ISSN: 2456-8090 (online)

DOI: 10.26440/IHRJ/0605.08557

Knowledge, Attitude and Practice of Smoking Cessation Advice among Dental Students in Delhi-NCR

SUMEDHA KUSHWAHA¹ , WAIROKPAM BHOOMIKA DEVI²

Cite this article as: Kushwaha S, Devi WB. Knowledge, Attitude and Practice of Smoking Cessation Advice among Dental Students in Delhi-NCR. Int Healthc Res J. 2022;6(5):OR1-OR9. https://doi.org/10.26440/IHRJ/0605.08557

Author Affiliations:

1. Ph.D Student, Population Health Sciences, Temerty Faculty of Medicine, Institute of Medical Sciences, University of Toronto (https://orcid.org/0000-0001-9145-7257)
2. Department of Paediatric and Preventive Dentistry, Dental College, RIMS, Lamphelpat, Imphal, Manipur, India

Contact Corresponding Author at: sumedha.kushwaha90@gmail.com

ABSTRACT

INTRODUCTION: The problem of tobacco abuse is not recent and has been documented well in history in various cultures all over the world. Dental colleges house vast number of potential tobacco cessation counsellors as budding health professionals who are in direct contact with patients

AIM: The main objective of present study was to assess the knowledge, attitude and practice of smoking cessation advice among dental students in Delhi-NCR.

MATERIALS AND METHOD: A cross sectional study was conducted among 2953 undergraduate clinical students of third year, fourth year and Internship were enrolled in the study from 18 dental colleges in Delhi- National Capital Region (NCR) using a pre-tested, self-administered questionnaire was employed as an instrument. The questionnaire’s content, face and criterion validity were checked and reliability was tested using Cronbach’s Alpha and Inter Class Co-relation. Statistical analysis used included  quantitative statistics, student t test and ANOVA

RESULTS: Students demonstrated considerable knowledge regarding smoking related policies in the institution, technique and products used for smoking cessation and impact of smoking on oral health, general health and treatments to be performed. However, only half of them had a positive attitude towards tobacco cessation counselling to patients and practice this in the hospital setting.

CONCLUSION:  Based on the results of the study, there is a need to further motivate students on smoking cessation advice.

KEYWORDS: Undergraduate Dental Students, Smoking Cessation, NRT, Tobacco

INTRODUCTION

Nearly half of all cancers in Indian men and a quarter of all cancers in Indian women, are attributed to high prevalence of tobacco use.¹ The problem of tobacco abuse is not recent and has been documented well in history in various cultures all over the world.² It is a negative social trend and an important public health problem. Aligning with the international strategies, India was amongst the first few countries to ratify the WHO Framework Convention on Tobacco Control (FCTC) in 2004.³ Besides this, at national level, comprehensive tobacco control legislation –Cigarette and other Tobacco Products Act (COTPA) was enacted in 2003. The National Tobacco Control Program in India (2007-2008) works at National, State and District levels.⁴ Recently, it has been advised by the Dental Council of India to open a tobacco cessation centre in every dental college.⁵ It is an appreciable move as colleges house vast number of potential tobacco cessation counsellors as budding health professionals who are in direct contact with patients. Specifically, dental professionals encounter patients of various ages and may notice signs of tobacco use at a very early stage and are therefore in an exceptional position to offer preventive care.⁶ They can serve as role models for the patients and the society and encourage governments to put in place tobacco control measures.⁷

