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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 4  |  Issue : 1  |  Page : 21-29

Perceptions of smoking cessation counseling among dental students in Riyadh, Saudi Arabia: A cross-sectional study


1 College of Dentistry, Riyadh Elm University, Riyadh, Kingdom of Saudi Arabia
2 College of Dentistry, King Saud University, Riyadh, Kingdom of Saudi Arabia
3 College of Dentistry, King Khalid University, Abha, Kingdom of Saudi Arabia
4 College of Dentistry, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia

Date of Submission12-Dec-2018
Date of Acceptance19-Dec-2018
Date of Web Publication20-Feb-2019

Correspondence Address:
Dr. Abdulmalik A Alhussain
College of Dentistry, Riyadh Elm University, Riyadh
Kingdom of Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijas.ijas_20_18

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  Abstract 


Context: The dental clinic is presumed to be a suitable and practical place for smoking cessation counseling. Clinical dental students have an opportunity to play a crucial role in educating their patients about the impact of smoking and promote their oral and general health.
Aims: This study aims to determine the perceptions of clinical dental students toward smoking cessation counseling and the barriers to promote it.
Settings and Design: This cross-sectional study was conducted in Riyadh, Saudi Arabia in July 2017 among clinical dental students and interns of five dental schools.
Subjects and Methods: We used a questionnaire derived from a similar study. The online questionnaires were distributed through social media.
Statistical Analysis Used: Data analysis was achieved using SPSS 24.0 Mac version (Release 24.0, IBM, USA) through Chi-square test. Statistical significance was considered at P < 0.05.
Results: A total of 291 individuals participated in the study. Most of the respondents were nonsmokers (79.4%). In comparison between junior and senior dental students with regard to their perceptions of smoking cessation counseling, it was found that there was no significant difference between the two groups. Most of the respondents were interested in becoming trained on how to assist patients to quit (72.9%). Furthermore, the majority of participants inquired about their patients' smoking status (87.6%). The most frequently cited barrier was lack of training to help patients quit smoking (67%).
Conclusions: This study identified the lack of appropriate training and insufficient knowledge toward tobacco use cessation counseling.

Keywords: Cessation, dental student, Saudi Arabia, smoking


How to cite this article:
Alhussain AA, Alsaif RF, Alahmari JM, Aleheideb AA. Perceptions of smoking cessation counseling among dental students in Riyadh, Saudi Arabia: A cross-sectional study. Imam J Appl Sci 2019;4:21-9

How to cite this URL:
Alhussain AA, Alsaif RF, Alahmari JM, Aleheideb AA. Perceptions of smoking cessation counseling among dental students in Riyadh, Saudi Arabia: A cross-sectional study. Imam J Appl Sci [serial online] 2019 [cited 2019 May 19];4:21-9. Available from: http://www.e-ijas.org/text.asp?2019/4/1/21/252593




  Introduction Top


Tobacco use is arguably the most preventable cause of death around the globe,[1] resulting in approximately 6 million lives annually around the world, with an anticipation of growing in numbers to reach 8 million by 2030.[2] It has devastating impacts on the human body,[3],[4] including numerous oral conditions. Oral conditions can include oral mucosal lesions, periodontitis, delayed wound healing, halitosis (bad breath), dysgeusia (faulty taste), and teeth staining.[5],[6],[7] Smoking is also known to cause serious harm to overall health including respiratory disease, cardiovascular disease, macular degeneration, and adverse pregnancy outcomes.[3] Smokers are more likely to develop cancers compared to nonsmokers.[3]

Saudi Arabia is considered as one of the top five importing countries of tobacco worldwide.[8] A study conducted by the World Health Organization in 2006 revealed that the prevalence of tobacco consumption was 22% in the kingdom[2] while another study undertaken in 2012 showed an increase in the prevalence of smoking to be 27.9%.[9] Plenty of factors are believed to play a role in raising this harmful habit, especially lack of awareness in maintaining good health, low cost of a cigarette pack, stress, and being surrounded by a smoking environment.[10],[11] Despite that, over 70% of tobacco users are willing to quit, and >50% of smokers have made failed attempts to stop smoking.[12],[13] Moreover, Al-Mohrej et al. showed that religious and social reasons were the most incentives and motivating aspects that led people to quit smoking by 57% whereas 40% had chosen to abstain for health concerns.[14]

Dental practitioners as well as clinical dental students have a unique opportunity to play a crucial role in educating their patients about the impact of smoking in addition to promoting their oral and general health. Many reviews have presumed that the dental setting is a suitable and practical place to get involved in antismoking campaigns.[15],[16] In addition, as the dental visits are more consistent and long in duration, it would be an excellent approach for intervention and reinforcement.[17] Not only but also, since more than half of smokers visit the dentist on any given occasion.[18],[19] Fortunately, smoking cessation activities practiced by dental professionals can attain about 10%–15% of the annual quitting rate.[20] Still, barriers have been reported from dental schools whereas the major obstacle was patient disinterest in receiving advice, followed by lack of training and skills.[21]

There are no current studies reported in Saudi Arabia that have evaluated dental students' attitudes and practices toward smoking cessation counseling. This study aims to determine the perceptions of clinical dental students toward smoking cessation counseling and the barriers to promote it.


