Smoking Cessation Counseling: Practices, Determinants, and Barriers in a Sample of Iranian Primary Care Dentists
Smoking Cessation Counselling among Iranian Primary Care Dentists
Abstract
Objectives: Despite the successful tobacco smoking cessation counseling (TSCC) efforts of dental professionals, Iranian primary care dentists have not fully utilized their potential for TSCC provision. Thus, this study assessed the TSCC practices and their associations with socio-professional attributes, knowledge, and attitude, and explored the TSCC barriers and their socio-professional determinants in a sample of Iranian primary care dentists.
Materials and Methods: This cross-sectional study was conducted at Comprehensive Healthcare Centers (CHCs) in Tehran Province, Iran from March to June 2019. All dentists practicing in these centers (n=190) completed self-administered questionnaires regarding TSCC-related knowledge, attitude, practice, and barriers. Simple and multiple linear regression and multiple logistic regression tests were used for statistical analyses.
Results: The respondents (n=180, response rate=93%) were predominantly females (81.6%), recent graduates (69.6%), and non-cigarette smokers (90.2%), with a mean age of 34±9.98 years. Most performed 'Ask' (90.6%) and 'Advise' (69.1%), while a few were engaged in 'Assess' (33.7%) and fewer in 'Assist,' with 21.3% making physician referrals and 31.5% making psychologist referrals. Non-smokers (B=0.80, 95% CI: 0.19 to 1.40; P=0.01), and those with a more positive attitude (B=0.06, 95% CI: 0.04 to 0.08; P< 0.001) were more likely to provide TSCC. The main identified barriers included “absence of educational resources for patients”, “time constraints”, and “lack of patient cooperation.
Conclusion: Although the selected sample of Iranian primary care dentists performed “Ask” and “Advise” more frequently than their peers, their TSCC practice required further improvement through simplified guidelines, customized pathways, training, team work, and resource advocacy.
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14. Nichter M. Introducing tobacco cessation in developing countries: an overview of Project Quit Tobacco International. Tob Control. 2006 Jun;15 Suppl 1(Suppl 1):i12-7.
15. Lando HA. Promoting Tobacco Cessation in Low- and Middle-Income Countries. J Smok Cess. 2016 Jun;11(2):66-9.
16. Carr AB, Ebbert J. Interventions for tobacco cessation in the dental setting. Cochrane Database Syst Rev. 2012;2012(6):Cd005084.
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19. Ebn Ahmady A, Golmohammadi S, Ayremlou S, Khoshnevisan MH, Lando HA. Tobacco cessation practices of senior dental students in Iran. Int Dent J. 2011 Dec;61(6):302-6.
20. Razavi SM, Zolfaghari B, Doost ME, Tahani B. Attitude and practices among dentists and senior dental students in iran toward tobacco cessation as an effort to prevent oral cancer. Asian Pac J Cancer Prev. 2015;16(1):333-8.
21. Gouya MM, Seif-Farahi K, Hemmati P. An overview of Iran's actions in response to the COVID-19 pandemic and in building health system resilience. Front Public Health. 2023 Feb;11:1073259.
22. Khoshnevisan MH, Ghasemianpour M, Samadzadeh H, Baez RJ. Oral health status and healthcare system in I.R. Iran. J Contem Med Sci. 2018;4(3):107-8.
23. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Br Med J. 2007;335(7624):806-8.
24. Iran administrative division September 24, 2016. Available at: https://www.citypopulation.de/en/iran/admin/ /Accessed March 29, 2024.
25. Khami M, Ebn Ahmady A, Ahmadian M, Razghi S. Knowledge, attitude and skills of dental students of Tehran and Shahid Beheshti dental schools towards tobacco cessation counseling. J Dent Med. 2014 Sep 10;27(3):208-15.
