ST product characteristics and relationships with perceptions and behaviors among rural adolescent males: a qualitative study.

Although smoking declines in the United States, the prevalence of male adolescent smokeless tobacco (ST; moist snuff and chewing tobacco) use remains unchanged. ST product characteristics, such as flavoring, packaging, and branding, could influence adolescents' ST initiation and continued use. This qualitative study examines the potential role of product characteristics in shaping ST-related perceptions and behaviors among rural adolescent males. Semi-structured individual interviews were conducted at three California rural high schools. ST users were asked about their experiences and perceptions related to product characteristics. Interviews were transcribed, coded, and analyzed using a general inductive approach. Participants associated flavored ST with appealing non-tobacco products, such as chewing gum and alcohol. Availability of different varieties and flavors stimulated interest and curiosity in sampling or switching between ST products. Time-limited promotional flavors and packaging also enhanced product appeal. Adolescent ST users preferred certain brands based on perceived brand features and perceived nicotine content, associating higher-strength brands as better suited for experienced ST users. Brand preferences frequently reflected perceived ST brand popularity within peer groups. Based on these observations, potential ST regulation and health education campaigns to address misconceptions about ST characteristics could influence adolescents' ST-related perceptions and reduce ST use among this vulnerable population.

Smokeless Tobacco Decision-Making Among Rural Adolescent Males in California.

Smokeless tobacco (ST) use among US high school males living in rural areas exceeds national levels. Subgroups at heightened risk of ST use have been identified, but less is known regarding ST decision-making within high-risk groups. The study objective was to describe rural adolescent males' perceived ST acceptability, health risks, and social implications and how those perceptions differ between ST users and never-users. Semi-structured individual interviews were conducted with a purposeful sample of 55 male students (32 ST ever-users) at three rural California high schools. Interviews were audio recorded and professionally transcribed. Investigators collaboratively developed a codebook based on thematic content and then independently coded transcripts, reconvening frequently to achieve consensus. Coded text was systematically organized into themes following a general inductive approach. ST users and non-users shared multiple ST-related perceptions, including: that ST is a common, normative way of life in rural "country" culture among certain groups; that ST use conveys oral health risks; and that the decision to use (or not to use) is rooted in personal choice. ST users' and never-users' perceptions differed regarding the immediacy, severity, and inevitability of health risks, particularly relative to cigarette smoking. Other differences included perceived parental permissiveness and the expected social benefits of ST use, such as peer acceptance and conveying maturity. Within this population of rural male adolescents, ST users emphasized the social benefits of ST use, while acknowledging but discounting health risks. Differences and similarities in tobacco perceptions among adolescents living in similar environments may inform effective health communication.

Oral health perceptions of paediatric palliative care nursing staff.

Systematic oral care reduces oral complications among children in paediatric palliative care (PPC), yet little is known about the oral health perceptions of PPC nursing staff. This qualitative cross-sectional study used semi-structured interviews based on phenomenography to explore PPC nursing staff's perceptions of oral health and the relationship of oral care to comfort and quality of life. A purposive sample of nine nursing staff employed at a California PPC facility participated. Five themes emerged from the analysis of the interviews: signs of oral health, reasons for oral care, adaptation of oral care on a case-by-case basis, barriers to providing oral care, and facilitators of improving oral care. The perceived importance of oral health was the underlining similarity between the themes. A need for further research in the area of oral PPC is indicated. Collaboration with dental professionals may be needed to create oral PPC guidelines that fit the complex needs of children with life-limiting illnesses.

Smokeless tobacco cessation cluster randomized trial with rural high school males: intervention interaction with baseline smoking.

