title: Identifying Multilevel Barriers to Tobacco Intervention in Postdoctoral Dental Education.
abstract: The aims of this mixed-methods study were to assess tobacco treatment behaviors among residents and faculty in dental specialty postdoctoral programs and to explore factors in training and practice related to tobacco treatment education. Surveys and focus groups were conducted with a convenience sample of participants at three postdoctoral residency programs in New York City. Surveys assessed tobacco cessation training and behaviors. Focus groups explored barriers to implementing tobacco cessation treatment in educational settings. Data were collected between May and December 2013. Among the 160 faculty and residents identified as potentially eligible for the study, 60 were invited by program directors to participate, and 50 subsequently completed the survey and participated in a focus group (response rate of 31.3%). Survey results indicated high levels of asking patients about tobacco use and advising patients to quit. In contrast, specific tobacco cessation assistance and follow-up care occurred less frequently. There were statistically significant differences in tobacco cessation intervention across the specialties surveyed, but not between residents and faculty. Focus group comments were grouped into three broad areas: clinician factors, organizational support, and structural and contextual factors. Focus group results indicated that participants experienced significant organizational and structural barriers to learning about and providing tobacco treatment. Participants from each specialty indicated that multi-level barriers impeded their provision of evidence-based tobacco cessation interventions in postdoctoral educational settings. They suggested that didactic education should be reinforced by organizational- and systems-level changes to facilitate comprehensive tobacco education and effective cessation treatment in future dental practice.
authors.affiliation: Dr. Albert is Director of Division of Community Health, Director of Dental Public Health Residency Program, and Associate Professor, College of Dental Medicine, Columbia University; Ms. Bruzelius is with the Department of Epidemiology, Mailman School of Public Health and Section of Population Oral Health, College of Dental Medicine, Columbia University; Dr. Ward is Program Manager, Section of Population Health, College of Dental Medicine, Columbia University; and Dr. Gordon is Associate Professor and Associate Head for Research, Department of Family and Community Medicine, University of Arizona. daa2@columbia.edu.
authors.forename: David A
authors.initials: DA
authors.lastname: Albert
authors.affiliation: Dr. Albert is Director of Division of Community Health, Director of Dental Public Health Residency Program, and Associate Professor, College of Dental Medicine, Columbia University; Ms. Bruzelius is with the Department of Epidemiology, Mailman School of Public Health and Section of Population Oral Health, College of Dental Medicine, Columbia University; Dr. Ward is Program Manager, Section of Population Health, College of Dental Medicine, Columbia University; and Dr. Gordon is Associate Professor and Associate Head for Research, Department of Family and Community Medicine, University of Arizona.
authors.forename: Emilie
authors.initials: E
authors.lastname: Bruzelius
authors.affiliation: Dr. Albert is Director of Division of Community Health, Director of Dental Public Health Residency Program, and Associate Professor, College of Dental Medicine, Columbia University; Ms. Bruzelius is with the Department of Epidemiology, Mailman School of Public Health and Section of Population Oral Health, College of Dental Medicine, Columbia University; Dr. Ward is Program Manager, Section of Population Health, College of Dental Medicine, Columbia University; and Dr. Gordon is Associate Professor and Associate Head for Research, Department of Family and Community Medicine, University of Arizona.
authors.forename: Angela
authors.initials: A
authors.lastname: Ward
authors.affiliation: Dr. Albert is Director of Division of Community Health, Director of Dental Public Health Residency Program, and Associate Professor, College of Dental Medicine, Columbia University; Ms. Bruzelius is with the Department of Epidemiology, Mailman School of Public Health and Section of Population Oral Health, College of Dental Medicine, Columbia University; Dr. Ward is Program Manager, Section of Population Health, College of Dental Medicine, Columbia University; and Dr. Gordon is Associate Professor and Associate Head for Research, Department of Family and Community Medicine, University of Arizona.
authors.forename: Judith S
authors.initials: JS
authors.lastname: Gordon
mesh_terms: D001291:Attitude of Health Personnel; D001294:Attitude to Health; D002983:Clinical Competence; D003376:Counseling; D003792:Dental Records; D003812:Dentist-Patient Relations; D003815:Dentists / Q000523:psychology*; D004499:Education, Dental, Graduate; D057286:Electronic Health Records; D055317:Evidence-Based Practice; D005179:Faculty, Dental; D005260:Female; D017144:Focus Groups; D006801:Humans; D007396:Internship and Residency; D008297:Male; D009519:New York City; D036301:Qualitative Research; D012649:Self Concept; D013039:Specialties, Dental / Q000193:education; D020340:Tobacco Use Cessation
keywords: advanced dental education; dental education; postdoctoral dental education; smoking cessation; tobacco; tobacco dependence treatment