) """"""""Comparative Effectiveness and Feasibility of SBIRT in a General Dental Clinic"""""""" addresses the broad Challenge Area, (05) Comparative Effectiveness Research and specific Challenge Topic, 05-DE-102: Treatment of tobacco and drug dependence in dental settings. This protocol describes a 2-year, randomized controlled trial designed to achieve two primary aims: 1) to evaluate the short-term effectiveness of screening, brief intervention and referral services (SBIRT) for tobacco and other psychoactive substance use when delivered separately and in combined forms and 2) to evaluate the feasibility of implementing SBIRT for patients with at-risk substance use in a community general dental setting. This research will provide the basis for a more ambitious clinical trial that would be conducted in multiple dental settings and include a longer follow-up period. To achieve Aim 1, 175 patients who are smokers and at-risk substance users (including at-risk alcohol users) will be recruited from the general dentistry clinic at the University of Connecticut Health Center. Research staff will use the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), developed by the World Health Organization, to identify eligible patients. Participants will be randomized to one of three experimental conditions: 1) a smoking-only brief intervention group;2) a smoking + other substance use brief intervention group;or 3) a wait-list control condition that includes general dental health counseling. Those assigned to the """"""""active"""""""" treatment conditions will be given a brief intervention that will link the patient's screening assessment data with dental risk factors associated with tobacco only or tobacco + other substance use. Participants will be re- interviewed at 12-weeks post randomization to assess outcome and process measures using a combination of quantitative and qualitative interviewing methods. Regarding Aim 2, the timing of this opportunity and implementation of this clinical trial provides a unique opportunity to follow two cohorts of dental residents to examine the impact of SBIRT residency training on subsequent clinical practice. The first cohort will already be on staff when the study begins and will not have received SBIRT training as part of the residency requirements. The second cohort of residents will be exposed to a three-hour SBIRT training session that will supplement the residency requirements for July, 2010. Although residents will not be asked to provide the brief interventions for the randomized study, they will be encouraged to reinforce the information delivered by research staff. Differences between the two cohorts with regard to attitudes, knowledge and willingness to engage in SBIRT program activities will be measured. There has been a remarkable growth in translational research organized around the SBIRT concept, with numerous clinical trials conducted, new screening tests developed, and implementation programs evaluated to determine the feasibility of SBIRT in primary care and other medical settings. Despite the obvious relevance of SBIRT to the prevention of dental pathology, there has been little attention to the determination of its feasibility, effectiveness and implementation in dental settings. We believe there is now a real research opportunity to not only evaluate the effectiveness of SBIRT with dental patients, but also to improve the technology so that oral health practitioners can feel confident conducting screening, brief intervention and referrals for at-risk users of tobacco, alcohol and other substances. The research described in this application could have significant implications on both clinical science and public health dentistry.
There has been a remarkable growth in translational research organized around the SBIRT concept, with numerous clinical trials conducted, new screening tests developed, and implementation programs evaluated to determine the feasibility of SBIRT in primary care and other medical settings. Despite the obvious relevance of SBIRT to the prevention of dental pathology, there has been little attention to the determination of its feasibility, effectiveness and implementation in dental settings. We believe there is now a real research opportunity to not only evaluate the effectiveness of SBIRT with dental patients, but also to improve the technology so that oral health practitioners can feel confident conducting screening, brief intervention and referrals for at-risk users of tobacco, alcohol and other substances. The research described in this application could have significant implications on both clinical science and public health dentistry.
