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STUDENT CONTRIBUTION
Year : 2021  |  Volume : 34  |  Issue : 2  |  Page : 80-83

Knowledge and attitude of dental students of Navi Mumbai on tobacco cessation counseling: A cross-sectional study


Department of Periodontics, Bharati Vidyapeeth (Deemed to be University) Dental College and Hospital, Navi Mumbai, Maharashtra, India

Date of Submission26-Feb-2021
Date of Decision20-Jun-2021
Date of Acceptance20-Sep-2021
Date of Web Publication21-Dec-2021

Correspondence Address:
Divyangana Vashi
Bharati Vidyapeeth (Deemed to be University) Dental College & Hospital, Sector 7, Belpada Navi Mumbai- 400614, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1357-6283.332961

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  Abstract 


Background: Due to the increasing awareness about the harmful effects of tobacco, quite a few tobacco users have shown interest in quitting. But, still there is lack of knowledge, lack of tobacco cessation support, and strong cultural habits which influence their inability to quit. Dentists are less likely to provide tobacco cessation advice and counseling and they feel inadequately prepared to provide tobacco cessation education to their patients as compared to physicians and other health professionals. Furthermore, tobacco cessation counseling is not yet a part of routine dental practice and is not incorporated in the dental curriculum. The purpose of this study was to determine the knowledge and attitude of dental students of Navi Mumbai on tobacco cessation counseling. Methods: It is a cross-sectional survey-based study. A total of 691 interns and 4th year BDS students were assessed using a structured questionnaire. Results: About 75.3% of the participants claimed that they were not sufficiently trained to provide tobacco cessation counseling. However, 84.2% indicated willingness to counsel their patients regarding the same. About 62.1% felt that the patients do not listen to dental students about quitting and 89.6% of students agreed that counseling patients on tobacco cessation is their duty. Discussion: Dental students lacked confidence in providing counseling to tobacco users due to lack of knowledge on tobacco cessation counseling. However, majority of the participants were also motivated to undertake special training for counseling. The study highlights the importance of introducing tobacco cessation counseling program in the curriculum of dental students to create awareness about the same and to help dental professionals provide effective tobacco cessation counseling.

Keywords: Counseling, dental students, tobacco cessation


How to cite this article:
Vashi D, Talreja PS, Rathod V, Thorat V. Knowledge and attitude of dental students of Navi Mumbai on tobacco cessation counseling: A cross-sectional study. Educ Health 2021;34:80-3

How to cite this URL:
Vashi D, Talreja PS, Rathod V, Thorat V. Knowledge and attitude of dental students of Navi Mumbai on tobacco cessation counseling: A cross-sectional study. Educ Health [serial online] 2021 [cited 2022 Aug 15];34:80-3. Available from: https://www.educationforhealth.net/text.asp?2021/34/2/80/332961




  Background Top


One of the leading causes of premature death, disease, and disability is tobacco use.[1] It results in approximately 6 million deaths annually[2] and India leads the world in this respect.[3] There has been an increase in awareness about the harmful effects of tobacco. Many tobacco users have shown interest in quitting[4] but due to lack of knowledge[5], lack of tobacco cessation support[6], and strong cultural habits[7], they are unable to quit. Dentists are less likely to provide tobacco cessation counseling and they feel inadequately prepared to do so.[8],[9] Furthermore, tobacco cessation counseling is not yet a part of routine dental practice and dental curriculum.[10] Other health-care professionals are preferred and known to provide better tobacco cessation counseling,[11],[12] however dentists can also contribute significantly to this. There is not enough scientific evidence regarding the knowledge and attitude of dental students' counseling techniques.

Aim

To determine knowledge and attitude of dental students in Navi Mumbai on tobacco cessation counseling.


  Methods Top


A cross-sectional study was conducted among interns and 4th year BDS students of the colleges of Navi Mumbai. The questionnaire used in this study was a modified version of the questionnaire used in an Australian survey.[12] The aim was to assess the knowledge and attitudes of the students towards tobacco cessation counseling and their skills as counselors. The questionnaire was in English and consisted of 17 close-ended questions divided into two categories [Table 1]. The first part aimed to assess the knowledge of the participants toward tobacco cessation counseling, while the second part was designed to determine their attitudes toward the same.
Table 1: Questionnaire

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A total sample size of 691 students was selected to participate in the survey.


  Results Top


Knowledge

A total of 97.8% of the respondents said that they take tobacco use history from all the patients. Only 52.1% said that they could identify the lesions in the patient's oral cavity caused by the use of tobacco, while 83.2% were aware of the role tobacco plays in causing oral cancer. More than half, 70.6%, students did not know whether any written tobacco use policy existed in their institution. When asked about the utilization of strategies for tobacco cessation counseling, 87.3% said that they asked the patients about smoking status. Among other strategies utilized, 86.3% answered that they will suggest nicotine replacement therapy to the patients who wished to quit, 75.5% said that they will arrange follow-up visits to discuss tobacco use and 26.3% will provide written information and self-help material.