26. Ahmadianghalehsorkh M, Khami M, Ahamdi A, Razeghi S, Yazdani R. Effectiveness of two interactive educational methods to teach tobacco cessation counseling for senior dental students. Eur J Dent. 2017 Jul;11:287-92.
27. Tobacco TC. A clinical practice guideline for treating tobacco use and dependence: 2008 update: a US public health service report. Am J Prev Med. 2008 Aug;35(2):158-76.
28. Halboub E, Jafer MA, Khormi HI, Kariri AA, Atiah SA, Lughbi SJ, et al. Attitudes and practices of tobacco cessation counseling among Saudi dental professionals: A nationwide cross-sectional survey. Niger J Clin Pract. 2022 Apr;25(4):502-8.
29. Prakash P, Belek MG, Grimes B, Silverstein S, Meckstroth R, Heckman B, et al. Dentists' attitudes, behaviors, and barriers related to tobacco‐use cessation in the dental setting. J Pblic Health Dent. 2013 Mar;73(2):94-102.
30. Khalaf M. Smoking cessation practices in Kuwaiti general dental clinics. Med Princ Pract. 2013 Sep;22(6):576-82.
31. Patel AM, Blanchard SB, Christen AG, Bandy RW, Romito LM. A survey of United States periodontists' knowledge, attitudes, and behaviors related to tobacco-cessation interventions. J Periodontol. 2011 Mar;82(3):367-76.
32. Rajput S, Gadiyar A, Kumar A, Kamat A, Gaunkar R, Jain A. Tobacco cessation counseling: Are dentists doing enough? J Indian Assoc Public Health Dent. 2020 Jan;18(1):60-5.
33. Chan HL, Chan AKY, Chu CH, Tsang YC. Smoking cessation in dental setting: a narrative review on dental professionals' attitude, preparedness, practices and barriers. Front Oral Health. 2023 Sep;4:1266467.
34. John J, Thomas D, Richards D. Smoking cessation interventions in the Oxford region: changes in dentists' attitudes and reported practices 1996–2001. Br Dent J. 2003 Sep;195(5):270-5.
35. Bangera D, Takana M, Muttappallymyalil J. Tobacco cessation: attitude and practice of dentists in Northern United Arab Emirates. East Mediterr Health J. 2018 May;24(5):419-26.
36. Ford P, Tran P, Keen B, Gartner C. Survey of Australian oral health practitioners and their smoking cessation practices. Aust Dent J. 2015 Mar;60(1):43-51.
37. Ford PJ, Farah CS. Oral health therapists: what is their role in Australian health care? Int J Dent Hyg. 2013 Feb;11(1):22-7.
38. Campbell HS, Sletten M, Petty T. Patient perceptions of tobacco cessation services in dental offices. J Am Dent Assoc. 1999 Feb;130(2):219-26.
39. Mehta A, Kaur G, Popli R, Khurana S. Tobacco use cessation efforts among private dental practitioners of Delhi, India. Dent 3000. 2020 Jul 23;8(1):11-23.
40. John JH, Yudkin P, Murphy M, Ziebland S, Fowler GH. Smoking cessation interventions for dental patients--attitudes and reported practices of dentists in the Oxford region. Br Dent J. 1997 Nov;183(10):359-64.
2. Jha P, Peto R. Global effects of smoking, of quitting, and of taxing tobacco. N Engl J Med. 2014 Jan;370(1):60-8.
3. Country factsheet on Iran: Tobacco use atlas; 2024. Available at: https://tobaccoatlas.org/factsheets/iran-islamic-republic-of/ /Accessed February 3, 2024.
4. Abbasi-Kangevari M, Ghanbari A, Fattahi N, Malekpour M-R, Masinaei M, Ahmadi N, et al. Tobacco consumption patterns among Iranian adults: a national and sub-national update from the STEPS survey 2021. Sci Rep. 2023 Jun;13(1):10272.
5. United States. Public Health Service. Office of the Surgeon General, United States. Office on Smoking. The health consequences of smoking: a report of the Surgeon General. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office of Smoking and Health; 2004.
