保健医療科学

2020Vol.69 No.1 p.73－82＜ Research Data ＞
Current status and issues of smoking cessation efforts in dental clinics
in Japan: Tobacco control based on interprofessional collaboration
TANO Rumi 1), MIURA Hiroko 2), AOYAMA Hitoshi 3),
OZAKI Tetsunori 4), TAMAKI Yoh 5), YOKOYAMA Tetsuji 1)
1)

Department of Health Promotion, National Institute of Public Health
Department of International Health and Collaboration, National Institute of Public Health3)
Tochigi Prefectural Collage of Health and Welfare
4)
Department of Community Dentistry, School of Dentistry, Nihon University
5)
Department of Health and Welfare Service, National Institute of Public Health2)

Abstract
Objectives: To analyze the current status of smoking cessation promoted by dental clinics in Japan and toinvestigate the issues faced in promoting tobacco control measures through interprofessional collaboration.
Methods: A questionnaire survey on smoking cessation was conducted from October to November 2018. Of
the 1,020 dental clinics that were sent the questionnaire, 406 responded (response rate: 40.0%). Of these,the 400 valid responses were included in the analysis set. The analysis consisted of basic tabulation andbivariate and multivariate analyses based on the status of collaboration. The significance level was set to
below 5%.
Results: 91.5% of the respondents be aware of the current smoking status of patients, and 69.8% had
performed examinations for smoking cessation during treatment for periodontal disease. 46.3% of them
responded that there are problems with supporting smoking cessation, and that the most common problem(67.0%) was “smoking cessation is not included in the reimbursement of medical fees”. Meanwhile, 30.8%of the dental clinics were not doing anything in particular regarding education on smoking cessation, and34.6% of those admitted to having problems with promoting cessation, stating the reason to be “inadequatesmoking cessation skills.” Only 11.8% were promoting smoking cessation in collaboration with areas otherthan dentistry, while 91.5% were enforcing outpatient visits for smoking cessation treatment as well as collaborating with physicians.
Conclusions: The findings suggested that only a few dental clinics are supporting smoking cessation incollaboration with areas other than dentistry. They also demonstrated the need for education for dental
healthcare personnel to improve their skills related to smoking cessation efforts.
keywords: dental clinics, smoking cessation, content analysis, interprofessional collaboration(accepted for publication, December 19 2019)

I. Introduction
The adult smoking prevalence in Japan is on a yearly decline and is presently at 17.7%, according to the results of asurvey conducted in 2017[1]. However, the rate of decline
appears to have flattened out in recent years. In addition,
the rate at which smoking cessation treatment is covered
under health insurance plans is low, and the success rate ofsmoking cession in individuals after 9 months of visiting an
outpatient department for smoking cessation treatment isapproximately 30% [2]. In this situation, there is a demand
for the promotion of smoking cessation based on interprofessional collaboration that is centered on healthcare workers; this relates to the national policy goal of decreasing
the percentage of adult smokers [3]. Tobacco control in advanced countries now involves the promotion of restrictions

Corresponding author: TANO Rumi
2-3-6 Minami, Wako, Saitama 351-0197, Japan.
Tel: +81-48-458-6151 /Fax: +81-48-458-6714
E-mail: tano.r.aa@niph.go.jp

J. Natl. Inst. Public Health, 69 (1) : 202073

TANO Rumi, MIURA Hiroko, AOYAMA Hitoshi, OZAKI Tetsunori, TAMAKI Yoh, YOKOYAMA Tetsuji
on tobacco as well as the proactive involvement of dental
healthcare personnel in smoking cessation. In the UnitedStates, which took the lead in dental smoking cessationintervention, dentistry was engaged from the initial stage ofthe preparation of tobacco control measures [4], and at least
80% of dentists routinely performed smoking cessationinterventions [5]. At almost the same time as the UnitedStates, the United Kingdom also clarified the role of dental
healthcare personnel in the promotion of smoking cessation[6], while Swedish dental healthcare personnel are reported
to regard smoking as a major health problem [7]. As such,it is now internationally understood that smoking cessationintervention involving dentistry is effective [8]. However,for smoking cessation in dental practice in Japan, it was
shown that the interest of dental healthcare personnel in
performing smoking cessation intervention for patients
increased [9,10] only after the publication of many casereports on smoking cessation. For the promotion of smoking cessation in dentistry in Japan, henceforth, a strategy
for smoking cessation by dental healthcare personnel that
includes collaboration between multiple disciplines needs
to be investigated. However, the current status of smoking
cessation in dental clinics has not been sufficiently elucidated.
This study aimed to reveal the current status of and problems on smoking cessation in dental clinics by surveying
the implementation of smoking cessation in dental clinics inJapan, the content of smoking cessation efforts, and collaboration with other professions.

