Original Contributions
Cover Story
Patient-reported receipt of oral cancer screenings and smoking cessation counseling from US oral health care providers: National Health and Nutrition Examination Survey, 2015-2016

https://doi.org/10.1016/j.adaj.2019.07.017Get rights and content

Abstract

Background

Oral health care providers are encouraged to screen for oral cancer (OC) and oropharyngeal cancer (OP) and promote smoking cessation to their patients. In this study, the authors investigated the prevalence and correlates of receiving OC and OP screening and tobacco and OC and OP counseling from oral health care providers.

Methods

The authors analyzed self-reported survey data from the National Health and Nutrition Examination Survey 2015-2016 for participants who reported a dental visit. They created different samples for each subanalysis and categorized them according to smoking status. The authors calculated weighted proportions and adjusted odds for receiving tobacco counseling and screening for OC and OP in a dental office.

Results

Overall, 25.85% of US adults 30 years or older who had ever visited an oral health care professional received OC and OP screening. Odds of receiving an OC and OP screening were lower among current cigarette smokers than among never cigarette smokers (adjusted odds ratio [AOR], 0.47; 95% confidence interval [CI], 0.30 to 0.74) and among non-Hispanic blacks (AOR, 0.36; 95% CI, 0.22 to 0.59), Mexican Americans (AOR, 0.23; 95% CI, 0.10 to 0.53), non-Hispanic Asians (AOR, 0.21; 95% CI, 0.13 to 0.35), and those of other races (AOR, 0.39; 95% CI, 0.24 to 0.65), than among non-Hispanic whites. Participants with a high school education or more had higher odds of receiving an OC and OP screening (AOR, 1.88; 95% CI, 1.04 to 3.43) and counseling for screening (AOR, 1.64; 95% CI, 1.07 to 2.51) than did those with less than a high school education. Participants with family incomes of 400% or more of the federal poverty guideline had higher odds of receiving OC and OP screening (AOR, 5.17; 95% CI, 2.06 to 12.94) but lower odds of receiving tobacco counseling (AOR, 0.45; 95% CI, 0.24 to 0.82) than did participants with family incomes of less than 100% of the federal poverty guideline.

Conclusions

Oral health care providers underscreen for OC and OP among high-risk groups, including current cigarette smokers, minorities, and people of low socioeconomic status. The authors charge oral health care educators to include OC and OP screening and smoking cessation counseling in training and continuing education programs to increase the confidence of oral health care providers.

Practical Implications

Potential to influence change on current pre-doctoral clinical training programs and to increase opportunities for continuing education courses that review the importance of, as well as, how to successfully complete smoking cessation counseling.

Section snippets

Study design

In our study, we used data from the National Health and Nutrition Examination Survey (NHANES) collected during 2015 and 2016. NHANES is a cross-sectional stratified multistage sampling study of noninstitutionalized US civilians across all life spans and is conducted by the Centers for Disease Control and Prevention National Center for Health Statistics. NHANES includes structured, self-reported, household, and person-level interviews, in addition to clinical examinations. The original survey

Receipt of OC examination

In our study, we showed that 25.85% of US adults 30 years or older who had ever visited an oral health care professional received an OC and OP examination. Results of the multivariable logistic regression revealed that current cigarette smokers (AOR, 0.47; 95% CI, 0.30 to 0.74) had lower odds of receiving an OC examination than never cigarette smokers (Table 1). Similarly, non-Hispanic blacks (AOR, 0.36; 95% CI, 0.22 to 0.59), Mexican Americans (AOR, 0.23; 95% CI, 0.10 to 0.53), non-Hispanic

Discussion

Oral health care providers underscreen for OC and OP among high-risk groups, including current cigarette smokers, minorities, and participants of low socioeconomic status. Nearly 1 in 4 adults 30 years or older who had ever visited a dentist received an OC and OP screening. Similarly, 1 of 4 adults 16 years or older who visited a dentist within the past year received OC counseling, the highest proportion being those with an education level greater than high school. Among current cigarette

Conclusions

Approximately one-quarter of the US population received OC screenings by oral health care professionals. However, screening of current cigarette smokers and counseling patients to quit smoking remain relatively underaddressed. In addition, disparities among patients receiving OC screenings are present among race and ethnicity, socioeconomic status, and education level. Increased awareness of OC and OP risk factors by oral health care professionals and intensified screening and counseling for OC

Dr. Nelson is a senior doctoral degree candidate, Division Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, 188 Longwood Ave., Boston, MA 02115.

References (30)

  • C.M. Olson et al.

    Screening for oral cancer: a targeted evidence update for the U.S. Preventive Services Task Force

    (2013 April)
  • R.L. Siegel et al.

    Deaths due to cigarette smoking for 12 smoking-related cancers in the United States

    JAMA Intern Med

    (2015)
  • Smoking and health: report of the advisory committee to the surgeon general of the Public Health Service

    (1964)
  • Smoking and health: a report of the surgeon general

    (1979)
  • The health consequences of smoking: 50 years of progress—a report of the surgeon general

    (2014)
  • Cited by (0)

    Dr. Nelson is a senior doctoral degree candidate, Division Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, 188 Longwood Ave., Boston, MA 02115.

    Dr. Kennedy was a master's degree candidate, Division Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, MA, when the work described in this article was conducted. Dr. Kennedy is now is an associate dentist, Massachusetts State Employee Fund, Alliance Dental Center, Quincy, MA.

    Dr. Aldosari is a doctoral candidate, Division Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, MA, and a lecturer, Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University, Riyadh, Saudi Arabia.

    Dr. Agaku is a lecturer and part-time faculty, Division Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, MA, and was the deputy associate director of science, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, when the work described in this article was conducted.

    Dr. Vardavas is a lecturer and part-time faculty, Division Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, MA, and affiliated with the School of Medicine, University of Crete, Heraklion, Greece.

    Disclosure. None of the authors reported any disclosures.

    View full text