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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 9  |  Issue : 5  |  Page : 117-120  

Smoking cessation advice: Knowledge, attitude, and practice among clinical dental students'


1 Department of Public Health Dentistry, College of Dental Sciences, Davanagere, Karnataka, India
2 Department of Prosthodontics, College of Dental Sciences, Davanagere, Karnataka, India
3 Department of Prosthodontics, Yenepoya Dental College, Yenepoya University, Mangalore, Karnataka, India

Date of Web Publication27-Nov-2017

Correspondence Address:
Allama Prabhu
Departments of Public Health Dentistry, College of Dental Sciences, Davanagere, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpbs.JPBS_118_17

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   Abstract 


Background: Smoking is the single most important public health challenge facing the National Health Service. The detrimental effects on the general health of tobacco smoking are well documented. Smoking is a primary risk factor for oral cancer and many oral diseases. Dental professional scan plays an important role in preventing adverse health effects by promoting smoking cessation. Objective: To assess the knowledge, attitude, and practice among clinical dental students in giving smoking cessation advice and to explore the barriers to this activity. Materials and Methods: A total of 262 clinical dental trainee of two dental colleges (College of Dental Sciences and Bapuji Dental College) of Davangere city were included in the survey. A self-administered questionnaire was administered to assess the knowledge, attitude, and practice toward Tobacco Cessation Advise. Results: Among the 262 participants in the study, around 51% said they know about Nicotine Replacement Therapy, and among them, only 4.6% were aware of the options available in the market. When asked about 5A's of tobacco cessation, only 35.5% were aware of it. Similarly, when asked about 5R's of tobacco cessation, 48.5% were unaware of it. Conclusions: The respondents did not have sufficient knowledge regarding tobacco cessation advice. With patient's disinterest and lack of time being quoted as the important barriers in providing tobacco cessation advice, it is highly recommended that there is need to incorporate few chapters on tobacco, its effect and cessation of habit in the undergraduate dental curriculum with simultaneous application of the same in clinical practice.

Keywords: Advice, attitude, dental students, smoking cessation


How to cite this article:
Prabhu A, Jain JK, Sakeenabhi B, Naveen Kumar P G, Imranulla M, Ragher M. Smoking cessation advice: Knowledge, attitude, and practice among clinical dental students'. J Pharm Bioall Sci 2017;9, Suppl S1:117-20

How to cite this URL:
Prabhu A, Jain JK, Sakeenabhi B, Naveen Kumar P G, Imranulla M, Ragher M. Smoking cessation advice: Knowledge, attitude, and practice among clinical dental students'. J Pharm Bioall Sci [serial online] 2017 [cited 2021 Sep 19];9, Suppl S1:117-20. Available from: https://www.jpbsonline.org/text.asp?2017/9/5/117/219261




   Introduction Top


Smoking is the single most important public health challenge facing the National Health Service (NHS). Smoking-related diseases are responsible for an estimated 18% of deaths in England and Wales and cost the NHS approximately ≤1.7 billion per year.[1] The detrimental effects on the general health of tobacco smoking are well documented and on average cigarette smokers die 10 years younger. Dental professionals can play an important role in preventing adverse health effects by promoting smoking cessation, as more than 50% of smokers see a dentist in any 1 year. The agenda for the UK stop smoking policy for the last decade has been directed by the White Paper on tobacco, “Smoking kills” than nonsmokers.[1]

Smoking causes certain fatal diseases, such as chronic obstructive pulmonary disease (emphysema and chronic bronchitis), cancer and ischemic heart disease. Between 1950 and 2000, approximately, 70 million people died due to tobacco use; over the next 50 years, another 450 million might die from smoking-related diseases.[2],[3] Smoking is a primary risk factor for oral cancer, as well as leukoplakia, periodontitis, and delayed wound healing.[4]

The statistics concerning active smoking are often published and well-known, whereas environmental tobacco smoke (ETS) is much more difficult to estimate. The difficulties include determining a measurement unit which could be reliable. Researchers look at nicotine and its metabolites' concentration in the blood, urine, and hair. Many studies have proved that substances present in side stream smoke, to which passive smokers are exposed, are extremely harmful. Substances burned in the tip of a cigarette, are 50 times more concentrated than those in the inhaled smoke.[5] The use of tobacco during pregnancy is one of the most important risk factors for neonatal and late fetal death.[6]

Smoking cessation is defined as sustained abstinence from cigarettes and other tobacco products for at least 6 months, but preferably for 1 year, as confirmed by measurement of expired carbon monoxide or other objective tests.[2] The methods of smoking cessation intervention can be classified as behavioral, pharmacological, or alternative.

However, some studies have revealed that most doctors rarely advise and assist smokers in quitting smoking due to a lack of training, skills and confidence in smoking cessation, as well as to other obstacles to performing smoking cessation interventions. Nicotine replacement therapy (NRT) is available on prescription in many countries, including the UK. Physicians provide the educational material, counseling along with NRT and play an important role because the proper use, contraindications and side effects of NRT should be understood.[6]

The purpose of this survey was to assess the knowledge, attitude, and practice of clinical dental students regarding smoking cessation advice (SCA) in Davanagere city, Karnataka.


