Dentists miss chances to urge patients to quit smoking

NEW YORK (Reuters Health) – - Healthcare providers, particularly dentists, frequently miss opportunities to advise patients about ways to stop smoking cigarettes, a new study shows.

Since 1996, the U.S. Public Health Service has been urging all healthcare workers to ask every one of their patients if they smoke and to counsel smokers to quit, said senior author Amy Ferketich, a professor at the Ohio State University College of Public Health in Columbus.

But when she and her colleagues analyzed survey data from 2010, they found that less than 12 percent of smokers who visited a dental worker and only half of smokers who saw a doctor reported receiving guidance about how to break the habit.

Tobacco researcher Stanton Glantz called the findings “quite striking.”

“Dental schools and other professional schools are not doing enough to teach how to deal with the issue,” he told Reuters Health. “It’s just a continuous slog to try to get time in the curriculum.”

Glantz directs the Center for Tobacco Control Research and Education at the University of California, San Francisco, and was not involved in the current study.

Researchers analyzed 2010 National Health Interview Survey data from 3,612 smokers who had visited a healthcare provider within the prior 12 months.

They reported their findings in a publication of the Centers for Disease Control and Prevention (CDC) called Preventing Chronic Disease.

The study found that only 50.7 percent of smokers who saw a physician said the doctor counseled them to quit.

Dentists scored far worse. Just 11.8 percent of smokers who saw a dentist or dental hygienist reported receiving advice on how to stop.

Ferketich told Reuters Health the striking difference between doctors and dentists surprised her.

“Dental students as well as medical students should get some training as to how to address the smoking issue,” she said.

“Provider advice to quit is quite powerful. In the end, the healthcare system can save money because patients will quit,” she said.

Counseling combined with nicotine-withdrawal pharmacology – in the form of patches, gum and lozenges – works, Ferketich said.

Since 1964, when the surgeon general first reported a link between smoking and lung cancer, 8 million Americans have been saved from premature smoking-related deaths, another 2014 study found (see Reuters Health story of January 7, 2014 here:

Smoking nonetheless remains the leading cause of preventable death in the United States, according to the CDC.

Pharmacist Lisa Kroon sees training as key to identifying smokers and counseling them to quit. Kroon is a professor at the University of California, San Francisco, School of Pharmacy and was not involved in the current study.

“Until providers are trained, it’s hard for them to take action,” she said. “To get smoking-cessation training incorporated into training is not an overnight process.”

Today, pharmacy students at her school get nine hours of smoking-cessation training, Kroon said. When she was a pharmacy student 20 years ago, she received just one hour.

Kroon believes pharmacists armed with nicotine-withdrawal drugs can play a lead role in helping smokers quit.

“The wagging-the-finger approach is not effective,” she said. “We need to provide healthcare professionals with more effective tools to help people stop.”

Dental epidemiologist Dr. Benjamin Chaffee told Reuters Health he believes the main barriers to dentists and hygienists counseling patients to stop smoking are a lack of time, a lack of training and a lack of confidence in their ability to have an impact.

Chaffee is a professor in the University of California, San Francisco, School of Dentistry and was not involved in the current study.

“The majority of dentists will tell you they think it’s an important part of their role, but a lower percentage will tell you they feel confident they know what to say and how to say it,” Chaffee said.

“There’s definitely room for improvements in the training dentists get as dental students, and there’s also room to strengthen the training and other resources available to them once they’re already in practice,” he said.

Each year, 7 out of 10 smokers visit a clinician, the U.S. Public Health Service practice guidelines say. Smokers are more likely to visit dental offices than doctors’ offices, Chaffee said.

“The missed opportunity is really tremendous,” he said.

SOURCE: Preventing Chronic Disease, online July 31, 2014.