II. Methods
1. Survey subjects and methods
This study aimed to understand the actual status ofsmoking cessation in dental clinics with a focus on regional collaboration. The study subjects were dental clinics
promoting accessible smoking cessation based on certain
requirements of a regional professional organization. Of
the dental clinics in the dental associations located in four
prefectures on the “List of Dental Clinics Implementing
Smoking Cessation” (accessed October 1, 2018), 1,020 clinics that are members of one metropolitan and two prefectural dental associations were selected as the subjects. The
survey period was from October 31 to November 13, 2018.
After gaining the approval of the clinic director, who is the
manager of the facility, an anonymized self-administeredquestionnaire survey was performed via postal mail.
2. Survey content
The survey items consisted of the respondents’ basic
characteristics (sex, age, number of years in professional

74

service), an overview of the respondent’s dental clinic(number of employees, number of years in operation), thesystem for implementing smoking cessation, methods used
to learn the theory and practice of smoking cessation, themean time allocated to smoking cessation per patient (atone examination session), the reasons for implementing
smoking cessation support, the content of the smoking cessation support being implemented, the status of collaboration on smoking cessation support, opinions about regional
collaborative support on smoking cessation, the nature of
problems (hindrance, blockage, etc.) encountered when
delivering smoking cessation support, and the content ofsmoking cessation promotion. Responses took the formof a number value for the mean time allocated to smoking
cessation efforts, a self-reported opinion on regional collaboration on smoking cessation, and a selection from two or
more responses for the other items.
The definitions documented in the questionnaire clarified
that “smoking” in this study included new types of tobacco(heated tobacco products, electronic cigarettes) in addition
to paper-wrapped tobacco, “employees” also included the
respondents themselves, and “collaboration” indicated “collaborative support on smoking cessation based on mutualreferral/inquiry by dental and other facilities, and throughthe respective roles develop tobacco control in multiple disciplines.” The questions asked about the current situation
as of October 2018.
3. Analyses
Of the 1,020 dental clinics to which the questionnaire
was sent, five were returned as undeliverable mail. 6 out of
406 responding dental clinics (recovery rate: 40.0%) were
excluded. The details are two returned a mostly uncompleted questionnaire and four responded that they were notpresently performing smoking cessation.
The basic tabulation and descriptive statistics, and acomparison of the various items, were performed using a2
χ -test based on the status of the collaboration. From theresults of the bivariate analysis, items showing a significant
difference were used as the explanatory variables and thestatus of collaboration was used as the objective variable inthe multivariate analysis that was performed via multiple
logistic regression. The statistical analysis was performed
using IBM SPSS Ver.25 (Japan IBM, Tokyo) and the significance level was set at below 5%.
Content analysis was performed of the free description
responses using the Berelson method as a reference [11].
The research question of the study was “What kind of collaboration do dental clinics require to promote effective andefficient smoking cessation in the region?” The response tothis question was set as “Dental clinics require ( ) to pro-J. Natl. Inst. Public Health, 69 (1) : 2020

Current status and issues of smoking cessation efforts in dental clinics in Japan: Tobacco control based on interprofessional collaboration
mote smoking cessation in collaboration with the region.”
After converting the responses into data form, the firstauthor aggregated the recorded units repeatedly for a totalof four times as the fundamental analysis. Categorizationof this analysis was performed by four researchers (a physician, a dentist, a nursing-teacher, and a dental hygienist)
including the first author, each performing it twice; finally,a consensus was reached. The reliability of each category
was confirmed by two individuals (one dentist engaged in
tobacco control and one public health nurse) not involvedin this study and the concordance rate was calculated using
the W.A. Scott formula [12].
4. Research ethics
This study was subjected to an ethical research review
by the National Institute of Public Health and was conducted once approval was granted (Ethical Approval Number:
NIPH­IBRA#12210). Before the study, written approval was
obtained from the president of the Japan Dental Association, to which the survey target clinics belonged. An explanation of the study purpose, study objective, reason for the
choice of subjects, method of collaboration, data handling,
and disclosure of the study results was included. It was also
explained that when disclosing the results, individual dental
clinics would not be identified and that consent to cooperate
in the study was based on the free will of the clinic director.
This information was attached to the anonymized questionnaire and sent to the subjects by postal mail. In order toconfirm that the subjects understood the explanation before
responding to the questions, a check column was placedat the beginning of the questionnaire. The questionnaire
was anonymized and consent to cooperate in the study was
obtained from the subjects by them returning the questionnaire in the enclosed return envelope.

