responses to items related to the scope of den-

tal practice are shown in Table 2. The majority of

respondents strongly agreed or agreed that it is withinthe scope of dental practice to ask patients if they

use tobacco (87 percent in total), to advise patients

to quit using tobacco (85 percent in total), to discuss

the health hazards of tobacco use (94 percent in to-

tal), and to discuss the benefits of stopping (91 per-

cent in total). Fewer respondents strongly agreed or

agreed that discussion of specific strategies for stop-

ping (70 percent) or prescription of nicotine gum (45percent) or patch (42 percent) is within the scope of

dental practice. The percentage of respondents who

strongly agreed that a specified service is within the

scope of dental practice varied widely. For example,

although 61 percent strongly agreed that discussion

of health hazards of tobacco use is within the scope

of dental practice, the percentage fell to 54 percent

for discussion of benefits of stopping, 34 percent for

discussion of specific strategies for stopping, and 15

percent for prescription of nicotine gum or patch.

Responses to items related to the effectiveness

of tobacco cessation activities in the dental settingare shown in Table 3. Sixty-nine percent of respon-

Table 1. Responses: professional responsibility items

Strongly Agree Agree Neutral Disagree Strongly DisagreeIt is the dental professionals responsibility to:

educate patients about the risks of tobacco userelated to overall health and well-being 52.2% 34.8% 10.1% 1.4% 1.4%

educate patients about the risks of tobacco userelated to oral health 79.6% 19% 0.7% 0 0.7%

encourage patients to quit using tobacco 42% 39.1% 10.1% 7.2% 1.4%

Table 2. Responses: scope of dental practice items

Strongly Agree Agree Neutral Disagree Strongly DisagreeIt is within the scope of dental practice to:

ask patients if they use tobacco 42% 44.9% 10.9% 2.2% 0

advise patients to quit using tobacco 37% 47.8% 10.1% 4.3% 0.7%

discuss health hazards of tobacco use 60.9% 32.6% 5.1% 0.7% 0.7%

discuss benefits of stopping 54.3% 37% 7.2% 1.4% 0

discuss specific strategies for stopping 34.1% 35.5% 20.3% 6.5% 3.6%

prescribe nicotine gum 15.3% 29.2% 35.8% 16.1% 3.6%

prescribe nicotine transdermal patch 14.7% 27.2% 36.8% 16.9% 4.4%

refer to cessation clinic or other health care professional 29.9% 40.1% 27% 2.2% 0.7%

Table 3. Responses: effectiveness items

Strongly Agree Agree Neutral Disagree Strongly DisagreeTobacco use cessation counseling offered in thedental office can have an impact on patients quitting. 19.6% 49.3% 29.7% 1.4% 0

The dental professionals time can be much betterspent doing things other than trying to reducetobacco use in patients. 5.1% 15.9% 28.3% 38.4% 12.3%

It is not worth discussing tobacco use with patientssince most people already know they should quit. 3.6% 7.2% 10.9% 51.4% 26.8%


4/6


5/6

May 2004 Journal of Dental Education 567

that the dental professionals time can be better spent

doing other things. These responses suggest that the

majority of students are positive about the extent to

which tobacco cessation promotion is effective in

helping patients to quit, but that some students may

have reservations about effectiveness.

Finally, incoming students interest in receiv-ing training is highly variable, ranging from signifi-

cant interest to no interest. Nearly one-quarter of re-

spondents were only slightly or not interested in

receiving tobacco cessation training. This may be

quite different in relation to many other topics in the

dental school curriculum. For example, if incoming

students were asked if they were interested in learn-

ing to diagnose carious lesions or to educate patients

about oral hygiene, it is likely that nearly 100 per-

cent would be very interested. Educators teaching

students tobacco cessation promotion skills may be

facing a somewhat different attitude among their stu-dents and must keep this in mind when designing

the curriculum.