  Subjects and Methods Top


This cross-sectional study was conducted in Riyadh, Saudi Arabia, among clinical dental students (fourth, fifth, and sixth years) and interns of five dental schools (King Saud University, King Saud bin Abdulaziz University for Health Sciences, Riyadh Elm University, Princess Nora bint Abdulrahman University, and AlFarabi Colleges) in July 2017 with a convenience sampling technique, using a self-administered questionnaire derived from a similar study conducted by Ford et al.[22] The questionnaire was presented in English since it is the primary language of instruction in Saudi Arabia. The questionnaire was transformed into an electronic form using Google Forms (Google Forms, 2018; a free web-based survey generator). Participation was voluntary, and participants were kept anonymous. The current study was granted the approval from the Institutional Review Board at King Abdullah International Medical Research Center before commencing the study. The questionnaire composed of five parts; demographic data, knowledge of smoking hazards, appropriate interventions, current practices, and perceived barriers with a total of 47 multiple choice questions. A link to the online questionnaires was generated and distributed by the researchers through social media (Facebook, Twitter, and WhatsApp) targeting the study population, including a consent to participate before filling it out. Dental students enrolled in the fourth and fifth academic years are referred to as “Juniors,” while students from the 6th year and dental interns are referred to as “Seniors.”

All the survey's questions were mandatory multiple choice questions. Thus, there was no missing data. Data were filled into appropriately designed Microsoft Excel sheet and then imported into SPSS program. Data management and analysis were achieved using SPSS 24.0 Mac version (Release 24.0, International Business Machines Corporation (IBM), New York, United States). Descriptive statistical analysis was performed for the study sample. Interferential statistics was accomplished using Chi-square test to compare frequencies between juniors and seniors. Statistical significance was considered at P < 0.05.


  Results Top


Demographic profile of participants

Completed questionnaires were gathered from 291 participants (juniors, 45.7% and seniors, 54.3%), in which females (52.9%) were slightly more than males (47.1%). Most of those who responded to the questionnaire were from Riyadh Elm University (41.9%). However, the majority of respondents were nonsmokers (79.4%). [Table 1] provides an overview of the demographic profile of participants.
Table 1: Demographic profile of participants

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Dental students' knowledge toward smoking hazards

The second set of questions were aimed to evaluate the dental students' knowledge toward smoking hazards relevant to dentistry as shown in [Table 2]. An overwhelming majority of dental students and interns have agreed that cigarette smoking and tobacco consumption would put the patient at greater risk for developing oral cancer (97.6%), laryngeal carcinoma (89.3%), coronary heart disease (88.7%), periodontal disease (95.5%), and implant failure (90.4%). However, fewer respondents have agreed that smoking is a predisposing factor for peripheral arterial disease (74.2%) and oral candidiasis (69.4%), with no significant differences between the two groups.
Table 2: Dental students' knowledge toward smoking hazards

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Dental students' attitudes regarding appropriate smoking cessation interventions

Participants were asked questions regarding the appropriate smoking cessation activities as shown in [Table 3]. The vast majority of participants either agreed or strongly agreed that it is appropriate to ask all patients about their smoking status (92.8%), inform patients of the benefits of quitting smoking (89.7%), explain the impact of smoking on the oral health (91.4%), and general health (89.7%). A high percentage of respondents recognized that it was appropriate to advise patients to quit smoking (83.9%). Nevertheless, just 76% thought it was convenient to assist patients to quit. More than two-thirds of respondents believed that referring patients to technology-based resources and discussing the use of nicotine replacement therapy would be appropriate interventions. Approximately, three-fourths of the participants were interested in becoming trained on how to assist patients to quit. A considerable proportion (74.9%) of dental students and interns were unanimous in their opinion on the appropriateness of providing motivational interviews to help patients stop smoking. However, none of the differences were statistically significant.
Table 3: Dental students' attitudes regarding appropriate smoking cessation interventions

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Current smoking cessation practices of dental students