INTRODUCTION: Adolescent males in rural areas use smokeless tobacco (ST). We assessed the efficacy of a school-based nurse-directed ST intervention among rural high school males. METHODS: Study high schools were randomly selected from a public high school list of California rural counties. Consenting high schools were stratified by school size and randomly assigned within strata to intervention or no-intervention groups. After gaining parental consent, male students completed baseline and 1-year follow-up questionnaires. The intervention included peer-led educational sessions and an oral exam by the school nurse who also provided brief tobacco cessation counseling. We used binary generalized estimating equation (GEE) models accounting for clustering within schools to test no difference between groups after adjusting for year in high school using both completers only and multiple imputation for those lost to follow-up. Subgroup analyses assessed Baseline Factor x Group interaction in GEE models. RESULTS: Twenty-one rural counties (72%), 41 randomly selected high schools (56%), and 4,731 male students (50%) participated with 65% retention. Nonsmoking ST users in the intervention group were significantly more likely to stop using ST at follow-up than those in the no-intervention group; there was no intervention effect among baseline ST users who also smoked. A higher percentage of baseline nonsmoking ST users reported smoking at follow-up than baseline non-ST-using smokers who reported using ST. DISCUSSION: A school-based nurse-directed ST cessation program was efficacious among rural nonsmoking ST-using high school males. The potential program reach holds significant public health value. Baseline ST use facilitated smoking at follow-up.

Dentists' attitudes and practices related to diabetes in the dental setting.

OBJECTIVE: The objective of this study was to determine general dentists' attitudes and practices related to patients with diabetes, a major public health issue with oral complications. METHODS: This study was a cross-sectional survey of 265 randomly selected general dentists who were Delta Dental providers in California, West Virginia, and Pennsylvania. RESULTS: Sixty-one percent of respondents believed that addressing diabetes was important to their role as a dentist, 86 percent advised patients with diabetes about periodontal risks, 18 percent provided diabetic-related services, 47 percent reported they knew how to assess for diabetes, and 42 percent felt well prepared to intervene with patients with diabetes. Adjusting for number of patients with diabetes and adult patients seen in the past month, dentists' formal training in diabetes assessment and management [odds ratio (OR) = 4.0, P = 0.000, confidence interval (CI) = 1.9, 8.5], and belief in the importance of their role as a dentist to intervene with patients with diabetes (OR = 1.6, P = 0.011, CI = 1.1,2.3) were both significant factors in providing services for patients with diabetes. Similarly, dentists' formal training (OR = 3.0, P = 0.02, CI = 1.2, 7.3) and belief in the importance of their role (OR = 1.9, P = 0.00, CI = 1.3, 2.6) were both significant factors in advising patients with diabetes about periodontal risk associated with diabetes. CONCLUSIONS: Formal training and personal beliefs are important factors related to dentists' behavior toward patients with diabetes in the dental setting.

Patterns and correlates of spit tobacco use among high school males in rural California.

OBJECTIVE: To assess patterns and correlates of spit [smokeless tobacco (ST)] use among high school males in rural California. METHODS: An 18-item, self-administered questionnaire was used to assess ST use among young males in 41 randomly selected high schools in 21 rural counties in California. To ensure confidentiality, students were instructed to seal their completed questionnaire in an attached envelope prior to returning it to the questionnaire administrator. RESULTS: Overall prevalence of ST use was 9.8 percent, significantly increasing with year in school from 5 percent among freshmen to 15 percent among seniors. ST use was highest among rodeo athletes at 42 percent compared with <6 percent among nonathletes; ST use was significantly higher among smokers (32 percent) who were 2.5-30 times more likely to use ST compared with nonsmokers, depending on race/ethnicity as a result of a significant race/ethnicity x smoking interaction of degree/magnitude. In addition, students who believed there was no, or slight risk of, harm from ST use were significantly more likely to use ST than students perceiving moderate or great risk, depending on race/ethnicity (odds ratios 3.6-13). Among all ST users, 40 percent used ST on at least 5 days in the previous week, 80 percent of those reporting a brand used the brand Copenhagen, and 41 percent (189) used ST within 30 minutes of waking. CONCLUSION: Dental public health practitioners, scholars, and policy-makers need to promote dental health through organized community efforts targeting high school male subgroups in rural areas that are at risk for ST-associated adverse health effects.

Tobacco control in pediatric dental practices: a survey of practitioners.

