• The primary outcome is self-reported consecutive quit at 3 and 12 months following intervention.
  
• Secondary outcomes are reduction in use, number of quit attempts at 3 and 12 months, and increases in readiness to quit.
  

• Conduct an economic analysis to determine the incremental cost per quit of the two interventions.
  
• Examine predictors of patient outcomes and the interaction of these variables with intervention condition.
  
• Examine patients’ report of practitioner protocol delivery at six weeks as a function of intervention condition.
  
• Examine the mediating effect of patient report of protocol delivery on patient outcomes across conditions.
  
• Assess practitioner report of implementation (at 3 months) and maintenance (at 12 months) of the protocol.
  
• Assess the effect of the intervention condition on changes in self-reported attitudes of dentists, dental hygienists, and dental assistants.
  

Although many dental practitioners now routinely incorporate the first two of the “5A’s” (Ask and Advise) into their practice, and previous research indicates that brief office-based interventions are effective in producing modest tobacco quit rates for dental patients, dental practitioners continue to perceive a number of obstacles to routine provision of tobacco cessation services. Many dental practitioners still believe that counseling patients to quit an addictive behavior is beyond the scope of their training or comfort.

Recent studies have shown that proactive phone counseling from State-sponsored telephone tobacco help lines has a positive effect on tobacco cessation. The use of these help lines offers a unique supplement to the dental professional that could reduce the burden on practitioner and enhance the likelihood of their patients’ quitting. Referral to a specialist is within the common heuristic followed by dental and medical practitioners. Therefore, we believe referral to a telephone help line may be an innovative way of enabling dentists and dental hygienists to encourage and support their patients to quit tobacco.

We will test two levels of intervention as compared to usual care in a randomized clinical trial in which 60 dental practices in Mississippi are randomized to one of three conditions. In one condition (“5A’s”), the dental team will provide a brief office-based intervention that is modeled on the “5A’s” advocated by the Clinical Practice Guideline. In the second condition (“3A’s” + THL), the dental team will provide the first three “A’s” (Ask, Advise, Assess), and then refer patients to the State-supported telephone help line for provision of the cessation counseling and follow-up support. In the third condition (Usual Care), volunteering practices will ask their patients only to complete our study surveys.