摘要：Objectives. We examined the association of smoke-free laws with dentists’ advice to quit smoking and referral to a quit line, among smokers who reported visiting the dentist in the past 12 months. Methods. We used the 2006 to 2007 Tobacco Use Supplement of the Current Population Survey merged with the American Nonsmokers' Rights Foundation Local Ordinance Database of smoke-free laws. The dependent variables were advice from a dentist to quit smoking and referral to a quit line, and the independent variable of interest was 100% smoke-free law coverage. We controlled for respondent demographics and an index of state-level smoking ban attitudes (included to ensure that the effect detected was not the result of social attitudes). Results. Smoke-free law coverage was associated with dental advice to quit smoking (odds ratio [OR] = 1.27; 95% confidence interval [CI] = 1.01, 1.59; P = .041), but not with referral to a quit line (OR = 1.33; 95% CI = 0.79, 2.25; P = .283). Conclusions. Interventions with dentists are needed to increase referrals to quit lines and other smoking cessation efforts. Smoking causes oral disease and dental therapy failures. 1–8 Tobacco cessation interventions delivered by dentists during oral examination are associated with cessation. 9–12 Although dentists can effectively promote cessation, particularly when they receive training to do so, 13–17 such practices are not widespread. 18–22 The US Public Health Service clinical practice guidelines promote the 5A's—ask about tobacco use, advise to quit, assess willingness to make a quit attempt, assist in the quit attempt, and arrange follow-up—as a standard tobacco use intervention. 1 Implementing just part of the 5A's, such as advising patients to quit, can affect patient behavior. 16,17,23,24 Several studies found that although oral health care providers are willing to implement the first 2 steps of the 5A's (ask, advise) they are reluctant to implement the last 3 (assess, assist, and arrange). 10,16,18,23,25 A survey of dentists in California, Pennsylvania, and West Virginia found that most dentists reported asking patients about tobacco use and advising them to quit, but fewer than half the dentists who asked about smoking provided follow-up or assistance with quitting. 25 These low rates are similar to those of health care providers in other areas. 18 As a result, some organizations advocate the 2A's+R (ask, advise, refer to a quit line) model of intervention. 26 A study that compared the effectiveness of the 5A's and 2A's+R models in dental settings found that a greater proportion of patients receiving the 5A's intervention quit but that the 2 groups showed no significant difference in abstinence at the 12-month follow-up. 26 Strong smoke-free laws are associated with changes in norms, attitudes, and behaviors surrounding tobacco use. These smoke-free laws may also encourage dental care providers to perceive smoking as denormalized or increase the salience of tobacco use for these providers, so that they are more likely to recommend a smoking cessation intervention. In the United States, implementation of 100% smoke-free laws is associated with a reduction in smoking prevalence and consumption, 27 decreased cardiovascular and pulmonary hospital admissions, 28 voluntary smoke-free home rules, 29 and reduced maternal smoking. 30,31 We hypothesized that the implementation of 100% smoke-free laws would affect not only individual health-related behavior, but also health care provider behavior, particularly in an area, such as oral health, where cessation training is not yet routinely implemented. We examined the effect of 100% smoke-free laws on dentist implementation of the 2A's+R model of intervention, particularly dental advice to quit and referral to a quit line, or cessation help line.
