The 13th World Conference on Tobacco OR Health

Objective: To implement and test the effectiveness of a system-level tobacco control intervention within one of the largest dental HMOs in the United States (185,000 members served by 14 dental clinics and over 200 clinicians). The approach was designed to be practical for many dental settings.

Methods: Dental facilities were matched on size, SES, smoking rate, and periodontal status and then randomly assigned to intervention or usual care control. Intervention clinics were trained in an “Assisted-Referral” team approach: dental clinicians assessed tobacco use, delivered tailored advice and brief counseling, and encouraged patients to talk by phone with a trained tobacco counselor. Patients could call from the dental clinic or request that the counselor call them back later. Counselors explored motivations and barriers for quitting; reviewed available support strategies and programs; and next steps.

Results: Preliminary data at 12 months show 95% of patients with an annual visit had tobacco use assessed; 95% received advice to quit and 75% received additional chair-side counseling in intervention clinics compared to 11% in control clinics (p<.01). Intervention clinic smokers receiving quit advice reported higher rates of clinician asking about interest in quitting (61% vs. 48% in controls; p<.0001), receiving written materials (30% vs. 17% for controls; p<.0001), having them talk to a counselor by phone in the clinic (20% vs. 4% for controls; p<.0001), and arranged a call back (23% vs. 4% for controls, p<.0001). The data show system-level tobacco interventions can be effectively integrated into routine delivery of dental care.