Reducing oral disease risk and promoting better oral health care are public health priorities. Smokers are at high risk for oral disease as a result of their tobacco use and other lifestyle choices (e.g., less than optimal dental care utilization and poor oral hygiene). As a result, smokers are a priority target audience for population- level, public oral health promotion efforts. Over the past 4 years, our programmatic research has demonstrated a need and opportunity to leverage the existing US tobacco quitline infrastructure to promote greater oral health care and tobacco cessation concurrently, thereby reaching smokers who are already motivated for behavior change and who may be receptive to oral health intervention. Within the US, more than 440,000 smokers receive free tobacco cessation treatment annually through publically-funded state tobacco quitlines. More than half of these programs are serviced by a single vendor (Alere Wellbeing). Stakeholders at Alere and the states who purchase their quitline services, as well as quitline callers we surveyed, support the concept of an integrated oral health promotion-tobacco cessation program. In response, we developed a theoretically-grounded, comprehensive, multi-modal behavioral program (Oral Health 4 Life) which is designed to promote better oral health care in conjunction with standard tobacco quitline counseling. This is a public health, not a clinical dental intervention. The program consists of behavioral counseling, supportive outreach via text messaging, and other health education and resource materials delivered in print and online-all designed to fit within the quitline infrastructure. By partnering with state quitlines, the program will reach a high- ris, high-need, typically lower-SES audience. We now seek continued support from NIDCR to implement and evaluate this program in a randomized trial. Following a small vanguard pilot (n = 10), 712 smokers will be recruited from three state quitlines managed centrally by Alere Wellbeing in Seattle, WA. Participants will receive either the Oral Health 4 Life program + standard quitline care or standard care alone. We hypothesize participants who receive the enhanced program will be more likely to see a dentist for a check-up/cleaning and to quit smoking at 6 month follow-up (primary outcomes). We also hypothesize these individuals will have greater improvement in their routine oral hygiene behaviors (brushing and flossing), and greater positive change in their oral health knowledge, attitudes, and beliefs. Effects on other risk factors which affect oral health, but are not central targets of the intervention (e.g., diet, alcohol use) and potential mediators of change will be explored. Finally, we will calculate the incremental cost of offering the Oral Health 4 Life program from the payer perspective and create a tool to allow future purchasers to assess their future 'willingness to pay'for the progra based on different pricing assumptions. If effective, the Oral Health 4 Life program could be disseminated nationwide, reaching hundreds of thousands of smokers each year, and could promote greater oral health care, enhance abstinence rates, and improve oral health outcomes among targeted smokers.

Public Health Relevance

The proposed study will evaluate the effectiveness and cost of a population-based, behavioral oral health promotion program delivered to smokers receiving treatment from tobacco quitlines. The program is designed to be disseminated nationwide through the existing tobacco quitline infrastructure, potentially reaching hundreds of thousands of smokers annually in the US. If the program is effective at improving smoking cessation rates and/or improving oral health care among smokers, it could improve oral health outcomes, reduce risk for future disease, and have a substantial public health impact.

National Institute of Health (NIH)
National Institute of Dental & Craniofacial Research (NIDCR)
Research Project--Cooperative Agreements (U01)
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Special Emphasis Panel (ZDE1)
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Clark, David
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Group Health Cooperative
United States
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Blasi, Paula R; Krakauer, Chloe; Anderson, Melissa L et al. (2018) Factors associated with future dental care utilization among low-income smokers overdue for dental visits. BMC Oral Health 18:183
Tiffany, Brooks; Blasi, Paula; Catz, Sheryl L et al. (2018) Mobile Apps for Oral Health Promotion: Content Review and Heuristic Usability Analysis. JMIR Mhealth Uhealth 6:e11432
McClure, Jennifer B; Blasi, Paula R; Cook, Andrea et al. (2017) Oral health 4 life: Design and methods of a semi-pragmatic randomized trial to promote oral health care and smoking abstinence among tobacco quitline callers. Contemp Clin Trials 57:90-97