Comparison of a high and a low intensity smoking cessation intervention in a dentistry setting in Sweden: a randomized trial

Eva Nohlert, Ake Tegelberg, Per Tillgren, Pia Johansson, Andreas Rosenblad, Asgeir R Helgason, Eva Nohlert, Ake Tegelberg, Per Tillgren, Pia Johansson, Andreas Rosenblad, Asgeir R Helgason

Abstract

Background: Tobacco is still the number one life style risk factor for ill health and premature death and also one of the major contributors to oral problems and diseases. Dentistry may be a potential setting for several aspects of clinical public health interventions and there is a growing interest in several countries to develop tobacco cessation support in dentistry setting. The aim of the present study was to assess the relative effectiveness of a high intensity intervention compared with a low intensity intervention for smoking cessation support in a dental clinic setting.

Methods: 300 smokers attending dental or general health care were randomly assigned to two arms and referred to the local dental clinic for smoking cessation support. One arm received support with low intensity treatment (LIT), whereas the other group was assigned to high intensity treatment (HIT) support. The main outcome measures included self-reported point prevalence and continuous abstinence (> or = 183 days) at the 12-month follow-up.

Results: Follow-up questionnaires were returned from 86% of the participants. People in the HIT-arm were twice as likely to report continuous abstinence compared with the LIT-arm (18% vs. 9%, p = 0.02). There was a difference (not significant) between the arms in point prevalence abstinence in favour of the HIT-protocol (23% vs. 16%). However, point prevalence cessation rates in the LIT-arm reporting additional support were relatively high (23%) compared with available data assessing abstinence in smokers trying to quit without professional support.

Conclusion: Screening for willingness to quit smoking within the health care system and offering smoking cessation support within dentistry may be an effective model for smoking cessation support in Sweden. The LIT approach is less expensive and time consuming and may be appropriate as a first treatment option, but should be integrated with other forms of available support in the community. The more extensive and expensive HIT-protocol should be offered to those who are unable to quit with the LIT approach in combination with other support.

Trial registration number: NCT00670514.

Figures

Figure 1
Figure 1
Flowchart of the study. Also presenting the proportion of people reported to be smoke-free (point prevalence) at the 12-month follow-up.

References

    1. Metoder för rökavvänjning (Methods for Smoking Cessation) Vol. 138. Stockholm: SBU Statens beredning för utvärdering av medicinsk metodik (The Swedish Council on Technology Assessment in Health Care); 1998.
    1. Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med. 2006;3:e442. doi: 10.1371/journal.pmed.0030442.
    1. Gordon JS, Severson HH. Tobacco cessation through dental office settings. J Dent Educ. 2001;65:354–363.
    1. Havlicek D, Stafne E, Pronk NP. Tobacco cessation interventions in dental networks: a practice-based evaluation of the impact of education on provider knowledge, referrals, and pharmacotherapy use. Prev Chronic Dis. 2006;3:A96.
    1. Helgason AR, Lund KE, Adolfsson J, Axelsson S. Tobacco prevention in Swedish dental care. Community Dent Oral Epidemiol. 2003;31:378–385. doi: 10.1034/j.1600-0528.2003.00111.x.
    1. Rökning och ohälsa i munnen (Smoking and oral health) Vol. 157. Stockholm: SBU Statens beredning för utvärdering av medicinsk metodik (The Swedish Council on Technology Assessment in Health Care); 2002.
    1. Dodson TB. Predictors of dental implant survival. J Mass Dent Soc. 2006;54:34–38.
    1. Jacob V, Vellappally S, Smejkalova J. The influence of cigarette smoking on various aspects of periodontal health. Acta Medica (Hradec Kralove) 2007;50:3–5.
    1. Sham AS, Cheung LK, Jin LJ, Corbet EF. The effects of tobacco use on oral health. Hong Kong Med J. 2003;9:271–277.
    1. Warnakulasuriya S, Sutherland G, Scully C. Tobacco, oral cancer, and treatment of dependence. Oral Oncol. 2005;41:244–260. doi: 10.1016/j.oraloncology.2004.08.010.
    1. Axelsson S, Helgason AR, Lund KE, Adolfsson J. Disseminating evidence from health technology assessment: the case of tobacco prevention. Int J Technol Assess Health Care. 2006;22:500–505. doi: 10.1017/S0266462306051439.
    1. Carr AB, Ebbert JO. Interventions for tobacco cessation in the dental setting (Review) Community Dent Health. 2007;24:70–74.
    1. Friedman L, Furberg C, DeMets D. Fundamentals of clinical trials. Second. Littleton, Massachusetts: PSG Publishing Company, Inc; 1985.
    1. Tillgren P, Nohlert E, Johansson P, Helgason AR, Tegelberg Å. Smoking cessation – an effectiveness study of two smoking cessation programs in public dentistry, County of Västmanland (Att sluta röka – en effektstudie av två rökavvänjningsprogram utförda inom Folktandvården, Landstinget Västmanland) Västerås: Mälardalen University, Department of Caring and Public Health Sciences; 2007.
    1. Tomson T. Diss. Karolinska Institutet, Department of Public Health Sciences Preventive Medicine, Division of Social Medicine; 2005. Telephone support for smoking cessation: The Swedish example.
    1. Helgason AR, Tomson T, Lund KE, Galanti R, Ahnve S, Gilljam H. Factors related to abstinence in a telephone helpline for smoking cessation. Eur J Public Health. 2004;14:306–310. doi: 10.1093/eurpub/14.3.306.
    1. Tomson T, Bjornstrom C, Gilljam H, Helgason A. Are non-responders in a quitline evaluation more likely to be smokers? BMC Public Health. 2005;5:52. doi: 10.1186/1471-2458-5-52.
    1. Tomson T, Helgason AR, Gilljam H. Quitline in smoking cessation: a cost-effectiveness analysis. Int J Technol Assess Health Care. 2004;20:469–474. doi: 10.1017/S0266462304001370.
    1. Prochaska JO, DiClemente CC. Stages and processes of self-change of smoking: toward an integrative model of change. J Consult Clin Psychol. 1983;51:390–395. doi: 10.1037/0022-006X.51.3.390.
    1. Fiore MC, Bailey WC, Cohen SJ, Dorfman SF, Goldstein MG, Grits ER. Treating Tobacco Use and Dependence. A clinical practice guideline. Rockville, MD: US Department of Health and Human Services; 2000.
    1. An LC, Zhu SH, Nelson DB, Arikian NJ, Nugent S, Partin MR, Joseph AM. Benefits of telephone care over primary care for smoking cessation: a randomized trial. Arch Intern Med. 2006;166:536–542. doi: 10.1001/archinte.166.5.536.
    1. Zhu SH, Anderson CM, Tedeschi GJ, Rosbrook B, Johnson CE, Byrd M, Gutierrez-Terrell E. Evidence of real-world effectiveness of a telephone quitline for smokers. N Engl J Med. 2002;347:1087–1093. doi: 10.1056/NEJMsa020660.
    1. Lancaster T, Stead LF. Self-help interventions for smoking cessation (Review) The Cochrane Collaboration; 2005.
    1. Nationella folkhälsoenkäten, Hälsa på lika villkor (Swedish National Public Health Survey, Health on Equal Terms) Östersund: Statens Folkhälsoinstitut (Swedish National Institute of Public Health); 2006.

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