III. Results
1. Basic characteristics of the respondents
Table 1 shows the basic characteristics of the respondents. The respondents consisted of 366 (91.5%) males and29 (7.2%) females. The ages were as follows: 185 (46.3%)
in their 60s, which was the most common, followed by 121(30.3%) in their 50s. Time period of service years was ≥30
years for 278 (69.5%), which was the most frequent, followed by ≥20 but <30 years for 88 (22.0%).

Table 1 B asic characteristics of the respondents(N=400)Sex

Male
FemaleNot mentioned
Age (years)
20s
30s
40s
50s
60s
≥70s
Not mentioned
Time period of service years<5 years≥5 years but <10 years≥10 years but <20 years≥20 years but <30 years≥30 years
Not mentioned
Number value: number of respondents (%)

366 (91.5)
29 (7.2)
5 (1.3)0 (0.0)6 (1.5)36 (9.0)
121 (30.3)
185 (46.3)
46 (11.5)
6 (1.5)0 (0.0)2 (0.5)26 (6.5)
88 (22.0)278 (69.5)
6 (1.5)

Table 2 Characteristics of dental clinics (N=400)
Number of employees†(all employees including the dentist)

Time period of years in service†<3

101 (25.3)

3–5
6–10
11–20
≥21
Not mentioned<5 years≥5 but <10 years≥10 but <20 years≥20 years
Unknown
Not mentioned

158 (39.5)
101 (25.3)
30 (7.5)
8 (2.0)2 (0.5)8 (2.0)7 (1.8)63 (15.8)315 (78.8)
3 (0.8)4 (1.0)

Number value: † number of facilities (%)

for 101 (25.3%) clinics. For years in operation, 315 (78.8%)
clinics answered ≥20 years, which was the most common,
followed by ≥10 years but <20 years for 63 (15.8%) clinics.
3. Implementation of smoking cessation support
The occupations providing smoking cessation support
were “dentist and dental hygienist” in 187 (46.8%) dental
clinics, which was the most common, followed by “dentist
only” in 164 (41.0%), “not fixed” in 23 (5.8%), and “dental
hygienist only” in 3 (0.8%) clinics, in that order. The meantime allocated to smoking cessation support per patient per
treatment session was 10 min for 93 (23.3%) dental clin(Number ofdental clinics)
120

N=400

100
80
60
40

2. Characteristics of the dental clinics analyzed
Table 2 shows the characteristics of dental clinics. The
number of dental clinics with 3–5 employees including parttime employees was 158 (39.5%), which was the most common, followed by <3 employees and then 6–10 employees

20
0

≤1

1＜ but ≤3

3＜ but ≤5

5＜ but ≤10

≥10

Not
mentioned

Time (min)Figure 1 S
 moking cessation support performance time(mean time allocated per patient per treatment)

J. Natl. Inst. Public Health, 69 (1) : 2020

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TANO Rumi, MIURA Hiroko, AOYAMA Hitoshi, OZAKI Tetsunori, TAMAKI Yoh, YOKOYAMA Tetsuji
Table 3 Implementation of smoking cessationNo
collaboration
n=353

P -value†26 (55.3)
26 (55.3)
7 (14.9)
11 (23.4)
3 (6.4)2 (4.3)170 (48.2)
131 (37.1)
116 (32.9)
48 (13.6)
11 (3.1)
6 (1.7)

0.356
0.016
0.012
0.075
0.252
0.240

367 (91.8)
232 (58.0)
211 (52.8)
169 (42.3)
66 (16.5)
17 (4.3)
14 (3.5)45 (95.7)
32 (68.1)
31 (66.0)
27 (57.4)
12 (25.5)
5 (10.6)
1 (2.1)322 (91.2)
200 (56.7)
180 (51.0)
142 (40.2)
54 (15.3)
12 (3.4)
13 (3.7)

0.289
0.136
0.054
0.025
0.076
0.021
0.586

65 (16.3)

13 (27.7)

52 (14.7)

