Purpose. Tobacco use is the number one preventable cause of disease and premature death in the U.S. This includes both oral and systemic diseases. Approximately 21 percent of adults are current smokers, and 1,200 children and adolescents begin regular use of tobacco daily. The U.S. Public Health Service has a goal of cutting adult smoking rates in half. Healthcare providers, including dental clinicians, have an essential role in helping tobacco-using patients quit by providing tobacco cessation interventions. Educational institutions need to implement curriculum components to prepare graduates with the necessary knowledge, skills, and attitudes to effectively fulfill this role. The purpose of this study was to evaluate the implementation of a Tobacco Use Intervention Program into clinical dental hygiene education of second-year dental hygiene students at a community college.
Methods. In order to implement the Tobacco Use Intervention Program in the over-full and demanding curriculum, it was decided that the approach would focus on brief interventions such as the Ask, Advise, Refer model with tobacco-users and health promotion interventions with non-users of tobacco. The convenience sample included sixteen second-year dental hygiene students in their final semester treating patients. A control group was not available. The study used two survey instruments to answer three program evaluation questions. One survey used a pretest/posttest model, and the students completed them at the beginning and end of the clinical course to report their tobacco use interventions, related attitudes, and intentions to continue interventions with future patients. The other survey instrument was completed twice during the study semester by students upon completion of the treatment of two different patients.
Results. Cross-tabulations were used to demonstrate changes in students’ frequency of providing tobacco use cessation counseling to their patients. Increases outnumbered decreases for most interventions, particularly for simpler behaviors. Sign tests and chi-square tests used to assess the survey outcomes did not demonstrate statistical significance for this small sample for most of the intervention behaviors. The students began their final clinical course reporting fairly high comfort levels and confidence; comfort levels remained consistent, while confidence increased over the study semester. Intentions to continue particular intervention behaviors showed increases for simpler, initiating-type behaviors and decreases for more involved interventions.
Conclusion. The simplified Tobacco Use Intervention Program was successfully implemented. Dental hygiene students did provide brief tobacco cessation counseling and preventive interventions. The increases in behavior from before program initiation to afterward were too small to be statistically significant, possibly due to the small sample size. The data did not show that comfort level and confidence increased greatly, but the students started with high levels. Letting the students choose the patients for completion surveys allowed adaptation to various course constraints and provided formative feedback for students. However, it may have introduced bias which diminished the usefulness of that data. It does appear that the implementation of the simplified Tobacco Use Intervention Program did support students’ learning and provision of interventions for their patients. It is recommended that similar simplified programs be implemented in other dental hygiene programs. Longitudinal studies with program graduates should assess their implementation of the interventions in their professional practice. Combining successive groups of graduates would create a larger study sample that could be compared with groups of graduates from before program implementation, serving as a control.
Key Words: tobacco dependence, tobacco/smoking cessation, tobacco use intervention, Five A’s; Ask, Advise, Refer; telephone quitline, nicotine replacement therapy, behavior change counseling, patient education, health promotion, dental hygiene education, clinical education.