Results
Among the 2,876 dentists contacted, 328 were determined to be ineligible (because of either type of practice or expired or revoked dental license), 11 submitted incomplete surveys, and 735 were nonresponders (explicit refusals, unable to be located, or unavailable). In total, 1,802 (70.7%) dentists completed interviews. Most of the questionnaires were completed via mail (n = 1,349). Additional responses were received via the Internet (n = 381), telephone (n = 28), fax (n = 30), or in person (n = 14). Most respondents were male (78.3%), white (78.6%), and aged 45 to 64 years (62.0%) (Table 1). Most dentists surveyed spent more than 35 hours in patient care per week (42.3%), worked in solo practices (66.4%), and did not see patients insured through Medicaid (71.6%). More than 85% of respondents surveyed reported their knowledge of TDT as moderate to excellent. Most respondents reported having had some TDT training; 30.8% reported 1 to 4 hours and 27.6% report more than 5 hours (Table 1).
Overall, respondents reported positive attitudes and perceptions about providing tobacco cessation counseling: 77.9% agreed that TDT should be part of a dentist's role, 96.4% agreed that they would be doing something positive for their patient by offering tobacco cessation counseling, 80.2% agreed that their patients' perception of them would improve; and 66.3% agreed that their colleagues' perception of them as a health care provider would improve. More than 90% of respondents reported having a chart system that includes a standard screening question about tobacco use (Table 1).
Cessation assistance was associated with the following provider characteristics: positive attitudes toward TDT (P < .001), a higher level of self-reported TDT knowledge (P < .001), more tobacco-related training hours received (P < .001), and larger patient volume (P = .03). Practice characteristics associated with cessation assistance included having 1 or more dental hygienists in the practice (P < .001) and a dental chart that included a tobacco use question (P < .001) (Table 1). Provider and practice characteristics associated with willingness to offer cessation assistance, among only those providers who did not currently provide assistance, were younger age (P < .001), female sex (P = .03), minority race/ethnicity (P = .01), more TDT training hours (P = .01), positive attitudes (P < .001), more hours spent in direct patient care (P = .02), being in a group practice (P = .01), and treating patients insured through Medicaid (P = .01) (Table 1).
Ninety-two percent of dental providers reported routinely screening for tobacco use, and 45% reported offering cessation assistance; 25% reported prescribing pharmacotherapy, and 32% reported referring patients to a quitline. Among those who were not currently providing assistance, nearly 55% (n = 926), reported they would be willing to change their practice patterns if sufficiently reimbursed (Table 2).
In multivariable analyses (Table 3), among all dentists surveyed (Model A), the likelihood of offering smoking cessation assistance was significantly higher among those having a chart system that included a screening question about tobacco use compared with those without such a system (β = 0.199, P < .001) and among those with positive attitudes about TDT (β = 0.152, P < .001). The probability of providing cessation assistance also significantly increased with increasing hours of TDT-related training. Similarly, providers who indicated that their rating of TDT knowledge was moderate to excellent were more likely (β = 0.225, P < .001) to provide assistance than providers who responded none to limited. Among providers who did not report currently offering cessation assistance (Model B), willingness to change this behavior with reimbursement was associated with more positive attitudes toward TDT (β = 0.266, P < .001). Higher levels of knowledge (β = 0.127, P < .05), working in a private group practice (β = 0.167, P < .001), and caring for patients insured through Medicaid (β = 0.147, P < .01) were also associated with increased willingness to provide this service if offered reimbursement (Table 3).