Advise and refer: Disparities among patients receiving tobacco cessation advice from dentists

Background: Smoking causes oral diseases and dental therapy failures. Full implementation of the 5As, including a referral to a quitline in the dentist's office, promotes cessation, however use of the 2As+R (ask, advise, and refer) is also effective. This study tests for demographic disparities regarding dentists' (1) advice to quit smoking and (2) referral to a cessation helpline, using patient reported data from smokers who visited the dentist in the last 12 months.

Methods: Two logistic regressions were completed.

Data: 2006/07 Tobacco Use Supplement of the Current Population Survey.

Dependent variables: being (1) advised by the dentist to quit smoking, and (2) referred to a tobacco cessation hotline. The survey instrument did not contain a question regarding dentists asking about tobacco use.

Independent variables: age, sex, marital status, education, employment status, income, race/ethnicity.

Results: Women (OR: 0.77, p=0.001), individuals age 50 to 64 (OR: 0.69, p=0.001) and 65 and over (OR: 0.45, p=0.001) were less likely, while respondents with less than a high school education were more likely (OR: 1.40 p=0.001) to report being advised to quit smoking. Respondents with a high school education or less were more likely (OR: 1.24, p=0.04) and NH whites less likely (OR: 0.77, p=0.046) to be referred to a cessation hotline.

Conclusion: Significant disparities regarding 2A+R exist in the dental healthcare setting. Older smokers in particular are being underserved, even though they are more likely to be socially disadvantaged, have higher rates of cigarette smoking, and are less likely to be offered cessation services.