Attitude

Although a large number of participants, 62.5%, were concerned that such counseling in dentistry may upset the dentist–patient relationship, 84.2% of participants planned to advise patients about tobacco cessation in their professional careers. About 62.1% believed that patients do not listen to dental students when they discuss tobacco use although a large majority of participants, 89.6%, agreed that giving tobacco cessation counseling to patients is a part of their role as a student, but 75.3% had a belief that they are not given enough training to counsel a tobacco user to quit using tobacco. About 92.9% of participants showed interest in attending special lectures in their colleges about tobacco cessation counseling and getting trained for the same.


  Discussion Top


The present survey assessed the knowledge and attitudes of the dental undergraduates in Navi Mumbai about providing tobacco cessation counseling.

Smoking in all public and workplaces is prohibited under Section 4 of India's Cigarette and Other Tobacco Products Act which came into effect on October 2, 2008. As per the legislation, most of the dental colleges have incorporated official policies banning smoking in their premises; however, not many enforce it.[13] This could be the reason that 70.6% of students were not sure of the existence of a written 'tobacco use' policy of their respective institutions.

Most of the participants (83.2%) were aware of the role tobacco plays in causing oral cancer and 62.5% could identify the lesions caused by the use of tobacco in the patient's oral cavity; however, they were hesitant in counseling since they were concerned that such counseling in dentistry may upset the dentist-patient relationship. Similar results were found in a study which was conducted in Faridabad, India among students of two dental colleges.[1] Even though 84.2% of the participants planned to advise the patients about tobacco cessation in their professional career, 62.1% of students felt that patients do not listen to them being dental students. This highlights the need of providing better training not only to provide knowledge to the students for counseling but also to build their confidence in providing tobacco counseling services.

The simple 5As model (Ask, Asses, Advise, Assist, Arrange) has been an effective guideline for tobacco cessation counseling.[14] This model was assessed through the questionnaire of this study. The strength of the guideline is its strong evidence base. The 2008 update of the guideline confirmed the benefits of the 5A treatments and the importance of the health-care system in the success of tobacco treatment strategies. A study was conducted among 773 Chilean women to assess a primary care intervention based on the 5As model for smoking cessation and whether it has a significant effect in reducing smoking prevalence. This study showed that a brief smoking cessation intervention based on a primary care setting in a low socioeconomic population could have a significant reduction in the smoking prevalence of women smokers of childbearing age. Most women affiliated with the intervention clinic were asked, assessed, and received advice for quitting. They significantly improved their knowledge on how to get assistance for quitting. About a third of these women were willing to make an attempt at quitting in the short term.[15]

Findings of our study were also consistent with the South Carolina study[9] where 89% of students agreed that dentists should be trained to provide tobacco cessation education, and only 39% thought that they themselves were adequately trained. In both the studies, students' opinions towards the role and training of dentists in providing tobacco use interventions differed by the academic year.

Another study conducted in Karnataka, India got response from three dental colleges which said that 94% of students were giving antismoking advice to their patients and only 47% said they had been taught to give antismoking advice suitable for the patients.[10]

One of the drawbacks of this study is, that the results are based on data collected from dental institutions in only one city in India and hence may not be generalizable. Although similar observations are made in various studies among dental students, a wide range of dental colleges needs to be included to confirm the same.

According to a survey conducted from 2003 to 2009, dental schools have been active in conducting comprehensive curriculum reviews. Respondents indicated that the primary reasons for the configuration of the current curriculum were perceived success, compatibility with faculty preferences, faculty comfort, and capacity/feasibility. Key catalysts for curricular change were 'findings of a curriculum review conducted', students' feedback about curriculum, and administration and faculty dissatisfaction.[16]

To enhance dental education in a way that it provides maximum benefit not only to the patients but the community at large, a constant endeavor to bring about changes in the curriculum is deemed necessary. Students' feedback about the curriculum by means of questionnaire-based surveys can be on the various ways which can help the educationists bring about this necessary timely change.

The American Dental Education Association (ADEA), since 2005, has made change and innovation in dental education as one of the Association's major initiatives. The primary conduit for this initiative has been the ADEA Commission on Change and Innovation in Dental Education (ADEA CCI). The Association through the ADEA CCI has published a series of white papers to assist schools as they develop innovative curricula; written, with extensive input from communities of interest, a set of competencies describing the new general dentist; initiated a liaisons program, currently with representatives from different dental schools.[16]

In 2009, ADEA in collaboration with the Academy for Academic Leadership conducted the Dental School Curriculum Format and Innovations Survey. In regard to the results of this survey many innovations were advocated in the dental education literature. Among them were, “establishing clinical group practice teams to provide continuity in faculty-student relationships.” The second most frequently implemented innovation was “increasing student interaction with patients in the first and second years.”[16]

Dental students did not show much confidence in providing tobacco cessation counseling which could help the tobacco users in quitting. However, they do realize that it is their duty as dental professionals to give tobacco cessation counseling. Introducing evidence-based teaching including hands-on and patient-based training may improve the confidence of the students in providing counseling. Moreover, the inclusion of comprehensive tobacco education in the dental curriculum will provide students, an opportunity to have an impact on their patient's quality of life and overall health. Especially in India where there is a large population indulging in tobacco use, it becomes the duty of a dental professional to prevent and treat all the diseases of the oral cavity, including those caused by the use of tobacco. Preventive and oral hygiene practices with tobacco cessation counseling should be incorporated in routine dental care.

