Predictors of Smokeless Tobacco Susceptibility, Initiation, and Progression Over Time Among Adolescents in a Rural Cohort.

BACKGROUND: Use of smokeless tobacco (ST, moist snuff and chewing tobacco) is elevated among male rural youth, particularly participants in certain sports, including baseball. OBJECTIVES: This study aimed to assess factors associated with adolescent male athletes' ST-related behaviors over time, including: baseline use, initiation, and progression in use intensity in a school-based longitudinal cohort. METHODS: Baseline and one-year follow-up questionnaires assessed sociodemographic characteristics, environmental factors, and tobacco-related perceptions and behaviors among 9- to12th-grade interscholastic baseball players in 36 rural California schools. Population characteristics were compared among ST use categories (never, experimental, and experienced users). Multivariable models using generalized estimating equations were estimated for outcomes among baseline ST never-users (ST susceptibility and future initiation) and experimenters (ST expectations and progression in ST use). RESULTS: Of 594 participants, over half (57%) had ever tried a tobacco product and the most common products tried were ST (36%) and electronic cigarettes (36%). Being older, perceiving less ST harm, being Non-Hispanic White, using alcohol or other tobacco products, having family or friends who use ST, and being receptive to advertising were associated with greater baseline ST use. Baseline alcohol consumption, lower perceived ST harm, peer use, and susceptibility and expectations were predictive of ST initiation and/or progression at one-year follow-up. Conclusion/Importance: Certain environmental, socio-demographic, cognitive, and behavioral factors predict ST susceptibility and later initiation and progression in use. Interventions addressing these factors have potential to prevent ST uptake and continued use within this high-risk adolescent population.

Factors Influencing Dental Hygienists' Decisions to Pursue Doctoral Degrees.

Purpose: To identify the factors that have influenced dental hygienists to pursue post-graduate education opportunities, specifically dental (DDS, DMD) as compared to academic doctoral degrees, such as doctor of philosophy (PhD) or doctor of education (EdD).Methods: A convenience sample of dental hygienists with doctoral degrees were identified from multiple sources (n=140) and sent a 27-item web-based survey. Univariate logistic regression analysis was used to explore the influence of independent variables (respondents' demographic and personal characteristics, influential persons and experiences, encouraging and motivating factors) on the respondents' decision to pursue either a dental or an academic doctoral degree.Results: Of the 140 potential participants, 69 (n=69) responded (49% response rate): 17 dental degree respondents, 46 academic degree respondents. In contrast to academic degree respondents, those with dental degrees graduated from dental hygiene programs more recently (p=0.03), spent less time working as a dental hygienist (p=0.01), considered themselves mechanically inclined (p=0.03), and preferred to learn a new skill rather than read about a current research study (p=0.002). Both groups agreed that working one-on-one with people was important to career satisfaction. Dental degree respondents were more likely to have been influenced or encouraged to pursue dentistry by dentists (p=0.01) and family (p=0.004). Academic degree respondents were more likely to have had experiences with a researcher/scientist (p=0.004) or had been influenced by an educator (p=0.01). Only 40% of all respondents reported that dental hygiene instructors were instrumental in encouraging their advanced education.Conclusion: Dental hygienists possessing characteristics similar to the academic degree respondents in this study should be encouraged to pursue academic doctoral education, providing the necessary skills to advance the dental hygiene profession.

Effects of mandatory continuing education related to infection control on the infection control practices of dental hygienists.

The infection control (IC) practices of dental hygienists, who were practicing in states with and without mandatory continuing education (CE) related to IC, were compared using a nationwide survey approach. The percentages of respondents from states with mandated IC CE, who reported compliance with 8 practices described in the current IC guidelines and acquiring more CE units and taking more recent IC CE, were greater (P < .005) than the percentages of respondents from states without the requirement.

Factors Influencing California Dental Hygienists' Involvement in School-Based Oral Health Programs.

PURPOSE: To assess the influence of community oral health experiences during entry-level dental hygiene education on participation in community oral health events after graduation and the facilitators and barriers experienced by dental hygienists in participating in these programs. METHODS: A 27-item survey, consisting of items related to community oral health experiences during and after entry-level education, was distributed by the California Dental Hygienists' Association to all dental hygienists whose email addresses were in their database. Frequencies of participants' responses to each survey item were calculated. Chi-square analysis was performed to identify significant relationships among variables. RESULTS: Response rate was 8%, with 513 out of the 6,248 contacted having responded. Additionally, 95% of the respondents had participated, as entry-level students, in community oral health experiences such as school-based oral health educational programs. Respondents agreed that participation in these programs was valuable to their professional development and encouraged them to participate after graduation; both these variables were related (p<0.01) to their participation in community experiences as a licensed dental hygienist. Most (75%) respondents reported participation in community events after graduation. The most commonly reported facilitators, encouraging participation, were an interest in helping people (89%) and professional development (59%). Barriers included conflict with work (61%), family time commitment (52%), and no knowledge of existing programs (24%). CONCLUSION: Dental hygienists' involvement in school-based oral health programs is enhanced by their community experiences as a dental hygiene student. Barriers and facilitators need to be addressed to increase the number of programs and participants so that more children can benefit.

Perceptions and Attitudes of Dental Hygiene Educators About the Establishment of Doctoral Education Programs in Dental Hygiene.

