Carol Kunzel, PhD, Evanthia Lalla, DDS, MS, David A. Albert, DDS, MPH, Hong Yin, and Ira B. Lamster, DDS, MMSc. School of Dental and Oral Surgery, Columbia University, 630 West 168th St., New York, NY 10032, 212-304-7176, ck60@columbia.edu

The opportunity exists for dentists to provide primary care in the dental office. Such care is consistent with the growing evidence-base of the profession. Two cases in point are tobacco use and management of the diabetic patient. Both tobacco use and diabetes mellitus are two well-documented risk factors for oral disease. By engaging in such office-based behaviors as actively intervening to promote smoking cessation and identifying and monitoring diabetes mellitus patients, dentists have an opportunity to improve both their patients' oral and systemic health. Study data indicate that dentists' performance of smoking cessation behaviors and diabetic patient screening/management behaviors is less than optimal. Collected via mail survey of active general practitioners (GPs) in the northeastern USA during fall 2002 (n=105, response rate =80%), study data show that while seventy-five percent of GPs obtain information on smoking from new patients verbally or with a questionnaire, only 45% almost always/always record the information in patients' charts, and only 42% almost always/always advise patients who use tobacco to quit. In regards to the diabetic patient, 54% of GPs often discuss with such a patient how well-controlled s/he is, while 14% often refer the patient to monitor blood glucose levels. According to the Theory of Planned Behavior (TPB), prior to developing interventions to change dentists' behavior, it is important to determine the degree to which the behavior is under the influence of positive/negative attitudes [Attitudes], perceived support of significant others [Norms], or feelings of efficacy [Behavioral Control]. Because TPB permits the addition of other variables considered potentially influential, awareness of the implications of smoking for oral health [Smoking-Oral Health Awareness] was considered in relation to smoking cessation practices, and awareness of the implications of diabetes for oral health was also considered in relation to managing the diabetic patient [Diabetes-Oral Health Awareness]. Multiple regression analyses indicate that smoking cessation counseling (R2=.46, p<.001) is primarily influenced by the Normative (beta=.31, p<.001), Behavioral Control (beta=.26, p<.01), and Smoking-Oral Health Awareness (beta=.36, p<.001) components. Management of the diabetic patient (R2=.28, p<.001) is primarily influenced by the Attitudinal (beta=.23, p<.05) and Diabetes-Oral Health Awareness (beta=.39, p<.001) components. The content of future interventions can be informed by the relative importance of the predictive components. Awareness of the respective oral-systemic health connection is the most influential predictor of GPs' smoking cessation behaviors as well as their diabetic patient management behaviors. Supported by NIDCR DE014898.

Learning Objectives:

The participant will
• learn current rates pertaining to dentists' in-office smoking cessation behaviors and diabetic patient management behaviors,
• become aware of the potential for using the Theory of Planned Behavior to identify factors that influence dentists' performance of such primary care behaviors, and
• consider the applicability of study results based on such theories for informing the content and design of future interventions.

Keywords: Diabetes, Smoking Cessation

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.