PURPOSE: The study purpose was to determine tobacco-related knowledge, attitudes, and practice behaviors of American Academy of Pediatric Dentistry (AAPD) members. METHODS: A 26-item survey was distributed to a national, random sample of 1,700 AAPD members. Frequencies, odds ratios and 95% confidence intervals assessed factors related to tobacco control behaviors. RESULTS: Of 1,700 questionnaires, 1,292 (82%) were returned and usable. Over 75% of respondents agreed that it is a pediatric dentist's responsibility to help patients who wish to stop using tobacco; only 142 (11%) had prior tobacco prevention/cessation training. Of those untrained, 905 (70%) were willing to be trained. Not knowing where to send patients for counseling and feeling ineffective with helping patients to stop their tobacco use were significant barriers reported by nearly half the respondents. Two hundred forty-five (19%) reported always/often asking their adolescent patients about tobacco use; 491 (38%) reported always/often advising known tobacco users to quit; and 284 (22%) reported always/often assisting with stopping tobacco use. Feeling well prepared to ask about tobacco was significantly associated with assisting tobacco users (odds ratio=8.9; 95% confidence interval=6.6-12). CONCLUSION: Continuing education programs are needed to enhance the knowledge and skills of pediatric dentists to promote tobacco control behaviors.

Nursing Administrators' Views on Oral Health in Long-Term Care Facilities: An exploratory study.

Purpose: To explore the knowledge, attitudes, and practices of supervising nurse administrators (SNAs) regarding the oral care provided to long-term care facility (LTCF) residents and the role of dental professionals in those facilities.Methods: The investigators of this study partnered with the National Association of Nursing Administrators to send this cross-sectional study consisting of a 35-item electronic survey to its members whose email addresses were in their database. Online software tabulated responses and calculated frequencies (percentages) of responses for each survey item.Results: Of the 2,359 potential participants, 171 (n=171) completed the survey for a 7% response rate. Only 25% of the respondents were familiar with the expertise of dental hygienists (DHs), however once informed, the majority were interested in having DHs perform oral health staff trainings, oral screenings, and dental referrals and initiate fluoride varnish programs. Most respondents correctly answered the oral health-related knowledge items, understood that oral health is important to general health, but reported that the LTCF residents' oral health was only "good" or "fair." Fewer than half, (48%) of the SNAs were "very satisfied" with the quality of oral care provided to the residents. While more than half reported that they had no dentist on staff or on-site dental equipment, 77% reported that they would consider on-site mobile oral care services. Oral health training for staff was provided primarily by registered nurses, however only 32% reported including identification of dental caries as part of the in-service training.Conclusion: This exploratory study lays the foundation for more extensive research investigating various strategies to improve the oral health of LTCF residents, including increased collaboration between DHs and SNAs.

Patterns and correlates of tobacco control behavior among american association of pediatric dentistry members: a cross-sectional national study.

BACKGROUND: To determine the tobacco-related knowledge, attitudes, and practice behaviors among US pediatric dentists. METHODS: A survey was conducted in 1998 among a national, random sample of 1500 American Academy of Pediatric Dentistry members. Chi-square tests and logistic regression with odds ratios (ORs) and 95% confidence intervals assessed factors related to pediatric dentists' tobacco control behaviors. RESULTS: Response was 65% for the survey. Only 12% of respondents had prior tobacco prevention/cessation training. Of those untrained, 70% were willing to be trained. Less than two-thirds correctly answered any of four tobacco-related knowledge items. Over one-half agreed pediatric dentists should engage in tobacco control behaviors, but identified patient resistance as a barrier. About 24% of respondents reported always/often asking their adolescent patients about tobacco use; 73% reported always/often advising known tobacco users to quit; and 37% of respondents always/often assisting with stopping tobacco use. Feeling prepared to perform tobacco control behaviors (ORs = 1.9-2.8), a more positive attitude score (4 points) from 11 tobacco-related items (ORs = 1.5-1.8), and a higher statewide tobacco use prevalence significantly predicted performance of tobacco control behaviors. CONCLUSION: Findings suggest thatraining programs on tobacco use and dependence treatment in the pediatric dental setting may be needed to promote tobacco control behaviors for adolescent patients.

