Encouraging primary care physicians to help smokers quit. A randomized, controlled trial.

STUDY OBJECTIVE: To increase the effect that primary care physicians have on their patients who smoke. DESIGN: Randomized, controlled trial with 112 general internists and their patients who smoke. PATIENTS: Sample of 1420 patients from a general medicine clinic of a city-county teaching hospital, who smoke at least one cigarette a day and were recruited regardless of their interest in quitting smoking. INTERVENTIONS: Physicians were randomly assigned to one of four groups: participants who received a protocol for smoking management and a lecture on the consequences and management of smoking (control); in addition, had nicotine gum freely available to patients (gum); had stickers attached to their smokers' charts (reminder); or had both gum and reminders (both). MEASUREMENTS AND MAIN RESULTS: The percentage of patients with a return visit at 6 months who quit smoking (alveolar carbon monoxide of less than nine parts per million) was 1.3% (control), 7.7% (gum), 7.0% (reminders), and 6.3% (both). At 1 year the percentages were 2.7%, 8.8%, 15.0%, and 9.6%, respectively. Subsequent pairwise comparisons showed that the three intervention groups were not significantly different, but that each was significantly different from the control group (P less than 0.05). Physicians in all three intervention groups spent significantly more time than did the physicians in the control group counseling their patients about smoking. CONCLUSIONS: The availability of nicotine gum or labeling the charts of smokers can help primary care physicians increase their success rates two- to six-fold in helping patients quit smoking. If all primary care physicians used these procedures, they could help an additional 2 million smokers quit.

Clinical effect of a sanguinaria dentifrice on plaque and gingivitis in adults.

A clinical trial was conducted to evaluate the effects of a sanguinaria-zinc chloride dentifrice on the prevention of plaque formation and gingivitis. A total of 59 young adults, 18 to 30 years of age, either performed supervised brushing with a 0.075% sanguinaria-0.05% zinc chloride dentifrice, a 0.24% sodium fluoride dentifrice, or rinsed daily with a 0.05% NaF solution. Clinical evaluations for plaque and gingivitis were performed after 7, 14, and 21 days of the test regimen. After 21 days, all subjects resumed twice daily supervised brushing and flossing and post-test evaluations were conducted after two weeks. The results showed that after 7, 14, and 21 days both groups using dentifrices had significantly less plaque and gingivitis than the group using the rinse, and there were no significant differences between the two groups using either the sanguinaria-ZnCl2 or the NaF dentifrices.

Helping smokers quit: a randomized controlled trial with private practice dentists.

Fifty private practitioners and their office staff members were randomly assigned to one of four groups: participants received a protocol for smoking management and a lecture on the consequences and management of smoking, or in addition, had nicotine gum freely available to patients, had stickers attached to their charts, or had gum and reminders. The percentage of patients in each group who had quit smoking a year later was 7.7, 16.3, 8.6, and 16.9, respectively, indicating a significant main effect for the gum conditions. The availability of nicotine gum also significantly increased the amount of time that patients reported they received smoking cessation counseling from the dentists and office staff.

Overreporting of smokeless tobacco use by adolescent males.

This study evaluates the impact of a pipeline assessment (salivary cotinine determination) on the accuracy of self-reported use of cigarettes and smokeless tobacco by 160 rural seventh- and eighth-grade males ranging in age from 12 to 16. Half of them were randomly assigned to complete a questionnaire on tobacco use prior to revealing the biochemical validation materials and collecting samples. The others had the samples collected prior to receiving and completing the questionnaires. The questionnaire-first group reported significantly greater smokeless tobacco use than did the pipeline-first group. Only for the latter were their self-reports significantly corroborated by the cotinine results. These results suggest that the utilization of a biochemical pipeline not only can improve self-reported tobacco use but also may help identify perceptions about the social desirability of using harmful substances.

Evaluation of biochemical validation measures in determination of smoking status.

This study was designed to evaluate the use of salivary cotinine, salivary thiocyanate, and expired-air carbon monoxide as biochemical validation measures for assessing the smoking status of adults. The participants were 20 known non-smokers plus 216 admitted smokers and 102 proclaimed quitters participating in a clinical trial of approaches to facilitate smoking cessation. Conventional analytical procedures were utilized. By use of data from known non-smokers and admitted smokers, the sensitivity and specificity of the validation measures were as follows: salivary cotinine, 99% and 100%; expired-air carbon monoxide, 96% and 100%; and salivary thiocyanate, 67% and 95%, respectively. The salivary cotinine and expired-air carbon monoxide tests confirmed smoking cessation for 55% and 74%, respectively, of the proclaimed quitters. The length of time since quitting was significantly related to the results observed with the latter measures. Consideration of these observations along with various practical factors suggests that expired-air carbon monoxide assays may be the validation measure of choice for most clinical trials.

Counseling medical and dental patients about cigarette smoking: the impact of nicotine gum and chart reminders.

To investigate methods for improving and expanding the counseling of smokers by physicians and dentists, we assigned 112 physicians and 50 dentists (in separate studies) to one of the following conditions: the control or advice-only group received a one-hour lecture on the consequences and management of smoking and a booklet detailing a four-step protocol for counseling patients about smoking; three other groups received, in addition, either, protocol reminder stickers placed on their patients' charts; nicotine gum made freely available to their patients; or both chart reminders and nicotine gum. Exit interviews of 1,091 medical and 647 dental patients indicated that the presence of chart reminders and/or the availability of nicotine gum increased the time spent counseling and altered the nature of the smoking cessation counseling provided by both physicians and dentists.

Comparisons of various salivary parameters in smokers before and after the use of a nicotine-containing chewing gum.

This study was designed to compare various salivary parameters between smokers and non-smokers and to determine the influence of a nicotine-containing chewing gum (used to aid in quit-smoking efforts) upon these same parameters. At the baseline examination, subjects were assigned to one of three groups: non-smokers who did not utilize any gum, smokers provided a nicotine-containing gum, and smokers provided a placebo gum. Saliva was collected from all subjects and analyzed for acidogenicity and buffer pH as well as for levels of thiocyanate, lactoperoxidase, lysozyme, lactoferrin, and secretory IgA. After 15 weeks of gum usage, saliva was again collected from each subject and the identical analyses performed. Significant differences were observed between smokers and non-smokers with regard to three parameters: The saliva of smokers contained greater concentrations of thiocyanate and lower concentrations of lactoferrin, at the baseline examination and after the 15-week test period. In addition, the CO content of alveolar air was higher in smokers at both examination periods. In contrast, the use of the nicotine gum per se had no effect on any of the test parameters.

Effects of nicotine-containing chewing gum on oral soft and hard tissues: A clinical study.

A double-blind clinical trial was conducted to determine whether the use of a chewing gum containing 2.0 mg nicotine (as an adjunct to a stop-smoking program) had any effects upon oral health. A total of 193 adults who smoked cigarettes volunteered with informed consent, were given routine dental prophylaxes, and were examined for the presence of plaque, stained pellicle, gingivitis, calculus, and general oral pathosis. The subjects were then randomly assigned to use either a nicotine-containing or a placebo chewing gum. After 15 weeks the subjects were recalled and re-examined. Smoking cessation was determined through questionnaire and analysis of the carbon monoxide content of alveolar air. At the completion of the study, 79 subjects had used the placebo gum and 78 had used the nicotine gum. Data analysis indicated that the nicotine chewing gum had no significant influence on any of the oral health parameters graded, as compared to the placebo gum. The continuation of smoking, however, was associated with significant increases in gingivitis and calculus rates.