title: Internet delivered support for tobacco control in dental practice: randomized controlled trial.
abstract: 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.
authors.affiliation: 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
authors.forename: Thomas K
authors.initials: TK
authors.lastname: Houston
authors.forename: Joshua S
authors.initials: JS
authors.lastname: Richman
authors.forename: Midge N
authors.initials: MN
authors.lastname: Ray
authors.forename: Jeroan J
authors.initials: JJ
authors.lastname: Allison
authors.forename: Gregg H
authors.initials: GH
authors.lastname: Gilbert
authors.forename: Richard M
authors.initials: RM
authors.lastname: Shewchuk
authors.forename: Connie L
authors.initials: CL
authors.lastname: Kohler
authors.forename: Catarina I
authors.initials: CI
authors.lastname: Kiefe
mesh_terms: 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