Perceptions Related to Use of Electronic Cigarettes among California College Students.

Purpose: To assess electronic cigarette (e-cigarette) use, factors associated with use, and exposure to e-cigarette-related information from health professionals in a sample of college students attending a public university in northern California, using a web-based survey.Methods: In this quantitative cross-sectional study, survey items assessed e-cigarette use, perceived risks and benefits, and exposure to e-cigarette-related information from health professionals and were pilot tested for feasibility and acceptability. Participants were recruited from three courses taught at a northern California public university and were given an electronic link to the survey with informed consent information. Frequency distributions and cross-tabulations were calculated for survey responses. The Mann-Whitney U-test was used to compare differences in perceived risks, benefits, and social consequences between ever-users and never-users.Results: Ninety-one individuals completed the web-based survey. Among respondents, 89% were aware of e-cigarettes, 49% were ever-users, and 10% were current (past-30 day) e-cigarette users. Compared to e-cigarette ever-users, never-users perceived a higher chance of experiencing 5 out of 8 physical and social risks from e-cigarette use (P<0.05). E-cigarettes, marijuana, and hookah were perceived to be less harmful to health than cigarettes. Few participants reported receiving counseling regarding e-cigarettes from health professionals, including dental hygienists. Counseling about the adverse health effects of cigarettes was more common in this study population.Conclusion: Dental hygienists must stay current with the scientific evidence related to e-cigarette use and incorporate such information into their client tobacco-related counseling. Addressing the perceived physical and social risks associated with e-cigarette use when counseling college students may deter them from initiating or continuing e-cigarette use.

The changing tobacco landscape: What dental professionals need to know.

BACKGROUND: Tobacco products in the United States and the patterns of tobacco use are changing. Although cigarette smoking prevalence has declined, dental professionals are likely to encounter substantial numbers of patients who have tried and are continuing to use new and alternative tobacco products, including cigars, water pipes (hookahs), and electronic cigarettes, as well as conventional and new smokeless tobacco products. METHODS: The authors reviewed conventional and new tobacco products in the United States, their adverse oral and systemic health effects, and their prevalence of use. RESULTS: Tobacco products other than cigarettes account for a substantial portion of tobacco use. For this reason, tobacco-use prevention and cessation counseling provided by dental health care professionals must address all tobacco products, including cigarettes, cigars, water pipes, and electronic cigarettes, as well as conventional and new smokeless tobacco products. Cigarette smoking and smokeless tobacco use are associated with immediate and long-term adverse health effects, including nicotine addiction, oral and systemic disease, and death. Novel products may attract new tobacco users, potentially leading to addiction that results in enduring tobacco product use and associated adverse health effects. CONCLUSIONS: This critical review of conventional, new, and emerging tobacco products presents information that dental professionals can use in providing tobacco-related counseling to patients who use or who are at risk for using tobacco products. PRACTICAL IMPLICATIONS: It is essential that dental professionals are knowledgeable about tobacco products and are able to answer patients' questions and provide them with evidence-based tobacco-related counseling. This information may prevent patients from initiating use or help reduce or cease use to avoid immediate and long-term adverse health effects, including nicotine addiction, oral and systemic disease, and death.

Oral Health Prevention and Toddler Well-Child Care: Routine Integration in a Safety Net System.

BACKGROUND AND OBJECTIVE: Applying topical fluoride varnish (FV) to young children's teeth is an effective therapeutic strategy for preventing early childhood caries (ECC). In 2008, the pediatricians at Contra Costa Regional Medical Center and Health Centers became concerned that our low-income pediatric patients had high rates of ECC and very limited access to dental care. We formed an interdisciplinary safety net-academic partnership with the University of California San Francisco to implement routine FV applications, along with oral health education, screening, and referral during well-child exams for children aged 1 to 5 years. METHODS: Over 3 years, the team developed clinical policies, educational materials, billing, and support systems to facilitate implementation in the primary care setting. A pilot study was performed in 2 health centers; improvements to the implementation plan were made. A team of local providers and academic partners performed system-wide didactic and hands-on trainings and spread this intervention to the remaining 6 health centers. Continued improvement strategies and provider feedback were pursued with each measurement cycle. RESULTS: In August 2012, 95% of all children aged 1 to 5 years who were seen for well-child checkups received a FV application and oral health education during their primary care well visit. Repeat measurement in April 2014 showed a sustained rate of 97% application of FV for children in this age group seen for well-child visits. CONCLUSIONS: With institutional commitment and an academic partnership, a safety net institution can integrate routine FV applications and oral health interventions into well-child visits to reduce ECC.

