Despite the health hazards of tobacco use, approximately 47 million Americans continue to use tobacco. In the primary care medical setting, it has become standard practice to provide all smokers with brief, physician-provided advice, assistance, and follow-up to encourage quitting. In this approach, even less motivated smokers who would not have independently sought treatment often increase their readiness to quit, reduce their cigarette consumption, or achieve smoking cessation. The primary care dental team, including dental clinicians and hygienists, has a credible, central role in providing such smoking cessation advice, and in providing information concerning the oral health effects, including the head and neck cancer risks, of tobacco use. Given that unrealistic optimism regarding one's tobacco-related illness risk attenuates smokers' motivation to quit, providing patients with information regarding the personal impact of tobacco on their health is likely to enhance minimal contact smoking cessation interventions by increasing quitting motivation. The overall goal of this project is to test the effect of personalized risk feedback on short and long-term smoking components of biomarker feedback focusing on: a) level of tobacco exposure (alveolar carbon monoxide level); and b) tobacco-related oral damage (through dental hygienist examination of teeth and oral mucosa). The study will use a prospective, experimental design to assess the effect of this intervention on smoking cessation, health and smoking-related cognitions and mood at 3 and 12 months. Participants will be randomized to 1 of 3 smoking cessation treatment conditions: 1) Standard Care only (SC) will receive standard care dentist-provided smoking cessation advice, assistance and follow-up; 2) Standard Care + Dental Hygienist-provided Motivational Counseling (SC+MC) will receive standard care plus motivational smoking cessation counseling provided by a trained dental hygienist, and 3) Standard Care Dental Hygienist-provided Motivational Counseling + Personalized Risk Feedback (SC+MC+PRF) will receive standard care plus motivational counseling and personalized risk feedback. The overarching aim is to test the effect of personalized risk feedback on smoking cessation and to examine potential mechanisms and moderating effects of the personalized risk feedback. Receiving personalized risk feedback in the dental setting, especially when paired with dentist-provided minimal contact smoking cessation advice and dental hygienist-provided motivational counseling, could increase smokers' motivation for quitting, and represent an important translational, multidisciplinary strategy for tobacco-related cancer prevention.