MATERIALS AND METHOD

Cross-Sectional study was conducted to assess knowledge, attitude and practice of smoking cessation advice among undergraduate clinical dental students in Delhi- National Capital Region (NCR). A total of 18 dental colleges are present in Delhi-NCR according to the Dental Council of India5. Four of these are Government and rest are Private. Ethical clearance was sought, a request letter was sent to Head of Institution and written consent was obtained to conduct the study. Undergraduate clinical students of third year, fourth year and Internship; belonging to regular and supplementary batches; willing to participate in the study by providing a written consent were included in the study. However, students who were absent on the day of the study or did not give informed consent or were a part of the dental institution which did not grant permission to conduct the study or whose questionnaires were incompletely filled at the time of analysis were excluded from the study. A pre-tested, self-administered questionnaire was employed as an instrument. All questions were close ended. The content, face and criterion validity were checked. Reliability of the questionnaire was tested using Cronbach’s Alpha and Inter Class Co-relation. A method of Convenience sampling was employed. 4500 students constituted the total population. 3225 questionnaires were distributed and filled, out which 272 questionnaires were excluded as they were incomplete, giving us a final sample size of 2953 students. Current Smokers were defined as those respondents who reported smoking at least 100 cigarettes in their lifetime and who, at the time of survey, smoked either every day or some days. Ever Smokers were defined as those respondents who reported smoking at least 100 cigarettes in their lifetime and who, at the time of the survey, did not smoke. Never Smokers were those respondents who reported never having smoked 100 cigarettes.⁸ 

RESULTS

Out of the total 2953 students, 30.4% were males 69.6% were females. 32.9% of the total were from third year, 31.5% from fourth year and 35.6% from internship. 92.7% sample of the total was from Private and rest from Government colleges. 79.9% constituted never smokers and rest smokers- out of whom 4.7% were ever smokers and 15.4% were current smokers. Out of all 899 males in the study- 8.7% were ever smokers, 29% were current smokers and 62.3% were never smokers.

Whereas, among 2054 females- ever smokers constituted only 3.0%, current smokers 9.4% and never smokers 87.6%. The difference of smoking between the two genders was found to be highly significant (p=0.001).

When compared year wise, it was found that from 973 third year students 3.8%, 10.1% and 86.1% were ever, current and never smokers respectively. Out of the 928 fourth year students 5.4%, 17.2%, 77.4% were ever, current and never smokers respectively Among the 1052 interns 4.9%, 18.7% and 76.4% were ever, current and never smokers respectively. The difference was found to be statistically significant (p=0.002). Out of 139 ever smokers and 455 current smokers only 38% and 57% tried to quit respectively. The difference between the groups was found to be statistically significant (p=0.02).

Table 1 depicts percentage wise depiction for questions regarding knowledge about a written smoking policy in the college, presence of a tobacco cessation centre in the college, presence of smoking cessation pamphlets and posters in the waiting area, knowledge of 5A’s and 4R’s tobacco cessation technique, use of NRT in tobacco cessation, anti-depressants being used in tobacco cessation, relevance of  taking history of smoking prior to implant placement, whether you advise a smoker to abstain from smoking pre and post oral surgery and whether a smoker when tested for bleeding on probing, shows less bleeding.

Table 2 depicts attitude of the respondent towards the subject of smoking cessation advice on a five-point Likert Scale. Strong agreement, agreement, disagreement, strong disagreement was sought for whether a dental student should regularly advice patients to quit tobacco, if dental students should be given any specific and formal training on tobacco cessation techniques, whether equal priority should be given to tobacco cessation counselling and dental treatment if dental student’s motivation is effective in cessation, whether they perceive tobacco cessation as an important part of the curriculum, whether tobacco use was a personal decision by patients, if there are too many barriers that prevent a student from helping patients to quit smoking and whether a dental student who himself smokes is ineffective in giving tobacco cessation advice.

Table 3 show descriptive data of the practice of the respondent towards the subject of smoking cessation advice on a four point Likert Scale. Questions included, if students asked about their patient’s smoking status, whether they offer smoking cessation counselling to their patients, if students motivate their patients to quit smoking, whether they advise patients to quit tobacco through cold turkey method, whether they inform patients about the benefits of quitting, if they

assist patients to give up smoking, if they arrange follow-up visits to discuss cessation with tobacco using patients, if they discussed Nicotine Replacement Therapy with their patients, whether students kept a record of the patient smoking status, whether students recommend the use of approved pharmacotherapy except in special circumstances.  