   Materials and Methods Top


A questionnaire-based survey was conducted among clinical dental students (3 years BDS, Final year BDS and House surgeons) of Bapuji Dental College and Hospital; and College of Dental Sciences, Davangere. All the students and house surgeons present on that day of the survey were included in the study. The respondents were approached directly by the researchers and asked to answer the questionnaire in the presence of the researcher. Before the survey, the permission was obtained from the principals of the respective colleges and programme was scheduled accordingly. First and 2nd year students were not included in the study as they are not exposed to clinical posting.

Inclusion and exclusion criteria

Inclusion criteria

All the clinical dental students and teaching faculty members present on the day of the survey.

Exclusion criteria

Respondents absent on the day of the survey and 1st and 2nd year students as they are not exposed to clinics.

Questionnaire

The prefabricated validity tested questionnaire consisted of 23 questions which assessed knowledge, attitude, and practice regarding “SCA.” The questions used were mainly close-ended. In the beginning of the questionnaire, the personal information regarding the respondents was obtained like year of study, gender, and age.

Ethical considerations

Ethical approval was obtained from the ethical committee of College of Dental Sciences; Davangere Informed consent was obtained from the respondents before the survey.

Statistical analysis

All returned questionnaires were coded and analyzed. Results were expressed as a number and percentage of respondents for each question and were analyzed using the SPSS Version 17 (SPSS Inc., Chicago, IL, USA link) software. Chi-square test was performed for inferential analysis, and the level of statistical significance was set at P = 0.05.


   Results Top


Among the 262 participants in the study, 54.2% (n = 142) were males and 45.8% (n = 120) were females [Graph 1]. The participants were aged between 20 and 27 years.



Over half of the numbers of respondents were students (53.3%) and the rest were dental house surgeons (46.7%).

Around 55.3% participants were nonsmokers. Among them, 66% advised patients who were smokers to stop smoking. When asked about the negative effects of smoking on dental and general health, 37.4% answered that it had an effect on dental health [Table 1] and almost same percentage 37% agreed it affected both dental as well as general health. About 46.5% of the respondents were aware of the ill effects of smoking on health.
Table 1: Response when asked about knowledge regarding oral manifestations encountered in smokers

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When asked about the association between smoking and lung cancer, 64.9% were aware about the association. The majority (63.4%) of the respondents were aware of the symptoms of smoking [Table 2].
Table 2: Response when asked about the knowledge of the general manifestations of smoking

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When asked about the modes of tobacco cessation, only 21.8% knew about the various modes. Only 14.1% were aware of the barriers of tobacco cessation advice. Around 52.60% of the respondents said they had knowledge regarding NRT and among them, only 4.6% were aware of the options available in the market [Table 3]. When asked about their knowledge regarding 5A's of tobacco cessation, only 35.5% were aware. Similarly, when asked about 5R's, 48.5% were not aware regarding the 5 R's of tobacco cessation [Table 4].
Table 3: Response when asked about barriers in providing smoking cessation advice

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Table 4: Response when asked about the knowledge regarding the elaboration of five R's of smoking cessation

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Only 24% knew about the time duration of tobacco cessation for the individual patient. Only a few (27%) of the respondents opined that the patients should be recalled after tobacco cessation. About 58.4% responded said they know the effect of passive smoking. Around 43.9% of the respondents said they were prepared to give SCA. Only 32.1% said they required further training regarding tobacco cessation.


   Discussion Top


This survey of clinical dental students' knowledge, attitude, and practice regarding SCA has shown that the students have good knowledge of the effects of tobacco on dental and general health and a positive attitude toward providing SCA to patients.[1]

The results of our study showed that most of the dental students lack knowledge of smoking cessation when compared with physicians evaluated in other studies such as knowledge, beliefs, attitudes, confidence, and practices: implications for the treatment of tobacco dependency.[2] This might be due to inadequate training in smoking cessation interventions after graduation and a lack of emphasis on smoking education in the medical schools.[2]

The results of this study indicate that many dental offices participating in the survey did not have prior training in tobacco control, did not ask their patients about tobacco use, and did not provide advice about NRT therapy. In addition, patient expectations do not create a demand for these services.[2] The interesting fact is that it was not only the never-smokers who supported the idea of a smoking ban in public places, but also a great number of smokers agreed with the idea. Implementation of the smoking ban in public places is supported by 42.7% of smokers and the smoking ban was less welcomed in pubs and discos (42.7% in the group of smokers). There is strong agreement that smoking should be banned, especially in public places. Even current smokers agree, although not as eagerly.[2] However, in our result, about 43.9% support smoking in public place and 42.7% support ban in public place.

