Abstract
Tobacco use impacts every organ in the body. Dental professionals observe the detrimental oral and systemic consequences of tobacco use. Routine dental hygiene and dental appointments are an ideal opportunity for tobacco cessation discussions. Oral health care professionals can take the lead in assisting patients with evidence-based tobacco cessation strategies. Incorporation of tobacco cessation treatment within the curriculum of dental and dental hygiene programs will promote interprofessional tobacco cessation services. The purpose of this short report is to describe the process of introducing a Tobacco Treatment Specialist (TTS) program into the curricula of four health professional programs (dentistry, dental hygiene, pharmacy, and physician assistant) within a university health sciences center. Upon graduation, all involved students may qualify for TTS credentials. This report describes the importance of the interprofessional team, particularly dentists and dental hygienists, in the implementation of the first dental school-based certified tobacco treatment training program and incorporation of tobacco treatment content into interprofessional healthcare program curricula.
- evidence-based practice, health professional training
- interprofessional education, curriculum development
- tobacco cessation
- tobacco dependance treatment
Introduction
Approximately 40 million adults in the United States (US) currently use cigarettes and 4.7 million middle and high school students currently use at least one tobacco product, including e-cigarettes.1 Nearly 4% (3.6%) of all adults smoke cigars and 2.4% of adults currently use smokeless tobacco.1 Cessation from tobacco-use disorder is difficult, often requiring multiple quit attempts. In 2015, two-thirds of people who smoked reported wanting to quit. Approximately half of them received advice in cessation from a healthcare provider and fewer than one in ten remained abstinent one year after quitting.2 Advice from a dental professional about tobacco cessation may encourage quit attempts by patients, but advice alone does not result in successful cessation.3 Evidence-based smoking cessation interventions can lead to a significant reduction in mortality, yet evidence-based approaches are underutilized worldwide.4 Fewer than 33% of quit attempts are aided by evidence-based treatment. While evidence-based behavioral counseling is important, researchers reported that only half of health care providers offered tobacco cessation counseling.4 Behavioral interventions, when combined with nicotine replacement pharmacotherapies, have been found to increase tobacco abstinence rates over counseling alone.4 While combination counseling and pharmacotherapy is important fewer than 5% of people who want to quit receive behavioral counseling and tobacco cessation pharmacotherapy.2 Clinicians have identified a lack of tobacco treatment training as a roadblock in providing tobacco cessation services.5 As of 2022, the Commission on Dental Accreditation has not required tobacco cessation or motivational interviewing techniques as competencies within dental or dental hygiene programs.6,7
This lack of training has indicated the importance and need for formalized education in counseling techniques and pharmacology education for practicing oral health care providers in the form of continuing education (CE), in addition to implementation within the curricula of dental and dental hygiene programs.8 The Council for Tobacco Treatment Training Programs (CTTTP) addressed the need for such education upon its formation in 2008. The goal of CTTTP is to ensure that healthcare professionals are prepared to meet the needs of diverse and complex populations of people who use tobacco products. The CTTTP provides program accreditation for new and existing programs provided the eleven program competencies are met. Currently there are 25 accredited Tobacco Treatment Training Programs in the US and internationally.9
Objective/Challenge
The purpose of this short report is to describe and evaluate the process of introducing a Tobacco Treatment Specialist (TTS) program into the curricula of four health professional programs (dentistry, dental hygiene, pharmacy, and physician assistant) within a university health sciences center in the Southeastern US. This short report further supports the need for training that equips dental hygiene and dental providers with evidence–based treatment strategies to address tobacco use disorder and the need to incorporate tobacco cessation strategies into accreditation standards for dental and dental hygiene education programs.
Needs assessment
In 2002, a needs assessment survey at the University of West Virginia University School of Dentistry (WVU SOD) indicated 70.9% of people who used tobacco were interested in quitting and approximately half were interested in having assistance with tobacco use cessation.10 With this information, the periodontal dental faculty and dental hygiene faculty were enthusiastic to assist with tobacco cessation. From 2000-2008, (prior to the accreditation process of the CTTTP) the periodontal and dental hygiene faculty followed guidelines in the Clinical Practice Guideline for Treating Tobacco Use and Dependence: US Public Health Report.11 In 2009, the electronic dental health records in the dental clinic were expanded to include the Initial Tobacco Questionnaire and Tobacco Counseling Intervention forms for dental students, dental hygiene students, and dental faculty use with their tobacco-using patients. As newer tobacco products, such as e-cigarettes, arrived on the market, the forms were updated to reflect the current marketplace. An analysis of responses within the Initial Tobacco Questionnaire and Tobacco Counseling Intervention electronic dental forms provided information regarding the success of the current tobacco cessation efforts and areas in need of improvement. A timeline of events is presented in Figure 1.
