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Year : 2019  |  Volume : 10  |  Issue : 1  |  Page : 32-39

Assessment of smoking cessation advice: Attitude, practice, and barriers among clinical dental students

Department of Periodontology, Hazaribag College of Dental Sciences and Hospital, Hazaribag, Jharkhand, India

Date of Web Publication15-Mar-2019

Correspondence Address:
Mohammed Ahsan Razi
Department of Periodontology, Hazaribag College of Dental Sciences and Hospital, Demotand, Hazaribag - 825 301, Jharkhand
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/srmjrds.srmjrds_5_19

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Aims: The goal of this study was to assess the smoking cessation advice (SCA): Attitude, practice, and barriers among dental students of Hazaribag College of Dental Sciences and Hospital, Hazaribag, Jharkhand, India. Subjects and Methods: The study population comprises of a total of 217 clinical dental students studying in Hazaribag College of Dental Sciences and Hospital. Data were obtained using a self-administrated questionnaire comprising of 25 multiple choice questions, based on Likert scale. Attitude-6, Practice–14, Barriers-5. The qualitative analysis on the distribution of opinion was assessed using Chi-square test, P < 0.05 was considered statistically significant. Results: The results of the present study showed that the attitude and practice of house surgeons were better than that of third and final year students for questions based on attitude toward smoking cessation questions such as – How effective do you think smoking cessation counseling provided by dentists? (P < 0.05), based on Practice in tobacco smoking cessation: Do you refer patients to appropriate service to help them stop smoking? (P < 0.05) were statistically significant. Conclusions: Despite having knowledge of smoking associated health risks and positive attitudes toward giving SCA to patients, dental students in the clinical scenario witnessed barriers to provide SCA. To ensure that when students graduate from dental school, they should not only have good knowledge but the confidence to provide effective SCA and be able to refer to specialists trained in smoking cessation programs. In conclusion, tobacco cessation advice, counseling of patients and referral to appropriate sources for treatment needs to be included as a part of the BDS curriculum to acquire skills in this aspect of dentistry.

Keywords: Dental education, prevention, smoking cessation, tobacco counseling

How to cite this article:
Razi MA, Debnath S, Prashant S, Chandra S, Khan KP, Singhal A. Assessment of smoking cessation advice: Attitude, practice, and barriers among clinical dental students. SRM J Res Dent Sci 2019;10:32-9

How to cite this URL:
Razi MA, Debnath S, Prashant S, Chandra S, Khan KP, Singhal A. Assessment of smoking cessation advice: Attitude, practice, and barriers among clinical dental students. SRM J Res Dent Sci [serial online] 2019 [cited 2022 Dec 5];10:32-9. Available from:

  Introduction Top

Despite the known harmful consequences, the use of tobacco is one of the largest public health threats world over. Tobacco which is primarily used in smoked and nonsmoked forms, it is one of the most important causes of morbidity and mortality, killing more than 7 million people per year with half of all deaths occurring in developing countries. According to a report, in India, a developing nation, with a large section of the population belonging to low socioeconomic status, various forms of tobacco use leads to 800,000–900,000 deaths annually in India due to use of different forms of tobacco.[1]

Smoking is one of the most common forms of tobacco use. It is the known cause of certain fatal diseases such as emphysema, chronic obstructive pulmonary disease, cancer, and ischemic heart diseases.[2],[3] Smoking during pregnancy plays an important risk factors for the postpartum and neonatal death.[4] In addition, tobacco smoking is also a primary risk factor for many oral diseases and condition, including halitosis, stained teeth and restorations, periodontal diseases, taste derangements, paucity in postoperative healing and recovery, oral precancerous lesions, and oral cancer. The burden of such oral diseases is particularly high for the poor population group who have limited accessibility of oral health services. Majority of dental implant failures are caused due to use of tobacco and its products.[4],[5],[6],[7],[8] India has approximately 12% (12 million) of the world smokers and more than one million deaths out of it.[9] Further, the prevalence of smoke-related mortality is increasing day by day. It is, therefore, if no regulations are implemented to ban smoking by government, deaths related to smoking is expected to increase to more than 8 million/year by 2030.[10] Although policies related to ban smoking in public places have been implemented by several countries to protect people from second-hand smoking exposure, the problem still remains challenging.[11] Smoking cessation is defined as sustained avoidance from cigarettes and other tobacco products for at least 6 months, but willingly for 1 year, as confirmed by the measurement of expired carbon monoxide or other objective tests.[6] Surveys of dental surgeons have consistently shown enthusiasm to participate in tobacco cessation campaigns and to undertake training on smoking cessation advice (SCAs). However, wide-ranging acceptance of tobacco use interventions in the field of dentistry have lagged behind, and limitations in primary care resources have downsized further efforts.[12] Smoking cessation counseling is more effective when given by healthcare workers as an improvement within their health treatment.[13] In addition to physicians, health-care providers from a variety of professions, including dentistry are in a particular position to deliver counseling to patients as they often visit more frequently during their course of dental treatment or for longer durations compared to general physicians.[14] Thus, dental professionals can play a major role in preventing adverse health effects by promoting smoking cessation, as more than 50% of smokers visit a dentist in any 1 year for dental-related problem.[15],[16],[17]