In comparison, smokers suffered mostly from sputum production and wheezing form of respiratory problems. This may be a consequence of the difficulty for smokers in distinguishing the signs caused by smoking itself from those originating from ETS, or their adaptation to typical symptoms, leading them to notice others.[2] Physicians (3.7%) prescribed oral antidepressants, whereas (2.8%) prescribed NRT therapy[7],[8] (NRT, nicotine gum, in all cases). In this study, among various NRT available 37.8% said they prescribe chewing gum and 37.4% said they prescribe sublingual tablets and remaining percent said they prescribe others forms. Most physicians (70.7%) did not schedule a follow-up visit.[5] In this study, 73% did not schedule follow up visits when they encountered smoking patients. It has been demonstrated that follow-up visits during the abstinence period often provide the physician with an opportunity to review the progress of smoking cessation, congratulate the patient, stress abstinence, identify problems (current and potential), and initiate a new intervention or modify the current one if necessary.[5]

When asked about barriers in providing SCA, most of them responded patient disinterest, lack of education, lack of time were the important factors but in another study by Kenneth WK Lack of training”, “unlikely to be successful,” and “possibility of losing patients” were the three barriers regarded as “very important” by dentist.[9],[10],[11] The dentists' cigarette smoking habits are relevant to their effectiveness as role models for their patients. As we shall see, they are also relevant to what dentists are likely to do to influence smoking habits. In this study, 44.70% of dentist were smoker similar to study by O'shea and Corah.[12]

Our results show that the smoking habits of dentists affect their inclination to offer advice or to prohibit smoking in their offices. Our finding parallels that drawn by Coe and Brehm from a study of a nationwide sample of physicians; they stated. Physicians who do not smoke are much more likely to advise patients to stop smoking than are physicians who do smoke.


   Conclusions Top


Despite having knowledge of associated health risks with smoking use and positive attitudes toward giving SCA to patients, clinical dental students perceived barriers to providing SCA. The challenge therefore for the undergraduate curricula is to address the motivation, reservations, and concerns that govern students' behavior, to ensure that when students graduate they do so not only with the knowledge but the confidence they need to provide what is known to be an effective and important health-care intervention and to be able to refer patients interested in stopping smoking to an appropriate source of help.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Clareboets S, Sivarajasingam V, Chestnutt IG. Smoking cessation advice: Knowledge, attitude and practice among clinical dental students. Br Dent J 2010;208:173-7.  Back to cited text no. 1
    
2.
Desalu OO, Adekoya AO, Elegbede AO, Dosunmu A, Kolawole TF, Nwogu KC. Knowledge of and practices related to smoking cessation among physicians in Nigeria. J Bras Pneumol 2009;35:1198-203.  Back to cited text no. 2
    
3.
Twyman L, Bonevski B, Paul C, Bryant J. Perceived barriers to smoking cessation in selected vulnerable groups: A systematic review of the qualitative and quantitative literature. BMJ Open 2014;4:e006414.  Back to cited text no. 3
    
4.
Albert D, Ward A, Ahluwalia K, Sadowsky D. Addressing tobacco in managed care: A survey of dentists' knowledge, attitudes, and behaviors. Am J Public Health 2002;92:997-1001.  Back to cited text no. 4
    
5.
Chadzyński R, Woźniak K, Nowogórska A, Domagała-Kulawik J. Exposure to passive smoking among current smokers and non-smokers. Pneumonol Alergol Pol 2009;77:440-5.  Back to cited text no. 5
    
6.
Thawani V, Pande S, Turankar A. Pharmacotherapy for treating tobacco dependence. Indian J Pharmacol 2003;35:402-3.  Back to cited text no. 6
  [Full text]  
7.
Cawkwell PB, Blaum C, Sherman SE. Pharmacological smoking cessation therapies in older adults: A review of the evidence. Drugs Aging 2015;32:443-51.  Back to cited text no. 7
    
8.
Okuyemi KS, Nollen NL, Ahluwalia JS. Interventions to facilitate smoking cessation. Am Fam Physician 2006;74:262-71.  Back to cited text no. 8
    
9.
Li KW, Chao DV. Current practices, attitudes, and perceived barriers for treating smokers by Hong Kong dentists. Hong Kong Med J 2014;20:94-101.  Back to cited text no. 9
    
10.
Hanioka T, Miki Ojima B, Kawaguchic Y, Hirata Y, Ogawa H, Mochizuki Y. Tobacco interventions by dentists and dental hygienists. Jpn Dent Sci Rev 2013;49:47-56.  Back to cited text no. 10
    
11.
Bhat N, Jyothirmai-Reddy J, Gohil M, Khatri M, Ladha M, Sharma M, et al. Attitudes, practices and perceived barriers in smoking cessation among dentists of Udaipur city, rajasthan, india. Addict Health 2014;6:73-80.  Back to cited text no. 11
    
12.
O'shea RM, Corah NL. The dentist's role in cessation of cigarette smoking. Public Health Rep 1984;99:511-4.  Back to cited text no. 12
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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