6. Tobacco or oral health: An advocacy guide for oral health professionals: FDI World Dental Federation. Available at: https://fdiworldental.org/tobacco-or-oral-health-advocacy-guide-oral-health-professionals /Accessed September 18, 2023.
7. Warnakulasuriya S, Sutherland G, Scully C. Tobacco, oral cancer, and treatment of dependence. Oral Oncol. 2005 Mar;41(3):244-60.
8. Jiang X, Jiang X, Wang Y, Huang R. Correlation between tobacco smoking and dental caries: A systematic review and meta-analysis. Tob Induc Dis. 2019;17:34.
9. Monograph on tobacco cessation and oral health integration: World Health Organization. Available at: https://www.who.int/publications/i/item/9789241512671 /Accessed February 3, 2024.
10. Tobacco free inititative: role of health professionals: World Health Organization. Available at: https://www.who.int/publications/i/item/9241593202 /Accessed February 3, 2024.
11. Michael C, Lori D, Joanna EC, Susan JB, Peter S, Anne P, Robert S. Estimating the number of quit attempts it takes to quit smoking successfully in a longitudinal cohort of smokers. BMJ Open. 2016 Jun;6(6):e011045.
12. Martha A, Sotiria S, Eleni L, Vasiliki S, Kondylia K, Andromachi S, et al. Success rates are correlated mainly to completion of a smoking cessation program. Eur Respir J. 2016;48(suppl 60):PA4599.
13. Abdullah ASM, Husten CG. Promotion of smoking cessation in developing countries: a framework for urgent public health interventions. Thorax. 2004 Jul;59(7):623.
14. Nichter M. Introducing tobacco cessation in developing countries: an overview of Project Quit Tobacco International. Tob Control. 2006 Jun;15 Suppl 1(Suppl 1):i12-7.
15. Lando HA. Promoting Tobacco Cessation in Low- and Middle-Income Countries. J Smok Cess. 2016 Jun;11(2):66-9.
16. Carr AB, Ebbert J. Interventions for tobacco cessation in the dental setting. Cochrane Database Syst Rev. 2012;2012(6):Cd005084.
17. Jannat-Khah DP, McNeely J, Pereyra MR, Parish C, Pollack HA, Ostroff J. Dentists' Self-Perceived Role in Offering Tobacco Cessation Services: Results From a Nationally Representative Survey, United States, 2010-2011. Preventing Chronic Disease. 2014;11:E196.
18. Ebn Ahmady A, Khoshnevisan MH, Heidari N, Lando HA. Dentists' familiarity with tobacco cessation programs in dental settings in Iran. J Public Health Dent. 2011 Sep;71(4):271-7.
19. Ebn Ahmady A, Golmohammadi S, Ayremlou S, Khoshnevisan MH, Lando HA. Tobacco cessation practices of senior dental students in Iran. Int Dent J. 2011 Dec;61(6):302-6.
20. Razavi SM, Zolfaghari B, Doost ME, Tahani B. Attitude and practices among dentists and senior dental students in iran toward tobacco cessation as an effort to prevent oral cancer. Asian Pac J Cancer Prev. 2015;16(1):333-8.
21. Gouya MM, Seif-Farahi K, Hemmati P. An overview of Iran's actions in response to the COVID-19 pandemic and in building health system resilience. Front Public Health. 2023 Feb;11:1073259.
22. Khoshnevisan MH, Ghasemianpour M, Samadzadeh H, Baez RJ. Oral health status and healthcare system in I.R. Iran. J Contem Med Sci. 2018;4(3):107-8.
23. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Br Med J. 2007;335(7624):806-8.
24. Iran administrative division September 24, 2016. Available at: https://www.citypopulation.de/en/iran/admin/ /Accessed March 29, 2024.