The World Health Organization has emphasized the prevention of tobacco use and tobacco cessation counseling guidelines as the priority goals in dentistry today.[18] The United State Public Health Service has issued clinical practice guidelines for treating tobacco use and dependence.[14] Despite these, there continues to be confirmation that dental professionals do not possess the appropriate education and training needed to assess the use of tobacco and provide proper tobacco cessation interventions.[19] Fortunately, in recent years, dental education has made good progress in preparing the next generation to offer effective tobacco cessation interventions during their clinical training.[20] Overall implementation of tobacco cessation as fundamental in dental practice is generally lacking.[20]

This necessitates the involvement of dental students in playing a pivotal role in reducing tobacco use by counseling their patients. The present study was designed to assess the attitude, practice, and barriers of dental students in SCA to the patients. Education and training regarding tobacco use and cessation are desired to be provided to the dental students throughout the dental curriculum in both theoretical and clinical perspectives.[21]

  Subjects and Methods Top

A questionnaire-based survey was conducted among clinical dental students (3rd year BDS, Final year BDS and House surgeon) of Hazaribag College of Dental Sciences and Hospital; Hazaribag, Jharkhand, India. All the students and interns present on the day of the survey were included in the study. The study populations were approached directly by the researchers and asked to answer the questionnaire in the presence of the researcher. Before the survey, the ethical clearance was obtained from the Institutional Ethical Committee of the college and informed consent was taken from participating students.

Inclusion and exclusion criteria

Inclusion criteria

All the clinical dental students and researchers were present on the day of the survey.

Exclusion criteria

  1. Students absent on the day of the survey
  2. 1st and 2nd year students as they are not exposed to clinical works yet.


The prefabricated questionnaire consisted of 25 multiple choice questions, based on Likert scale. These consisted of questions for assessing attitude (6), Practice (14), and barriers (5) regarding SCA [Figure 1] and [Figure 2]. The questions used were mainly close-ended. In the beginning of the questionnaire, the personal information regarding the respondents was obtained such as year of study, gender, and age.
Figure 1: Questionnaire page number 1

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Figure 2: Questionnaire page number 2

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  Results Top

Among the 217 participants in the study, 56% (n = 122) were female and 44% (n = 95) were male [Graph 1]. The participants were aged between 20 and 27 years.

Over 37% (n = 80) of the number of respondents were final year students. 34% (n = 74) were 3rd year students and 29% (n = 63) were house surgeons [Graph 2].

The response of study subjects based on attitude toward smoking cessation

Students showed positive attitude toward “How much is your responsibility as a dental student in smoking cessation counseling?” And “How confident you are in your ability to effectively offer smoking cessation counseling?” with maximum balloting toward considerable (35.94% and 42.86%) and great extent (56.68% and 23.96%). Whereas for some questions like “How effective do you think smoking cessation counseling provided by dentist?” “Do you think patients expect SCA from dentists?” “How optimistic you are in patient's ability to change their smoking habits?” And “Are there adequate opportunities available to you for training in smoking cessation and prevention counseling? Majority of students trusted on neutral answers of “to some extent” (50.23%, 39.17%, 40.55%, and 25.35%, respectively) [Figure 3]. Overall, the attitude of house surgeons was better than that of third and final year students for questions based on attitude toward smoking cessation questions like: How effective do you think smoking cessation counseling provided by dentists? (P < 0.05) [Table 1].
Figure 3: Overall response of study subjects based on attitude toward smoking cessation

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Table 1: The response of study subjects based on attitude toward smoking cessation

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Distribution of opinion on practice in tobacco smoking cessation

