Internet delivered support for tobacco control in dental practice: randomized controlled trial.
BACKGROUND
The dental visit is a unique opportunity for tobacco control. Despite evidence of effectiveness in dental settings, brief provider-delivered cessation advice is underutilized.


OBJECTIVE
To evaluate an Internet-delivered intervention designed to increase implementation of brief provider advice for tobacco cessation in dental practice settings.


METHODS
Dental practices (N = 190) were randomized to the intervention website or wait-list control. Pre-intervention and after 8 months of follow-up, each practice distributed exit cards (brief patient surveys assessing provider performance, completed immediately after the dental visit) to 100 patients. Based on these exit cards, we assessed: whether patients were asked about tobacco use (ASK) and, among tobacco users, whether they were advised to quit tobacco (ADVISE). All intervention practices with follow-up exit card data were analyzed as randomized regardless of whether they participated in the Internet-delivered intervention.


RESULTS
Of the 190 practices randomized, 143 (75%) dental practices provided follow-up data. Intervention practices' mean performance improved post-intervention by 4% on ASK (29% baseline, adjusted odds ratio = 1.29 [95% CI 1.17-1.42]), and by 11% on ADVISE (44% baseline, OR = 1.55 [95% CI 1.28-1.87]). Control practices improved by 3% on ASK (Adj. OR 1.18 [95% CI 1.07-1.29]) and did not significantly improve in ADVISE. A significant group-by-time interaction effect indicated that intervention practices improved more over the study period than control practices for ADVISE (P = 0.042) but not for ASK.


CONCLUSIONS
This low-intensity, easily disseminated intervention was successful in improving provider performance on advice to quit.


BACKGROUND
clinicaltrials.gov NCT00627185, http://www.webcitation.org/5c5Kugvzj.
Houston
Thomas K
TK
Surgical and Medical Acute care and Advanced illness Research and Transition sciences (SMAART) Center, VA HSR&D REAP, Birmingham VA Medical Center, Birmingham, AL, USA. thouston@uab.edu
Richman
Joshua S
JS
Ray
Midge N
MN
Allison
Jeroan J
JJ
Gilbert
Gregg H
GH
Shewchuk
Richard M
RM
Kohler
Connie L
CL
Kiefe
Catarina I
CI
D000329:Advertising; D003813:Dentistry; D006297:Health Services Accessibility; D006306:Health Surveys; D006801:Humans; D020407:Internet; D009062:Mouth Neoplasms / Q000209:etiology / Q000517:prevention & control*; D018579:Patient Selection; D012907:Smoking / Q000009:adverse effects*; D016540:Smoking Cessation / Q000379:methods*; D012944:Social Support; D011795:Surveys and Questionnaires; D013813:Therapy, Computer-Assisted / Q000379:methods; D016896:Treatment Outcome; D014584:User-Computer Interface