摘要：Objectives. To assess the effects of a novel oral health promotion program (Oral Health 4 Life; OH4L) delivered through state-funded tobacco quitlines. Methods. Using a semipragmatic design to balance experimental control and generalizability, we randomized US quitline callers (n = 718) to standard care or standard care plus OH4L. We followed participants for 6 months to assess effects on professional dental care and smoking abstinence. We collected data between 2015 and 2017. Results. Participants were racially diverse (42% non-White) and socioeconomically disadvantaged. Most (71%) reported fair or poor oral health, and all were overdue for routine dental care. At 6 months, professional dental care and abstinence did not significantly differ between arms, but abstinence favored the experimental arm and was significantly higher among experimental participants at 2 months in a complete case sensitivity analysis. Conclusions. OH4L was not effective for promoting dental care, but integrating oral health counseling with quitline counseling may offer some advantage for smoking cessation. Public Health Implications. We offer a model for conducting semipragmatic trials and partnering with tobacco quitlines to evaluate population-level public health interventions. Oral diseases such as cavities, gum disease, and oral cancer affect millions in the United States, resulting in unnecessary pain, potential disfigurement, emotional suffering, morbidity, and mortality. 1 The United States spends an average of $113 billion annually on dental care and another $6 billion on lost productivity because of missed work as a result of dental health issues. 2 Smokers are at increased risk for oral disease as a result of their tobacco use, other lifestyle risk factors, and low rates of dental care utilization. 3–6 The lack of routine dental care is particularly problematic, because oral health issues then go undiagnosed and untreated. It also prevents smokers from being counseled about appropriate oral hygiene and quitting tobacco. In short, smokers are an important target group for oral health promotion efforts. To reach smokers who do not routinely seek dental care, we proposed a novel strategy to embed an oral health promotion intervention in the standard tobacco cessation program offered through state-funded quitlines. The rationale for this was fivefold. First, smokers calling the quitlines have already made a commitment to behavior change. Therefore, they may be receptive to changing their oral health self-care or seeing a dentist. Second, state-funded tobacco quitlines are available nationwide and constitute a well-established, broadly accessible public health infrastructure. In 2016, more than 353 000 smokers received evidence-based treatment through publicly funded state quitlines, 7 and treatment is provided by trained counselors who can also advise smokers about basic oral health care. Third, several common distraction tips for managing smoking cravings (e.g., brush or floss instead of smoking) or tips for motivating sustained tobacco abstinence (e.g., see a dentist to remove tobacco stains from teeth) simultaneously support the goals of quitting smoking and improving oral health care. Thus, addressing both behaviors concurrently could have synergistic effects. Fourth, partnering with state quitlines helps reach socioeconomically disadvantaged smokers. Many of these individuals are uninsured or have Medicaid coverage 8 and, therefore, have limited access to dental care. In addition, many have limited education 7 or are from racial or ethnic groups known to have higher rates of oral disease and lower oral cancer survival rates. 9 Fifth, many state quitline callers do not seek routine dental care, 10 and both quitline callers and quitline providers support offering oral health promotion programs through the quitlines. 10–12 These factors demonstrate both a need and an opportunity to partner with state quitlines to improve oral health care among smokers; however, quitline providers have made it clear that interventions delivered through the quitlines must fit within the existing infrastructure and refer smokers to local low-cost dental providers rather than offering other types of intervention (e.g., treatment vouchers or transportation), which are not sustainable options for the quitlines. 12 Thus, we developed a theoretically grounded, comprehensive, multimodal oral health promotion program (Oral Health 4 Life; OH4L) designed to be integrated into a typical state quitline tobacco cessation program. We hypothesized that smokers receiving the OH4L program would be more likely to seek professional dental care and to quit smoking at long-term follow-up than would smokers who receive the standard quitline program. We report the main outcomes of this trial.