25. Khami M, Ebn Ahmady A, Ahmadian M, Razghi S. Knowledge, attitude and skills of dental students of Tehran and Shahid Beheshti dental schools towards tobacco cessation counseling. J Dent Med. 2014 Sep 10;27(3):208-15.
26. Ahmadianghalehsorkh M, Khami M, Ahamdi A, Razeghi S, Yazdani R. Effectiveness of two interactive educational methods to teach tobacco cessation counseling for senior dental students. Eur J Dent. 2017 Jul;11:287-92.
27. Tobacco TC. A clinical practice guideline for treating tobacco use and dependence: 2008 update: a US public health service report. Am J Prev Med. 2008 Aug;35(2):158-76.
28. Halboub E, Jafer MA, Khormi HI, Kariri AA, Atiah SA, Lughbi SJ, et al. Attitudes and practices of tobacco cessation counseling among Saudi dental professionals: A nationwide cross-sectional survey. Niger J Clin Pract. 2022 Apr;25(4):502-8.
29. Prakash P, Belek MG, Grimes B, Silverstein S, Meckstroth R, Heckman B, et al. Dentists' attitudes, behaviors, and barriers related to tobacco‐use cessation in the dental setting. J Pblic Health Dent. 2013 Mar;73(2):94-102.
30. Khalaf M. Smoking cessation practices in Kuwaiti general dental clinics. Med Princ Pract. 2013 Sep;22(6):576-82.
31. Patel AM, Blanchard SB, Christen AG, Bandy RW, Romito LM. A survey of United States periodontists' knowledge, attitudes, and behaviors related to tobacco-cessation interventions. J Periodontol. 2011 Mar;82(3):367-76.
32. Rajput S, Gadiyar A, Kumar A, Kamat A, Gaunkar R, Jain A. Tobacco cessation counseling: Are dentists doing enough? J Indian Assoc Public Health Dent. 2020 Jan;18(1):60-5.
33. Chan HL, Chan AKY, Chu CH, Tsang YC. Smoking cessation in dental setting: a narrative review on dental professionals' attitude, preparedness, practices and barriers. Front Oral Health. 2023 Sep;4:1266467.
34. John J, Thomas D, Richards D. Smoking cessation interventions in the Oxford region: changes in dentists' attitudes and reported practices 1996–2001. Br Dent J. 2003 Sep;195(5):270-5.
35. Bangera D, Takana M, Muttappallymyalil J. Tobacco cessation: attitude and practice of dentists in Northern United Arab Emirates. East Mediterr Health J. 2018 May;24(5):419-26.
36. Ford P, Tran P, Keen B, Gartner C. Survey of Australian oral health practitioners and their smoking cessation practices. Aust Dent J. 2015 Mar;60(1):43-51.
37. Ford PJ, Farah CS. Oral health therapists: what is their role in Australian health care? Int J Dent Hyg. 2013 Feb;11(1):22-7.
38. Campbell HS, Sletten M, Petty T. Patient perceptions of tobacco cessation services in dental offices. J Am Dent Assoc. 1999 Feb;130(2):219-26.
39. Mehta A, Kaur G, Popli R, Khurana S. Tobacco use cessation efforts among private dental practitioners of Delhi, India. Dent 3000. 2020 Jul 23;8(1):11-23.
40. John JH, Yudkin P, Murphy M, Ziebland S, Fowler GH. Smoking cessation interventions for dental patients--attitudes and reported practices of dentists in the Oxford region. Br Dent J. 1997 Nov;183(10):359-64.
| Issue | Vol 21 (Continuously Published Article-Based) | |
| Section | Original Article | |
| Keywords | ||
| Tobacco Use Smoking Smoking Cessation Dentists Primary Health Care Iran | ||
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How to Cite
1.
Khami MR, Bastani P, Varmazyari S. Smoking Cessation Counseling: Practices, Determinants, and Barriers in a Sample of Iranian Primary Care Dentists. Front Dent. 2024;21.