Our questionnaire-based survey indicates that there is a present need of change in the dental curriculum with respect to the introduction of tobacco cessation counseling program. This will benefit the patients immensely as dentists very frequently encounter patient who consumes tobacco. It will also help to change the student mindset that counseling in dentistry may upset the dentist-patient relationship. Moreover, students will feel more confident in providing counseling which may enhance the patient acceptance of the counseling.

As per the literature, surveys have been shown to bring about successful “innovation” changes in the dental curriculum. Hence conducting more surveys like this present study in India, may help in implementing better policies on tobacco cessation counseling training in dental schools of India.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Jain M, Akhilandan S, Sharma A, Jain V, Arora K, Sohlot US. Views of Indian Dental students on tobacco cessation counseling and their skills as counselors. J Oral Health Community Dent 2015;9:23-9.  Back to cited text no. 1
    
2.
Ezzati M, Lopez AD, Rodgers A, Vander Hoorn S, Murray CJ; Comparative Risk Assessment Collaborating Group. Selected major risk factors and global and regional burden of disease. Lancet 2002;360:1347-60.  Back to cited text no. 2
    
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World Health Organization. Global Status Report on Noncommunicable Diseases 2010. Geneva: World Health Organization; 2010. Available from: https://www.who.int/nmh/publications/ncd_report2010/en/. [Last accessed on 2020 Dec 02].  Back to cited text no. 3
    
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Gajalakshmi V, Peto R, Kanaka TS, Jha P. Smoking and mortality from tuberculosis and other diseases in India: Retrospective study of 43000 adult male deaths and 35000 controls. Lancet 2003;362:507-15.  Back to cited text no. 4
    
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Ministry of Health and Family Welfare. Global Adult Survey GATS India-2009-10. New Delhi: Government of India; 2010. Available from: https://ntcp.nhp.gov.in/assets/document/surveys-reports-publications/Global-Adult-Tobacco-Survey-India-2009-2010-Report.pdf. [Last accessed on 2020 Dec 02].  Back to cited text no. 5
    
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Perry CL, Stigler MH, Arora M, Reddy KS. Preventing tobacco use among young people in India: Project MYTRI. Am J Public Health 2009;99:899-906.  Back to cited text no. 6
    
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Pradeepkumar AS, Mohan S, Gopalakrishnan P, Sarma PS, Thankappan KR, Nichter M. Tobacco use in Kerala: Findings from three recent studies. Natl Med J India 2005;18:148-53.  Back to cited text no. 7
    
8.
Singh G, Sinha DN, Sarma PS, Thankappan KR. Prevalence and correlates of tobacco use among 10-12 year old school students in Patna District, Bihar, India. Indian Pediatr 2005;42:805-10.  Back to cited text no. 8
    
9.
Cannick GF, Horowitz AM, Reed SG, Drury TF, Day TA. Opinions of South Carolina dental students toward tobacco use interventions. J Public Health Dent 2006;66:44-8.  Back to cited text no. 9
    
10.
Rajasundaram P, Sequeira PS, Jain J. Perceptions of dental students in India about smoking cessation counseling. J Dent Educ 2011;75:1603-10.  Back to cited text no. 10
    
11.
Owen N, Davies MJ. Smokers preferences for assistance with cessation. Prev Med J 1990;19:424-31.  Back to cited text no. 11
    
12.
Rikard-Bell G, Groenlund C, Ward J. Australian dental students' views about smoking cessation counseling and their skills as counselors. J Public Health Dent 2003;63:200-6.  Back to cited text no. 12
    
13.
Regional Office for South-East Asia. Health Professionals in Tobacco Control: Evidence from Global Health Professional Survey (GHPS) of Dental Students in India. GHPS Fact Sheet. New Delhi: World Health Organization; 2005. Available from: https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5420a2.htm. [Last accessed on 2020 Dec 02].  Back to cited text no. 13
    
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US Department of Health and Human Services. Treating Tobacco Use and Dependence: Clinical Practice Guideline. Washington DC: Public Health Service; 2008. Available from: https://www.ncbi.nlm.nih.gov/books/NBK63952/. [Last accessed on 2020 Dec 02].  Back to cited text no. 14
    
15.
Puschel K, Thompson B, Coronado G, Huang Y, Gonzalez L, Rivera S. Effectiveness of a brief intervention based on the '5A'model for smoking cessation at the primary care level in Santiago, Chile. Health Promot Int 2008;23:240-50.  Back to cited text no. 15
    
16.
Haden NK, Hendricson WD, Kassebaum DK, Ranney RR, Weinstein G, Anderson EL, et al. Curriculum change in dental education, 2003-09. J Dent Educ 2010;74:539-57.  Back to cited text no. 16
    



 
 
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