Treatment of tobacco use and dependence: the role of the dental professional.

The purpose of this article is to discuss tobacco use and dependence, effective treatments, and the role of the dental professional. Tobacco dependence is discussed as a chronic condition characterized by a vulnerability to relapse that persists for perhaps years. The need for ongoing rather than just acute care is highlighted. Effective treatments for tobacco dependence exist. Brief clinical intervention makes a difference. It is recommended that every dental patient who uses tobacco be offered at least one of the effective treatments available. In so doing, dental professionals can play an important role in primary prevention of adverse health effects and can have an important public health impact by helping to counter tobacco use.

Conditional risk assessment of adolescents' electronic cigarette perceptions.

OBJECTIVES: To adapt an established instrument for measuring adolescents' cigarette-related perceptions for new application with electronic cigarettes (e-cigarettes). METHODS: In this exploratory study, 104 male high school students (40% tobacco ever-users) estimated the probability of potential e-cigarette risks (eg, lung cancer) or benefits (eg, look cool). We calculated associations between risk/benefit composite scores, ever-use, and use intention for e-cigarettes, and analogously, for combustible cigarettes. RESULTS: E-cigarette ever-use was associated with lower perceived risks, with adjusted differences versus never-users greater for e-cigarettes than for cigarettes. Risk composite score was inversely associated, and benefit score positively associated, with e-cigarette ever-use and use intention. CONCLUSION: Conditional risk assessment characterized adolescents' perceived e-cigarette risk/benefit profile, with potential utility for risk-perception measurement in future studies.

Effectiveness of a Screening and Brief Intervention protocol for heavy drinkers in dental practice: A cluster-randomized trial.

Results of a cluster-randomized trial of a Screening and Brief Intervention for heavy drinkers in dental practice are reported. Data were obtained from 103 heavy drinking patients recruited from randomized intervention (7; n = 50) and control (6; n = 53) practices. Analysis of data revealed that 6-month decreases in total drinks per week were significantly (p < .05) greater for heavy drinking intervention (43%) than control patients (21%)-a 4 drink per week difference. Similar decreases were obtained for quantity and frequency among intervention patients compared to control patients. Despite power limitations, the 6-month results support the effectiveness of the Screening and Brief Intervention.

Spit (Smokeless) Tobacco Intervention for High School Athletes: results after 1 year.

OBJECTIVE: To determine the efficacy of a spit tobacco (ST) intervention designed to promote ST cessation and discourage ST initiation among male high school baseball athletes. METHODS: This study was a cluster-randomized controlled trial. Forty-four randomly selected high schools in rural California were randomized within strata (prevalence of ST use and number and size of baseball teams) to either the intervention or the control group. Ninety-three percent of eligible baseball athletes participated, yielding 516 subjects in 22 intervention schools and 568 subjects in 22 control schools. Prevalences of sustained ST cessation and ST use initiation over 1 year were assessed by self-report. Multivariate logistic regression models for clustered responses were used to test the null hypotheses of no association between group and the two outcomes, adjusted for the stratified design and baseline imbalances between groups in significant predictors of ST use. RESULTS: Prevalence of cessation was 27% in intervention high schools and 14% in control high schools (odds ratio (OR)=2.29; 95% confidence interval (CI), 1.36-3.87). The intervention was especially effective in promoting cessation among those who, at baseline, lacked confidence that they could quit (OR=6.4; 95% CI, 1.0-4.3), among freshmen (OR=15; 95% CI, 0.9-260), and among nonsmokers (OR=3.2; 95% CI, 0.9-11). There was no significant difference between groups in the prevalence of ST initiation. CONCLUSIONS: This intervention was effective in promoting ST cessation, but was ineffective in preventing initiation of ST use by nonusers.