Practice in tobacco smoking cessation designates the attitude and practice among the student population. The present survey displayed that most of the students were having constructive attitude toward tobacco smoking cessation by balloting “considerable and great extent.” Students displayed their confused or balanced opinion by balloting “to some extent” option to the questions such as “Do you offer smoking cessation counseling to your patients?” “Do you assist the patient who smoke to give up?” “Do you refer patients to appropriate services to help them stop smoking?” “Do you keep record of patient smoking status?” and “Do you recommend the use of approved pharmacotherapy accept in special circumstances?” [Figure 4] Overall based on practice in tobacco smoking cessation for questions like: Do you refer patients to appropriate service to help them stop smoking? P < 0.05 were statistically significant. There was a positive opinion on practice in tobacco smoking cessation in house surgeons followed by final years and 3rd year students [Table 2] and [Table 3].
Figure 4: Overall distribution of opinion on Practice in tobacco smoking cessation

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Table 2: Distribution of opinion on practice in tobacco smoking cessation

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Table 3: Distribution of opinion on practice in tobacco smoking cessation

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Distribution of opinion on barriers in smoking cessation activity

Majority of students agreed on the fact “that smoking is the major health issue” and “you are comfortable to asking people about their tobacco status” (96.77% and 82.95%) and also showed their neutral opinion on “The discussions are too time-consuming” “You lack knowledge on the subject” And “You fear that patients may leave practice if counseled to give up smoking” [Figure 5]. Among clinical students 3rd year and final year faced maximum barriers in as they fear that patients may leave practice if counseled to give up smoking [Table 4].
Figure 5: Overall distribution of opinion on Barriers in smoking cessation activity

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Table 4: Distribution of opinion on Barriers in smoking cessation activity

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  Discussion Top

The dental professionals can play an important role in smoking cessation and prevention.[22] This survey of clinical dental students regarding knowledge, attitude, and practice toward SCA clearly show that the dental students have good knowledge of the effects of tobacco use on oral as well as on general health. They have shown positive attitude toward providing SCA to their patients. A study done by Wyne et al.[23] revealed confusions in the dental community regarding the extent of the dental professionals responsibility and role in tobacco intervention. Only a minority of them thought of tobacco intervention as their responsibility to a “great extent.” Several other studies in other countries have also led to similar results and reported that the dental professionals were uncertain of their role in providing SCA to the patients, and believed that it was not a part of dentistry.[24],[25],[26],[27] The attitude of dental students in taking responsibility for smoking cessation in the present study was generally promising.

The result of the present survey is in line with similar to several other studies previously carried out in different parts of the world[2],[15],[23],[28],[29] where dentists generally believed that it was also their responsibility to help their patients in smoking cessation or to prevent tobacco use in their patients. The dental team could play an important role in encouraging patients to quit using tobacco as they recognize and point out the damage caused by tobacco to the oral tissues and could highlight the general health benefits of quitting and to refer to professional cessation services if appropriate.[13] The present survey revealed that the participating clinical dental students had a good level of knowledge about potential health implications for tobacco users. The majority of participants correctly identified tobacco use with a variety of dental and other pathologies. Considering that at the time of the survey some of the students of the 3rd year had not completed the clinical posting in the department of oral medicine, the results of this survey are encouraging. Although the majority of students stated that their education should include SCA, only half of all respondents felt adequately or better prepared in providing advice to their patients. This result is in conformity with those of previous surveys which found only 40%–60% of students felt adequately trained.[30],[31],[32] Currently, standardized tobacco cessation educational curriculum does not exist instead tobacco use, and its effects are integrated into several chapters of the BDS curriculum. As part of the periodontology subject, smoking is identified as a risk factor for periodontal diseases, and there is emphasis given on the effect of cessation on treatment outcome throughout 3rd year, final year and during the internship. In the curriculum as part of oral medicine and oral pathology, the effect of tobacco on oral health is mentioned. During clinical postings of 3rd year, final year and house surgeons, chair-side teaching students are acquainted in details about the health consequences of tobacco use. In addition, deleterious effects of tobacco use and health promotion through camps and rallies such as on “world oral health day” (20th March) and world “No tobacco day” (31st May) are introduced as part of the public health awareness.[33] The revision of the curriculum would provide an opportunity for greater emphasis to be placed on tobacco cessation as a core learning outcome. Until adequate emphasis is placed on integrating the principles and practice of providing SCA into the undergraduate experience including the existence of national specialist smoking cessation services, we can expect there to be a continued dearth of practitioners willing to undertake such work with enthusiasm.[34]


The authors would like to express their sincere thanks to all the clinical students who participated in the study. Thanks are also due to Dr. Ujjal Chatterjee, Principal, Hazaribag College of Dental Sciences and Hospital for the permission in conducting survey and Dr. Praveen Shrinivas, Secretary, Hazaribag College of Dental Sciences and Hospital, Hazaribag, Jharkhand for their help and encouragement.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

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  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]

  [Table 1], [Table 2], [Table 3], [Table 4]


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