Internet delivered support for tobacco control in dental practice: randomized controlled trial
Department of Quantitative Health Sciences
Medical Subject Headings
Advertising as Topic; *Dentistry; Health Services Accessibility; Health Surveys; Humans; *Internet; Mouth Neoplasms; Patient Selection; Questionnaires; Smoking; Smoking Cessation; *Social Support; Therapy, Computer-Assisted; Treatment Outcome; User-Computer Interface
Bioinformatics | Biostatistics | Epidemiology | Health Services Research
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.
CONCLUSION: This low-intensity, easily disseminated intervention was successful in improving provider performance on advice to quit.
TRIAL REGISTRATION: clinicaltrials.gov NCT00627185, http://www.webcitation.org/5c5Kugvzj.
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Citation: J Med Internet Res. 2008 Nov 4;10(5):e38. Link to article on publisher's site
Houston, Thomas K.; Richman, Joshua S.; Ray, Midge N.; Allison, Jeroan J.; Gilbert, Gregg H.; Shewchuk, Richard M.; Kohler, Connie L.; and Kiefe, Catarina I., "Internet delivered support for tobacco control in dental practice: randomized controlled trial" (2008). Quantitative Health Sciences Publications and Presentations. 27.