Oral screening and brief spit tobacco cessation counseling: a review and findings.

This paper reviews five randomized controlled trials of brief spit (smokeless) tobacco (ST) cessation treatment by dental professionals consisting of oral cancer screening, cessation advice, self-help materials, and brief cessation counseling by a dental hygienist. In addition, original two-year findings from a randomized controlled trial to determine the effect of a dental-directed, peer-assisted ST intervention among high school baseball athletes in rural California (n=1084) are reported. In the latter study, results show sustained quitting at two years of 23 percent (32/141) in the intervention group and 13 percent (21/166) in the control group (OR=2.0, 95% CI 1.1-3.9) with subjects lost-to-follow-up considered non-quitters. The evidence presented supports the efficacy of oral screening and brief cessation counseling by dental professionals to promote ST cessation in the dental office or in athletic facilities. In addition, recommendations for policy and future research are presented.

Outcomes assessment related to professional growth and achievements of baccalaureate dental hygiene graduates.

The goals of the entry-level baccalaureate dental hygiene (DH) program at the University of California, San Francisco, include the preparation of scholars who will pursue additional study and research and the development of DH educators and leaders in the field of DH. The objective of this study was to evaluate whether the goals of the program were being achieved by assessing the professional growth and achievements of the graduates. Questionnaires were mailed to graduates of classes from 1960 to 2000, and the response rate was 66 percent (N = 468). Results indicated the following: 21 percent of the respondents completed a graduate or professional program, with most degrees being master's related to education (53 percent) and dental degrees (28 percent); 20 percent have held a faculty position in a DH educational program, with 26 percent holding leadership positions; 60 percent have been regular participants in DH professional organizations, with 36 percent of them holding leadership positions; and 61 percent have been active in a community organization, with 60 percent of them holding leadership positions. This outcomes assessment indicates that many UCSF DH graduates have become scholars, educators, and leaders in DH, and thus, the current program is successful at achieving its educational goals. Future studies should evaluate graduates of other DH programs on similar outcomes measures.

Doctoral dental hygiene education: insights from a review of nursing literature and program websites.

PURPOSE: Because dental hygiene education has had a similar trajectory as nursing education, this critical review addressed the question "What can the dental hygiene discipline learn from the nursing experience in their development of doctoral education?" Information on admission and degree requirements, modes of instruction, and program length and cost was collected from the websites associated with 112 of 125 PhD nursing programs nationally, and 174 of 184 Doctor of Nursing Practice (DNP) programs. In addition, searches of PubMed, Cumulative Index Nursing Allied Health Literature (CINAHL) and the Web of Science were utilized to identify key articles and books. The following 4 insights relevant to future dental hygiene doctoral education emerged from a review of nursing doctoral education: First, nursing doctoral education offers 2 main doctoral degrees, the research-focused PhD degree and the practice-focused DNP degree. Second, there is a well-documented need for doctoral prepared nurses to teach in nursing programs at all levels in managing client-care settings. Third, curricula quality and consistency is a priority in nursing education. Fourth, there are numerous templates on nursing doctoral education available. The historical background of nursing doctoral education was also reviewed, with the assumption that it can be used to inform the dental hygiene discipline when establishing doctoral dental hygiene education. The authors recommend that with the current changes toward medically and socially compromised patient populations, impending changes in health care policies and the available critical mass of master degree-prepared dental hygiene scholars ready to advance the discipline, now is the time for the dental hygiene discipline to establish doctoral education.

Developing a scholarly identity and building a community of scholars.

Progress in the dental hygiene discipline is predicated on the development of a community of scholars who explore questions related to the art and science of dental hygiene and clients in need of oral health care. Graduate dental hygiene education is challenged to develop programs that stimulate and nurture dental hygiene scholars as well as scientists. The need for the development of doctoral dental hygiene education is discussed.