The prevalence of smoking is 15.5% in the general population, but exceeds 30% among those with low income and low education. These smokers are less likely to proactively seek smoking cessation counseling, and less likely to have ever used evidenced-based treatment (EBTs, counseling and medications) for quitting smoking. Therefore, it is important to proactively reach smokers. Research supports the effectiveness of smoking cessation counseling in dental settings. However, barriers to consistent implementation include provider lack of time, training, and experience counseling smokers who are unmotivated to quit. Using technology could provide a cost-effective and time-efficient way of delivering evidenced-based smoking cessation in dental settings with a high degree of treatment fidelity. Because effective cessation programs already exist, innovations are needed to drive smokers to engage with EBTs. Our pilot study developed and tested a video- based smoking cessation induction intervention delivered through a Virtual Reality (VR) headset, while patients were undergoing teeth cleaning. Patients in an urban dental clinic (n=23) wore the VR headset to watch a 10- minute smoking cessation induction video during their teeth cleaning (not filmed in VR due to potential interference with clinical care). We demonstrated patient satisfaction, feasibility, impact on mediators, and no interference with clinical care. One month later, 5/23 patients reported smoking cessation, and 14/23 reported quit attempts. The primary aim of the UH3 Stage 3 randomized efficacy trial is to test whether the above intervention increases utilization of EBTs (Quitline, Clinic-based programs, NCI text message program, NRT or other smoking cessation medication) within 7-months post-appointment. Participants (n=376) will be smokers scheduled for a teeth cleaning at an urban dental clinic predominately serving underserved patients. Participants will be randomized to either the VR intervention, which consists of: 1) the video-based intervention via VR headset during their teeth cleaning, 2) brochure about EBTs, and 3) one month of text messages to motivate engagement with EBTs; or Control group, which consists of watching a control video on relaxation techniques through the VR headset (to maintain provider masking) during the teeth cleaning and receipt of the same EBT brochure as the VR group. Both groups will receive weekly text message assessments for one month after the dental appointment to assess mediators. We will objectively measure utilization of the Quitline, the text message programs, and clinic based programs. Secondary outcomes are treatment effects on quit attempts, biochemically verified abstinence, and motivation to quit. We will also assess moderators. Assessments will occur at baseline, weekly for one month after the appointment (via text), one month post- appointment, and 3 and 6 months later. Prior to UH3, the UG3 phase will involve finalization of the intervention, a usability study, provider interviews, creation of a seamless transition between the study intervention and EBTs, finalization of measures, impact on mediators, and satisfaction/acceptability data.
This study focuses on delivering a smoking cessation induction intervention during and after dental patients? teeth cleaning, providing access to smokers who may not otherwise seek treatment for smoking cessation. This is critical for public health, because the majority of current smokers are not ready to quit smoking. Because the intervention is video-and text message based, it is appropriate for low literacy and underserved populations, and could easily be disseminated to other dental clinics with minimal provider and patient burden.