Table 4 depicts statistically significant association between gender and knowledge, attitude and practice for various questions. Knowledge of institute having a tobacco cessation centre (p=0.016), waiting area in the institute providing pamphlets and posters to educate about the hazards of smoking (p=0.025), awareness of 4A and 5R technique for tobacco cessation (p=0.03) and NRT being used in tobacco cessation (p=0.036). Attitude of dental students for regularly and effectively advising their patients to quit tobacco (p=0.03), dental students be given specific and formal training on tobacco cessation techniques (p=0.008) and effectiveness of students to motivate patients for tobacco cessation (p=0.027). The practice of tobacco cessation among dental students like arranging for follow up visits to discuss tobacco cessation (p=0.05), discussing NRT with patients (p=0.018) and use of approved pharmacotherapy (p=0.04). 

Table 5 shows a significant association between year of study and various questions regarding knowledge, attitude and practice of students regarding tobacco cessation advice. Knowledge of whether the college had a written smoking policy (p=0.03), the presence of a tobacco cessation centre in the college campus(p=0.006),   awareness of 4A and 5R technique for tobacco cessation (p=0.01), NRT being used in tobacco cessation(p=0.02), anti depressants used for tobacco cessation (p=0.01), consideration of smoking status with respect to implant placement (p=0.03) and presence of less bleeding on probing in smokers(p=0.04) were found to be significant. Attitudes of the students, the opinions of dental students regularly and effectively advising patients to quit tobacco (p=0.02), the effectiveness of dental students in motivating patients to quit are effective (p=0.01) and informing non smokers about the harmful effects of second hand smoking (p=0.008) Practice of smoking cessation among the dental students, only discussion of NRT with patients (p=0.01) was found to be significant.

Table 6 depicts tobacco use association with the knowledge, attitude and practice of the students towards smoking cessation advice. Questions regarding knowledge of the presence of a tobacco cessation centre (p=0.01), NRT being used in tobacco cessation (p=0.009), advising smokers to abstain from smoking pre and post oral surgery (p=0.05) and testing of smokers for presence of bleeding on probing (p=0.05) were found to be statistically significant. When tobacco use was related with the attitude of the students regarding tobacco cessation counselling- the opinions of dental students regularly and effectively advising patients to quit tobacco (p=0.01), dental students to be given specific and formal training on tobacco cessation techniques (p=0.04), tobacco cessation to be an important part of the dental curriculum (p=0.016) and ineffectiveness of a smoker to give tobacco cessation advice (p=0.031) were found to be statistically significant.

DISCUSSION

The study conducted by Antal M et al.⁶  was in accordance to high percentage of females in the study. The study done by Murugaboopathy et al.⁹ was in agreement with our results of significant difference 

between smoking status of males and females. Reason can be an increased number of females; who are non smokers. GHPSS Data reveals that smoking prevalence among Indian dental third year students was low (9.6%) with 2.4% female smoking population, depicting similar results as our study.¹⁰ However,

 studies done by Bell GR et al.¹¹, GHPSS- data of Albania (30.1%) with 27.1% female smokers and Republic of Serbia, Belgrades (42.5%) with 47.2% females were found out be in contrast to our results.¹² Several studies also reported similar results, where it was found that 70% of smokers had the intent to quit, 34% made an

attempt to quit but only 2.5% were successful.^13-17 The studies done by Rajasundaram P et al (98.2%)¹⁸, was in contrast with our results depicting a high percentage of students being aware of the smoking policy. The study done by Tangade P. et al in which more than 90% of the respondents agreed and 82% were ready to do further course regarding cessation also¹⁹ was in accordance and in disagreement with Murugaboopathy V et al. (45%).⁹ When gender was compared with practice of tobacco cessation advice, Vannobbergen et al, found significant difference between the genders and showed females are more effective in providing cessation advice.²⁰ Our study results reveal that not even half of the study population (35.5%) of students prescribe NRT to patients which is in accordance with Singla A et al, where only 12.5% dentists prescribed NRT²¹ and in contrast with the results of study of Tangade P et al.¹⁹, which showed 70% of students prescribe NRT5 According to our study there was no significant difference found between the year of study and tobacco cessation advice given by students. Similar results were found by Tangade P et al.¹⁹, (63%) and Tomar SL,(60%)²² where students routinely ask about patients tobacco use.

