DESCRIPTION: While cigarette smoking has declined in prevalence, smokeless
tobacco use has consistently increased over the past, decade and an
estimated six million Americans use smokeless tobacco daily. The Surgeon
General has concluded that the use of smokeless tobacco can cause cancer and
oral lesions and can lead to nicotine addiction and dependence. Reduction
of smokeless tobacco use, therefore, is a significant public health goal.
Two recent studies demonstrated the effectiveness of having dental
hygienists provide brief cessation advice and materials to smokeless tobacco
users in the context of routine prophylactic oral health care. This study
will develop and evaluate two dissemination strategies for encouraging and
training dental hygienists to provide ongoing cessation counseling to
patients who use smokeless tobacco. One strategy builds on the workshop
training of hygienists that was effective in producing practice changes in
the investigators' current DENTAL study. The second strategy uses a
Self-Study model, a presumably less costly program, where patient and
training materials are mailed to target hygienists. Changes in practice
behaviors of hygienists in these two interventions will be compared to
similarly motivated hygienists in a No-Treatment Control group, who receive
self-study training materials at a later date. To increase
generalizability, the diffusion will be implemented in communities varying
in size in two regions of the United States -- Western Rocky Mountains (6
states) and Mid-Western Plains (5 states). Within each region and community
size, three communities similar in relative size, prevalence of smokeless
tobacco use, and number of hygienists per capita will be selected and
randomly assigned to each of the three conditions. Hygienists and dentists
within the targeted communities will be assessed at baseline. Hygienists
who complete the baseline assessment and their employer dentists will be
mailed recruitment materials to solicit their participation.
Post-intervention assessment will be conducted with participants and
selected non-participants in the intervention conditions and only with
responders in the No-Treatment Control group. Training for hygienists in
smokeless tobacco intervention will be comprised of either mailed materials
(Self-Study), or a three hour workshop (Personalized Instruction).
Hygienist participation in smokeless tobacco training (i.e., requesting
self-study materials or attending a workshop), changes in a hygienist's
smokeless tobacco counseling practices, and the attitudes of their employer
dentists will serve as outcome measures. Hygienist practice changes will be
assessed at 3 and 12 months after receiving training. Changes in employer
dentist attitudes will be assessed at 12 months following their hygienists'
receipt of training. Secondary aims include assessing demographic and
professional characteristics associated with participation and response to
training, and a cost analysis of the interventions.
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