Tobacco cessation messaging via dental care providers – 10/21/09

Q: One of your colleagues in Illinois would like information about tobacco cessation programs that focus on tobacco and oral cancer. Does anyone have examples of successful programs that promote smoking cessation through the dental care setting? Illinois is particularly interested in programs that utilize oral hygienists to provide prevention and cessation messaging.

A:

1. Alabama: In Alabama, over 100 dental hygienists have been trained on the Ask, Advise, Refer, Prescribe (AARP) protocol. They are eligible to receive one hour of CEU credit for completion of the training. The attached AARP presentation is used for the training of healthcare and social services providers.
    
   
2. Colorado: The American Dental Hygienists' Association had a five-year initiative called Ask, Advise, Refer http://www.askadviserefer.org that was directed specifically at dental hygienists and increasing tobacco cessation activities within oral health care settings. It met with some success in CO, but there were other states (California) that had greater success and champions.
    
3. Maryland: We don't have a specific initiative, but do partner with the state Office of Oral Health and recently did some focus groups with hygienists specifically addressing cessation and the Quitline. The report is not published, but if a state wants to contact DBerkowitz@dhmh.state.md.us, we can share it with them.
    
4. Michigan: Michigan has been working for years with health professionals in the oral health and hygiene field. The Michigan Dental Association and the Michigan Association of Dental Hygienists have been members of Tobacco-Free Michigan (statewide tobacco-free coalition). There are several collaborations and interventions that are noteworthy:
    
• In the last several years the Michigan Primary Care Association received a HRSA grant to work in collaboration with the state tobacco reduction program to train providers and health care professionals at federally funded community health centers about the 5As and how to intervene with their patients who use tobacco, including use of the Michigan Quitline fax referral system. The trainers for most of these one-day workshops are two dental hygienists trained by HHS to present on the 5As. These health centers are able to bill for tobacco interventions with their patients.
   
• As part of the HRSA grant, MPCA presented a daylong seminar to Michigan's Oral Health Coalition in Oct 2008. The audience included providers, third party payers, MDCH oral health program, consumer advocates, dental hygienists, and schools of dental hygiene. Because our neighboring state of WI has developed some excellent materials, the shared resources relied heavily on their contributions.
   
• As a result of the MPCA workshops, we collaborated to develop a one-hour webinar entitled Tobacco Prevention: Cessation for Dental Professionals. It is archived and available online. Also, see the American Dental Hygienists Association website, for excellent support on the Ask. Advise. Refer program.
   
• Joan McGowan is Associate Professor Emeritus of Dental Hygiene at U of M School of Dentistry. She is Michigan's STEP (Spit Tobacco Education Program) representative for the national program. She is a wonderful spokesperson and assertively represents the interests of dental hygienists in educating and addressing oral health related to tobacco use.
  
  In all training opportunities with dental professionals and hygienists, we promote the use of Medicaid CDDT code D1320, which provides reimbursement for tobacco counseling for prevention of oral disease.
   
5.  Minnesota: Currently, several tribal communities have chosen to establish cessation systems in their communities, after going through a two-year readiness assessment, which took place from April 2007 to March 2009. They are in the initial stages of providing cessation services, and beginning to create formal links to healthcare providers (including dentists). However, they are really in the first stages of collaborating with these entities. Feel free to contact kelly.milam@state.mn.us with any questions/comments.
    
6. New York: The New York State Department of Health's Tobacco Control Program provided a grant to the Center for Smoking Cessation at Seton Health to develop a statewide project, "The Empire Challenge" which replicated California’s successful Gold Rush project. The Empire Challenge was informed by the American Dental Hygienists’ Association (ADHA), the Robert Wood Johnson Foundation’s Smoking Cessation Leadership Center (SCLC) at the University of California at San Francisco, and the Dental Hygienists’ Association of the State of New York (DHASNY). The project's goal was to increase the number of referrals by dentists and dental hygienists to the NYS Smokers' Quitline. The project provided a variety of free educational resources and other supplies to dental practices. Hygienists had the ability to download order forms online, and access to an unlimited supply of free tobacco cessation resources and supplies for their practices. Additionally, a statewide incentive-based contest was created to increase the number of referrals to the New York State Smokers’ Quitline and to motivate hygienists.
    
   We do have some supplies from this program, and you can learn more about it at http://quitsolutions.org/. Click the tab titled Dental Hygienists. For more information, please contact Marge Mineau at (518) 459-2550. She was intimately involved in the 3-year project.
    
7. South Dakota: The South Dakota Department of Health’s Tobacco Control Program has partnered with the South Dakota Dental Association (SDDA) to provide training on the importance of the 5 A’s for tobacco cessation to all dental clinics. We provided a core group of Dental Hygienists with training on how to train other dental hygienists to screen for tobacco use at each and every visit. We also provided dental clinics with the following tobacco cessation resources:
    
• Helping Smokers Quit - A Guide for Clinicians. This is a pocket sized booklet which list the 5 A’s, available from the Public Health Services of the US-DHHS.
   
• Step-by-step instructions on how tobacco users can access the SD-QuitLine.
   
• Fax referral forms for prescription tobacco cessation medication available through the SD-QuitLine, as dental providers in South Dakota can prescribe medication.
   
  Although we do not see a significant percentage of SD-QuitLine referrals from dental providers, we have seen the numbers increase since we began this process.
   
8. West Virginia: West Virginia has a specific program called Save Face that addresses the addiction and prevention of oral tobacco product use, including a focus on the dental care setting, specifically dentists and dental hygienists to provide prevention and cessation messaging and fax to quit services for our state quitline!
    
   Learn more about this program at www.wvdtp.org (under Cessation programs). For more information, contact Kathy Danberry, WVDTP Tobacco Cessation Program Manager, at 304-558-6260 or Kathy.M.Danberry@wv.gov.

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