[Table 4] illustrates the current actions practiced by students and interns. A vast majority of participants stated that they always or most of the time inquired about their patients' smoking status (87.6%) and explained the effect of smoking on dental health (82.5%). A statistically significant increase (P < 0.05) was observed on advising patients to quit smoking, informing patients of the benefits of quitting, and explaining the effect of smoking on the overall health wherein a higher percentage of juniors compared to seniors reported they always advised their patients to quit smoking (59.4%), inform patients of the benefits of quitting (60.2%), and explain the effect of smoking on the overall health (60.2%). About 63% of respondents frequently assist patients in quitting smoking. However, 35.1% of participants reported that they never/hardly ever referred patients to technology-based resources while 67.7% considered it as an appropriate intervention. Surprisingly, a significantly greater proportion of seniors over juniors (20.3%; 10.5%) have never provided motivational interviews to help patients stop smoking (P < 0.05).
Table 4: Current smoking cessation practices of dental students

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Perceived barriers in the provision of smoking cessation interventions

Although not statistically significant, [Table 5] reveals the barriers encountered by dental students and interns to promote smoking cessation interventions into their dental practice. The most frequently cited barrier was lack of training and skills to help patients quit smoking (67%), followed by patients' negligence (66.7%). Likewise, insufficient time was suggested to be one of the main barriers as well (62.2%). More than three-fifths of participants reported that they did not have any/enough printed materials to help guiding patients to quit. While 58% of respondents did not have any idea on where to refer patients for smoking cessation counseling. However, nearly four out of ten of participants felt comfortable discussing smoking with patients. Unfortunately, only 44.7% of both juniors and seniors believe that they can be useful in helping their patients to quit.
Table 5: Perceived barriers in the provision of smoking cessation interventions

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  Discussion Top


This study revealed that dental students have a reasonable knowledge of smoking hazards that is relevant to dentistry. However, clinical dental students can play a pivotal role to help their patients quit smoking. Therefore, increasing their awareness about smoking cessation intervention strategies is fundamental to be included in their routine preventive and therapeutic measures. Lack of training is identified to be the main barrier for delivering smoking cessation intervention as it seems to be out of the dental curriculum's focus. We also found differences in smoking cessation practices between juniors and seniors. To the best of our knowledge, this is the first research that highlights the perceptions of clinical dental students toward smoking cessation counseling and the barriers to promote it in Saudi Arabia.

A successful intervention consists of five major steps (the “5 As”).[16] “Ask” about tobacco use status for all patients, “Advise” each tobacco user to quit, “Assess” whether he or she is willing to quit, “Assist” patient who is ready to make a quit attempt, and “Arrange” follow-ups. Based on the previously published data, the current smoking prevalence in Saudi Arabia is 39%.[23] However, the prevalence among dental student was 20.6% although it seems to be relatively high for those who are aware of the menace of smoking. Several studies corroborated that smoking cessation services provided by healthcare professionals improve quitting rate.[24],[25],[26] In the current study, a great proportion of students consider various appropriate methods of intervention to be carried out into the dental clinic. This finding confirms the results announced by previous studies from India and Italy.[27],[28] Yet, smoking cessation interventions are not always incorporated as a part of dental practice, even though it is well documented that dental setting is a suitable place to deliver smoking cessation advice.[29],[30] A similar study done in the United Arab Emirates among dentists showed that only 55% of dentists routinely inquire their patients' smoking status[31] while our study demonstrates more favorable results among dental students. However, the reason behind that might be past negative experiences.

Many studies have reported some barriers while providing smoking cessation interventions, including time constraints, lack of training and resources, patients' disinterest, and apprehension of negative influence on a dentist–patient relationship.[27],[32],[33] Similarly, our findings identified the lack of training and patients' disinterest as the most encountered barriers. These results may help to initiate the elimination or minimization of identified barriers. Murugaboopathy et al. suggested that patients' disinterest in accepting advice might be due to the traditional style of counseling and proposed the inclusion of more innovative approaches.[34] However, a proper training of dental students in smoking cessation techniques is highly desirable to bridge this gap. Rikard-Bell et al. proposed that providing such a course would be ideal during dental school to enhance the professional skills of future dentists.[35] Lastly, the recognition of smoking deleterious effects on the general and oral health alone is not enough in the provision of advice and assistance.


  Conclusions Top


The current study revealed no significant difference between junior and senior dental students. It also identified lack of appropriate training and insufficient knowledge toward tobacco use cessation counseling. Current day societies are in need of guidance in regard to smoking cessation that dental student may be able to offer. Therefore, their training needs of both theoretical and clinical are meant to be appropriately delivered. Thus far, the reduction of tobacco use has been proven when primary health care providers offer smoking cessation services. Hence, other health-promoting strategies must be implemented to further reduce tobacco consumption, to reach an ultimate solution to the case.

Acknowledgment

The authors are grateful to Dr. Hind Almodaimegh for giving us such an opportunity to carry out this research project. We are also thankful to Dr. Omar Almohrej for his guidance and supervision of this work.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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