History of the integration of the Tobacco Treatment Specialist program the Health Sciences Center
Faculty education
In 2010, after analysis of the electronic questionnaires about tobacco, it became evident that while most student oral health care providers were recommending tobacco cessation to their patients, not all were providing counseling and evidence-based tobacco treatment pharmacotherapy.12 This information was brought to the West Virginia University Health Sciences Center (WVU HSC) administration and selected dental hygiene and dental faculty were sent for on-site TTS training at the Mayo Clinic in Rochester, Minnesota. Upon return to the WVU SOD, the team was passionate about creating a certified tobacco treatment program at the SOD, and expanding it with interprofessional presenters from various disciplines, while keeping the management and administration of the program within the WVU SOD.
Tobacco cessation charge
The WVU HSC administration was supportive of the ambitious effort. The team was charged with developing a program to include tobacco research, counseling, cessation, and policy efforts and to provide in an interdisciplinary manner to practicing health care providers. Several years of collaborative work followed culminating in the creation of the certified tobacco treatment training program according to the CTTTP guidelines for accreditation.9
The application for accreditation occurred in 2017. The WVU SOD became the first dental school with a TTS Certification Program for health care providers led by dentists, dental hygienists and other interprofessional health care providers. The first TTS CE program was offered the following May. It was a successful initial program with 39 health care professional attendees and attendance greatly increased during each subsequent annual educational conference.
Expansion into student curricula
The WVU HSC houses five health science programs with students meeting twice a semester for interprofessional (IPE) educational sessions. One of these IPE sessions includes tobacco cessation case studies. The Academic Deans of the School of Pharmacy, School of Dentistry, Physician Assistant Program, and the Program Director for Dental Hygiene worked with the TTS faculty to adopt the TTS program certification into their specific departments’ core curricula. These four programs are serving as pilot programs for the implementation of TTS certification into their curricula with anticipation that all six programs will ultimately participate.
Each of the four programs identified the twenty-four student-faculty contact hours within their curricula on the topics of tobacco education, counseling, assessment, treatment planning, pharmacology, relapse prevention, diversity, specific health issues, documentation, evaluation, professional resources, law and ethics, professional development, and clinical competencies as required for certification through the national TTS program. (Table I). The four program deans and/or program director reviewed the eleven competencies/skill sets to determine where or if the required content was provided within the program’s curriculum. Each of the four programs provided course number and hours to document where the required twenty-four contact hours of tobacco treatment content are delivered within the students’ curricula. Any missing required TTS content was then supplemented during an interprofessional eight-hour educational session.
Core competencies and minimum hours required for TTS Accreditation9
Across each individual discipline, students had interactions with tobacco-using patients throughout their clinical training experiences. Health science students also worked with supplemental simulated tobacco treatment case presentations. All the health science students across the four disciplines who successfully attained a minimum score of 80% on the tobacco treatment training certification examination, treatment competencies as defined by their specific discipline and attested to the tobacco-free proclamation can tout the certified TTS credentials along-side their degree, upon graduation.
West Virginia University is the first HSC in the nation to formally offer TSS certification training as part of core curricula in health care programs of students in dental hygiene, dentistry, pharmacy, and physician assisting. This significant, multidisciplinary curricular implementation will improve health care providers’ tobacco knowledge and confidence in the provision of evidence-based pharmacotherapy and counseling to each tobacco-using client they encounter. In turn, this evidence-based intervention can lower the progression of periodontitis, reduce oral and whole-body cancers, improve cardiovascular/pulmonary health, and general health outcomes.
Conclusion
This short report provides a framework for health sciences centers and dental hygiene programs to utilize for implementation of TTS certification into their programs. There remains an ongoing need for educating all health care providers with evidence-based tobacco cessation strategies. The significance of this education cannot be overstated.
Footnotes
This manuscript supports the NDHRA priority area Professional development: Educational Models (epidemiology).
Disclosure
Research reported in this publication was supported by the National Institute of General Medical Sciences of the National Institutes of Health under Award Number 5U54GM104942-04. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
- Received January 28, 2022.
- Accepted May 6, 2022.
- Copyright © 2022 The American Dental Hygienists’ Association