The results of our survey of incoming dental

students are in many ways similar to the results of

Yip et al.s survey of senior students.14 Yip et al. sur-

veyed 302 senior dental students at a single institu-

tion to examine students attitudes toward smoking

cessation practice and to describe patterns of smok-

ing cessation counseling among the students. Senior

students attitudes toward tobacco prevention and

control practices in dental clinic settings were posi-

tive. For example, 71 percent agreed (somewhat or

strongly) that it is the dental professionals responsi-

bility to convince patients to quit. However, Yip et

al. also found that some students had reservations.

For example, 39 percent felt their time is better spent

on other practices besides tobacco cessation, and 83

percent felt that patient resistance is a barrier (some-

what or strong) to providing tobacco cessation ser-

vices. Yip et al. also found that, in general, attitudes

toward smoking cessation counseling practices and

barriers did not differ by gender, ethnicity, or cur-

rent smoking status, with a small number of excep-

tions. In addition, in general gender, ethnicity, and

current smoking status did not predict students ad-herence to smoking cessation practices.

What are the implications for curriculum de-

sign? The findings of this study suggest that there is

variation in dental students attitudes toward tobacco

cessation promotion. If the goal of tobacco cessa-

tion curricula is to influence students future clinical

practice behaviorsto produce practitioners who

incorporate tobacco cessation promotion as a rou-

tine component of dental practicethen instructors

must understand where students are starting from.

Attitudes, concerns, and reservations must be ac-

knowledged and addressed. It may be tempting to

ignore student resistance to a topic and simply presentthe facts to be memorized. However, if tobacco ces-

sation curricula are presented without acknowledg-

ment of students attitudes, beliefs, reservations, and

concerns, it is likely that students will listen quietly

but then fail to incorporate tobacco cessation pro-

motion as a part of their future clinical practice

behaviors.

Although lecture is a very efficient teaching

method for transmission of primarily factual mate-

rial, it may not be the most effective method for top-

ics in which attitudes play a significant role and vary

considerably within the class. For the didactic por-tion of tobacco cessation curricula, instructors may

want to experiment with the use of alternate teach-

ing methods, such as case-based discussion or small

group discussion. In this way, opportunities for de-

veloping awareness of ones own beliefs and atti-

tudes, as well as opportunities to hear other points of

view and approaches through discussion with peers

and faculty, can be provided.

Instructors must have clarity in their educa-

tional goals. Rollnick et al.16 suggest that, in facili-

tating behavior change, the goal is not to force people

to change, but to encourage dialogue and to help

people to begin to thinkabout changing their behav-

ior. Given the variability in students attitudes and

the reservations some students have, this concept is

relevant in the design of tobacco cessation curricula.

While some students will adopt tobacco cessation

promotion practices quite readily, others may hesi-

tate or resist doing so. An instructional approach that

encourages dialogue and ongoing examination of

motivations and concerns may ultimately be more

successful that an approach aimed at forcing com-

pliance.

In addition, given the marginal nature of some

students interest in tobacco cessation training, theinstitution must send a clear message that this is

something of value and is part of the role of the den-

tal professional. We must ensure that our informal

or hidden curriculum17 does not inadvertently nar-

row students understanding of their scope of prac-

tice. Ideally, tobacco cessation curricula should be


6/6

568 Journal of Dental Education Volume 68, Number 5

integrated throughout the dental school curriculum,

particularly in clinical activities. If mixed messages

are sent or if the tobacco cessation promotion cur-

riculum is partitioned in an isolated section of the

curriculum, it may be ineffective. The Surgeon

Generals Report on Oral Health in America empha-

sized the link between oral health and overall health,18and instructors need to reinforce that link, encourag-

ing students to conceive of their professional iden-

tity in a broad sense, as competent, knowledgeable,

caring health care providers who are interested in

the health behaviors that impact their patients oral

and overall well-being.

As Koerber et al.19 point out, dentists are called

upon to discuss health behavior changesoral home

care skills such as brushing and flossing, periodon-

tal treatment plans and recall programs, use of mouth

guards, dietary modificationswith patients every

day. As the mix of dental services delivered in theUnited States shifts toward a greater emphasis on

preventive services,20 the need for practitioners to

discuss health behaviors with patients will persist.

