Oral Health Promotion and Smoking Cessation Program Delivered via Tobacco Quitlines: The Oral Health 4 Life Trial

Abstract

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.

FIGURE 1—

Study CONSORT Diagram: Oral Health for Life (OH4L) Trial, United States, 2015–2017 ^aExcludes people known to be ineligible per quitline intake data (n = 1072). ^bPrimary reasons were no Internet access (n = 2283), saw dentist in previous 6 months (n = 1051), lost all natural teeth (n = 693), previous diagnosis with psychosis (n = 373), no text-messaging capacity (n = 351), unwilling to discuss oral health (n = 303), dental appointment already scheduled (n = 233), and planning to move in next 6 months (n = 170). ^cIndividuals ineligible and mistakenly randomized. Immediately removed from sample, not offered treatment, and not followed for data collection. Reasons for ineligibility were not mutually exclusive and included enrolled in another study already (n = 1), lived with an enrolled participant (n = 1), did not own cell phone or could not receive text messages (n = 2), already quit smoking (n = 4), and not eligible per state’s change to eligibility criteria for multicall quitline program (n = 12). ^dLost to follow-up includes the following reasons: unable to be reached, refused, deceased, or too ill to participate at contact.