Purpose: To assess the perceptions and attitudes of dental hygiene (DH) educators at selected colleges and universities regarding the establishment of doctoral educational programs in DH in the United States.Methods: An online survey of DH educators at the 58 U.S. schools offering baccalaureate or master's degree programs was used to assess participants' perceptions and attitudes regarding the following: need to establish doctoral programs in DH, interests in supporting their development, potential barriers and facilitators, and goals/motivators of potential enrollees. Percentages of respondents selecting each response were calculated for each survey item and responses of selected items analyzed for significant differences.Results: Of 608 potential participants, 203 completed the survey for a 33% response rate. More than half the respondents strongly agreed and a quarter more agreed that a DH doctoral program was needed to relate equitably with doctoral graduates of other health-related disciplines and to expand the DH body of knowledge by conducting discipline-specific research. A majority indicated likely interest in supporting the development of both clinically oriented and research-based doctoral programs. Significantly (p<0.01) more respondents with doctorates were interested in developing doctoral programs than those with a master's degree as their terminal degree. Respondents identified shortages of qualified educators and interested enrollees as primary barriers. Facilitators included support from the American Dental Education Association and the American Dental Hygienists' Association. Becoming a better researcher and an institutional administrator were perceived as chief motivations.Conclusion: The majority of DH educators perceived that doctoral educational programs in DH are needed to advance the DH profession.

Detection of Early-Stage Oral Cancer Lesions: A Survey of California Dental Hygienists.

Purpose: To assess dental hygienists' knowledge of early-stage oral cancer lesions and their practices, attitudes, barriers, and facilitators related to early detection.Methods: A 20-item survey containing images of oral lesions and related multiple-choice questions was distributed electronically by the California Dental Hygienists' Association to all dental hygienists whose email addresses were in their database. Response frequencies were calculated per survey item. Logistic regression analysis was used to explore associations.Results: Seven hundred fifty-one dental hygienists responded, yielding a 12% response rate. Respondents' correct identification of the six images of oral lesions varied from 40%-97%. Most respondents reported conducting oral cancer examinations (OCE) at every dental hygiene appointment and performing palpation during OCE. Regions of the mouth varied regarding the frequency of palpation. Lymph node palpation was considered the most commonly omitted step. Those who conducted palpations were 3.3 (95% CI: 1.4 to 7.9, p=0.006) times more likely to report that they knew someone with oral cancer and had detected oral cancer lesions than those who did not. Knowing a person with a history of oral cancer and previously detecting a cancerous lesion were also reported as factors encouraging respondents to bring suspicious lesions to the attention of the dentist. Discouraging factors were mostly related to the dentist' behavior, such as not referring a suspicious lesion for biopsy that the respondent identified.Conclusion: Detection of early-stage oral cancer lesions by dental hygienists may be enhanced through more extensive education of visual appearances of lesions and the importance of palpation in a comprehensive OCE.

Dental Hygienists' Attitudes Toward the Obese Population.

Purpose: To explore dental hygienists' attitudes toward the obese population and to determine whether there are differences in attitudes among those with different self-reported body images.Methods: The study population was dental hygienists whose email addresses were in the database of the California Dental Hygienists' Association (CDHA). CDHA distributed the electronic message containing study information, informed consent, and a link to the survey. The survey consisted of 14 items from the Fat Phobia Scale, 13 items from the Anti-fat Attitudes Questionnaire (AFAQ), 3 demographic questions, and 1 question on body image. Frequencies of responses for each survey item were calculated, and Likert-like scale responses from the AFAQ were analyzed to determine significant differences among self-reported body images.Results: Of the 6,248 email addresses in the CDHA database, 518 hygienists or 8% responded. Mild fat phobia was indicated by 57% of the word pair scores on the Fat Phobia Scale being higher than 2.50. On the AFAQ, 84% agreed to the statement, "People who weigh too much could lose at least some part of their weight through a little exercise." Significantly (p<0.05) more respondents who self-reported as overweight than underweight agreed to "I feel disgusted with myself when I gain weight" and "I worry about becoming fat," while more in the overweight than underweight category significantly (p<0.05) disagreed with "Fat people make me somewhat uncomfortable."Conclusion: Dental hygienists exhibited mildly negative attitudes toward the obese population. Curricula specific to the role of the dental hygienist in addressing the health effects of obesity are recommended.

Senior Dental Students' Knowledge and Attitudes Toward Dental Hygienists' Contributions to Comprehensive Patient Care.

Purpose: To assess senior dental students' knowledge and attitudes toward dental hygienists' contributions to comprehensive patient care and to compare the responses of students from two dental schools, one with a dental hygiene (DH) program, and one without a DH program.Methods: Senior dental students from one school with DH (n=363) and one without DH (n=111) were requested to complete a 15-item survey assessing knowledge of clinical duties of licensed dental hygienists, attitudes regarding outcomes of collaborating with hygienists, and demographic characteristics. Responses were collated, and frequencies of responses for each item were analyzed by Qualtrics software program. The chi-square test was used to compare responses of the two groups of dental students.Results: The response rate was 27%. More respondents from the school with DH than those from the school without DH significantly agreed to these statements: "collaborating with DH students in school, has given, or would have given me, a better understanding of the value a dental hygienist brings to my future dental practice" (p=0.02) and "having a DH program at a dental school leads to patients receiving more comprehensive preventive care" (p=0.01). The likelihood of employing a dental hygienist was not significantly different between the two groups of students. The perceived high financial cost was the most frequent reason not to employ a hygienist.Conclusion: Collaboration of dental and DH students in entry-level education results in dental students' greater understanding and support of the dental hygienists' contributions to comprehensive patient care.

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.