Enhanced health promotion skills, as cultivated in

tobacco cessation curricula, will apply to these other

areas as well and ultimately make students more ef-

fective practitioners. Again, we must help students

to make this link and encourage them to develop the

health promotion skills vital to effective clinical prac-

tice.

REFERENCES

1. Annual smoking-attributable mortality, years of poten-

tial life lost, and economic costs, United States, 1995-

1999. MMWR Morb Mortal Wkly Rep 2002;51(14):

300-3.

2. Tobacco effects in the mouth. NIH Publication No. 00-

3330. Washington, DC: U.S. Department of Health and

Human Services, Public Health Service, National Insti-

tutes of Health, National Institute of Dental Research,

National Cancer Institute, 2000.

3. Jansson L, Lavstedt S. Influence of smoking on marginal

bone loss and tooth lossa prospective study over 20

years. J Clin Periodontol 2002;29:750-6.

4. Mecklenburg RE. Tobacco prevention and control in den-

tal practice: the future. J Dent Educ 2001;65(4):375-84.

5. A clinical practice guideline for treating tobacco use and

dependence: a U.S. Public Health Service Report. JAMA

2000;283(24):3244-54.

6. Tomar SL, Husten CG, Manley MW. Do dentists and

physicians advise tobacco users to quit? J Am Dent Assoc

1996;127:259-65.

7. Albert D, Ward A, Ahluwalia K, Sadowsky D. Address-

ing tobacco in managed care: a survey of dentists knowl-edge, attitudes and behaviors. Am J Public Health

2002;92(6):997-1001.

8. Dolan TA, McGorray SP, Grinstead-Skigen CL,

Mecklenburg R. Tobacco control activities in U.S. dental

practices. J Am Dent Assoc 1997;128:1669-79.

9. Block DE, Block L, Hutton S, Johnson KM. Tobacco

counseling practices of dentists compared to other health

care providers in a midwestern region. J Dent Educ

1999;63(11):821-7.

10. Barker JG, Williams KB. Tobacco cessation activities in

U.S. dental and dental hygiene student clinics. J Dent Educ

1999;63(11):828-33.

11. Weaver RG, Whittaker L, Valachovic RW, Broom A. To-

bacco control and prevention efforts in dental education.

J Dent Educ 2002;66(3):426-9.12. Christen AG. Tobacco cessation, the dental profession,

and the role of dental education. J Dent Educ

2001;65(4):368-74.

13. Cabana MD, Rand CS, Powe NR, Wu AW, Wilson MH,

Abboud PC, Rubin HR. Why dont physicians follow

clinical practice guidelines? A framework for improve-

ment. JAMA 1999;282(15):1458-65.

14. Yip JK, Hay JL, Ostroff JS, Stewart RK, Cruz GD. Den-

tal students attitudes toward smoking cessation guide-

lines. J Dent Educ 2000;64(9):641-50.

15. Personal communcation, Dr. Richard Weaver, Center for

Educational Policy and Research, American Dental Edu-

cation Association, October 6, 2003.

16. Rollnick S, Mason P, Butler C. Health behavior change: aguide for practitioners. Philadelphia: Churchill

Livingstone, 2002.

17. Hafferty FW. Beyond curriculum reform: confronting

medicines hidden curriculum. Acad Med 1998;73(4):

403-7.

18. Oral health in American: a report of the surgeon general.

Rockville, MD: U.S. Department of Health and Human

Services, National Institute of Dental and Craniofacial

Research, National Institutes of Health, 2000.

19. Koerber A, Crawford J, OConnell K. The effects of teach-

ing dental students brief motivational interviewing for

smoking-cessation counseling: a pilot study. J Dent Educ

2003;67(4):439-47.

20. Seldin LW. The future of dentistry: an overview of a new

report. J Am Dent Assoc 2001;132:1667-77.

Documents

Tobacco 7 First Year