 REFERENCES

1. Rani M, Bonu S, Jha P, Nguyen SN, Jamjoum L. Tobacco use in India: Prevalence and predictors of smoking and chewing in a national cross sectional household survey. Tob Control.2003;12:e4.
2. Terry D. Rees. Oral effects of drug abuse. Critical Reviews in Oral Biology and Medicine.1992;3(3):163-84
3. The GTSS Collaborative Group. Tobacco use and cessation counselling: Global Health Professionals Survey Pilot Study, 10 countries. Tob Control 2006;15(Suppl II):ii31–4.
4. Kaur J, Jain DC. Tobacco Control Policies in India. Indian J Public Health. 2011; 55(3):220-27.
5. http://www.dciindia.gov.in/ (Accessed on 01/03/2022)
6. Antal M et al. Attitudes of Hungarian Dental Professionals to Tobacco Use and Cessation. Cent Eur J Public Health 2012; 20(1):45–9.
7. Harini Priya M, Bhat SS, Sundeep Hegde K. Prevalence, knowledge and attitude of tobacco use among health professionals in Mangalore city, Karnataka. J Oral Health Comm Dent 2008;2(2):19-24.
8. Centers for Disease Control and Prevention. State-specific secondhand smoke exposure and current cigarette smoking among adults―United States, 2008. MMWR Morb Mortal Wkly Rep. 2009;58:1232–5.
9. Murugaboopathy V, Ankola A, Hebbal M. Indian Dental Students’ Attitudes and Practices Regarding Tobacco Cessation Counseling. J Dent Educ;77(4):510-17.
10. The GTSS Collaborative Group. Tobacco use and cessation counselling: Global Health Professionals Survey Pilot Study, 10 countries. Tob Control 2006;15(Suppl II):ii31–4.
11. Bell GR, Groenlund C, Ward J. Australian dental students' views about smoking cessation counseling and their skills as counselors. J Public Health Dent 2006;63(3): 200-6.
12. WHO and CDC: Dental students and Tobacco Use in India. A pilot study for the Global Health Professional Survey (GHPS), 2005. http://www.who.int/tobacco/surveillance/ghps/en/index.html (Accessed on 10/5/2021)
13. American Lung Association Trends in tobacco use. Best Practices and Program Services. Epidemiology and Statistics Unit 2003.
14. Trosclair A, Husten MD, Pederson L, Dhillon I. Cigarette smoking among adults-United States. Morbidity Mortality Weekly Report 2002;51:642-5.
15. Spangler JG, George G, Foley KL, Crandall SJ. Tobacco intervention training: Current efforts and gaps in US medical schools. JAMA 2002;288:1102-9.
16. Trends in cigarette smoking among high school students - United States, 1991-2001. Morbidity and Mortality Weekly Report. 2002; 51:409-12.
17. Fellows JL, Trosclair A, Adams EK, Rivera CC. Annual smoking-attributable mortality, years of potential life lost, and economic costs-United States, 1995-1999. Morbidity Mortality Weekly Report 2002;51:300-303.
18. Rajasundaram P, Sequeira P.S, Jain J. Perceptions of dental students in India about smoking cessation counselling. J Dent Educ.2011;75(12):1603-10
19. Tangade P, Ravishankar TL. Tirth A, Mathur A,  Gupta V. Attitude of Dental Students, Interns and Practicing Dentists Towards Tobacco Use Cessation. J Oral Health Comm Dent. 2011;5(1):15-18
20. Vanobbergen, P. Nuytens, M. van Herk and L. De VisschereDental students’ attitude towards anti-smoking programmes: a study in Flanders, Belgium. Eur J Dent Educ. 2007; 11: 177–183
21. Singla A. et al. Tobacco Cessation Counselling Practices and Attitude among the Dentist and the Dental Auxiliaries of Urban and Rural Areas of Modinagar, India. Journal of Clinical and Diagnostic Research. 2014; 8(9): ZC15-ZC18
22. Tomar SL et al. Evaluation of Tobacco Use Cessation (TUC) in the Dental Office. Oral Health Prev Dent 2008; 4:27-47.

© Sumedha Kushwaha et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY-NC 4.0, which permits unrestricted use, distribution and reproduction in any medium, provided the use is not commercial and the original author(s) and source are cited.

Submitted on: 03-Jun-2021;  Accepted on: 12-Aug-2022