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Tobacco Use Screening and Advice to Quit
By James Padilla
(Tobacco Use Prevention and Control (TUPAC) Program Epidemiologist),
Humphrey Costello and Jessica Roberts
(TUPAC Evaluators, Wyoming Survey & Analysis Center).
Introduction
Although the prevalence of cigarette smoking continues a
steady decline, it is still the leading preventable cause of death,
killing about 480,000 people in the U.S. and 2,600 in New
Mexico annually. One in five New Mexico adults still smoke
cigarettes, which is about 300,000 people. Most smokers want
to quit using tobacco but struggle in succeeding, often making
many attempts before quitting for good. Dental providers can
play an important role in their patients’ efforts in quitting to-
bacco, especially because many smokers see their dental care
providers regularly and there are risks for oral disease from
tobacco use.
According to the U.S. Public Health Service Guideline,
Treat-
ing Tobacco Use and Dependence
, there is strong evidence that
health care providers who deliver tobacco dependence treat-
ment (the 5As—Ask, Advise, Assess, Assist, Arrange) can pro-
duce significant and sustained reductions in patient tobacco
use.
1
The U.S. Health and Human Services
Healthy People
2020
, for the first time, included goals for improving tobacco
screening and cessation counseling in dental care settings.
2
Nationally, among smokers who saw a dental care provider
(dentist or hygienist), in the past year, about 12% reportedly
received advice to quit smoking (vs. 51% who reportedly re-
ceived this advice from a medical doctor).
3
Dental providers
were more likely to advise smokers who were male, aged 45-
64, non-Hispanic White, covered by insurance other than
Medicare or Medicaid, or smoked more than half a pack daily.
A separate national study of dentists showed that more than
90% of dentists reported routinely asking patients about to-
bacco use, that 76% counsel patients, and 45% routinely of-
fer cessation assistance (cessation counseling referral, prescrip-
tion, or both).
4
Provision of cessation assistance was more
likely to be reported among dentists who work in a practice
with one or more hygienists, have a chart system that includes
a tobacco use question, have received training on treating to-
bacco dependence, or have positive attitudes toward treating
tobacco use.
Methods
In Spring 2014, the Tobacco Use Prevention and Control
Program (TUPAC) in the NM Department of Health commis-
sioned a randomized telephone survey (n=1,035) that included
questions about a variety of tobacco-related topics, including
questions about whether people are asked about their tobacco
use by their health care providers. Smokers were also asked if
they are advised to quit by their health care providers.
The sample for the survey consisted of phone numbers drawn
from both cell phones and landlines, with an oversampling
of the cell numbers to ensure sufficient completions in hard-
to-reach populations of interest. For the landline sample, 159
surveys were completed for a 14.3% response rate. For the
cellular sample, 876 surveys were completed for a 10.7% re-
sponse rate. After the completion of the data collection, the
data were weighted so the results would be representative of
the NM adult population. The weight does not change a re-
spondent’s answers.
The researchers used Pearson’s chi-squared tests to assess
whether differences in outcomes across priority populations
were statistically significant with 95% confidence.
Results
Seeing a dental care provider
: Among NM adults, 63.4%
reportedly saw a dental care provider (dentist or dental hy-
gienist) in the past 12 months, and a similar number (63.3%)
reported seeing a doctor, nurse, physician assistant, or nurse
practitioner, which will hereafter be referred to as “other
health care providers.”
[Figure 1]
shows that young adults (18-29 years) were more
likely to have seen a dental care provider to get care in the past
12 months at 71.7%, compared to older adults (30 years+) at
60.6%. It also shows that adults currently experiencing pov-
erty were less likely to have seen a dental care provider in the
past 12 months (53.1%) compared to adults who were not
experiencing poverty (69.9%). No statistical differences in see-
ing a dental care provider were observed based on a respon-
dent’s ethnicity or race.
continues
7
nmdental.org
Figure 1
Adults who
were older or
experiencing
poverty were
less likely to
report seeing
a dental care
provider in the
past year.