0.024

279 (69.8)
243 (60.8)
171 (42.8)
170 (42.5)
114 (28.5)
94 (23.5)
31 (7.8)
5 (1.3)36 (76.6)
37 (78.7)
22 (46.8)
25 (53.2)
22 (46.8)
21 (44.7)
2 (4.3)1 (2.1)243 (68.8)
206 (58.4)
149 (42.2)
145 (41.1)
92 (26.1)
73 (20.7)
29 (8.2)
4 (1.1)

0.277
0.007
0.549
0.114
0.003
0.000
0.340
0.564

366 (91.5)
187 (46.8)
92 (23.0)
85 (21.3)
63 (15.8)
42 (10.5)
8 (2.0)46 (97.9)
31 (66.0)
16 (34.0)
18 (38.3)
15 (31.9)
10 (21.3)
2 (4.3)320 (90.7)
156 (44.2)
76 (21.5)
67 (19.0)
48 (13.6)
32 (9.1)
6 (1.7)

0.095
0.005
0.056
0.002
0.001
0.010
0.240

374 (93.5)
244 (61.0)
217 (54.3)
93 (23.3)
80 (20.0)
7 (1.8)45 (95.7)
34 (72.3)
35 (74.5)
34 (72.3)
24 (51.1)
0 (0.0)329 (93.2)
210 (59.5)
182 (51.6)
59 (16.7)
56 (15.9)
7 (2.0)

0.506
0.090
0.003
0.000
0.000
0.330

Total

Collaboration

N=400

n=47

196 (49.0)
157 (39.3)
123 (30.8)
59 (14.8)
14 (3.5)
8 (2.0)

Methods of acquiring knowledge on support and skills
Reading books and articles
Participating in workshops and seminars
No specific learning method
Study groups and in-hospital study meetings
E-learning and attending lectures
Other

Reason for implementation of smoking cessation
Smoking is linked with dental disease
Smoking cessation is important and necessary in dentistry
We are professionals responsible for health promotion
Smoking cessation at dental clinics is effective
Consultation and questions on it were received from patients
Requests to introduce smoking cessation were received from the staff
Other

Targeted individuals
All patients
Other than "All patients"
Patients receiving dental treatment(such as periodontal disease)
Smokers interested in quitting
Maintenance
Smokers not considering quitting
Patients before a surgical treatment (implant/tooth extraction, etc.)
Patients who have already started smoking cessation
No specific target
Other

Content understood through interviews
Present smoking status
Past smoking experience and smoking cessation experience
For smokers, the status of preparedness to quit smoking
For non-smokers, the status of passive smoking
For smokers, calculation of the cumulative number of cigarettes smoked
For smokers, evaluation of level of nicotine addiction
Other

Main support content
The impact smoking has on the oral cavity area
The effect (changes/improvement) that smoking cessation has on the oral cavity area
Motivation to quit smoking
Referral/inquiry from other dental clinic with non-smoking out-patient department, etc.
Specific smoking cessation methods
Other

Number values: number of dental clinics (%)†χ2-testMultiple responses were permitted.

ics, which was the most common, followed by 5 min for 91(22.8%) clinics (Fig. 1).
Table 3 shows the results of questions on the implementation of smoking cessation. The most common method
used to learn the theory and practice on smoking cessation
support was “reading books and articles” for 196 (49.0%)
dental clinics, followed by “participating in workshops andseminars” for 157 (39.3%). Meanwhile, “no specific learning method” was the case for 123 (30.8%) dental clinics,
which was significantly more common among clinics withno collaboration than those with collaboration. “e-learningand attending lectures” was the case for 14 (3.5%) dental
clinics. Concerning the reason for implementing smoking
cessation support, “smoking is linked with dental disease”
was mentioned by 367 (91.8%) dental clinics, making it themost common, followed by “smoking cessation is importantand necessary in dentistry” for 232 (58.0%) clinics. With
regard to how patients receiving dental treatment became76

the subjects of smoking cessation support, “patients receiving dental treatment (such as periodontal disease)” wasthe case for 279 (69.8%) dental clinics, which was the mostcommon, followed by “smokers interested in quitting” for243 (60.8%) clinics. Moreover, “patients before a surgicaltreatment (implant/tooth extraction, etc.)” was the case for
114 (28.5%) dental clinics, “patients who have already started smoking cessation” for 94 (23.5%), and “all patients”
for 65 (16.3%) clinics, which were all low values. However,the values were significantly higher for dental clinics who
were collaborating than those who were not. The details on
smoking as understood from a medical interview or patientinterview were “present smoking status” for 366 (91.5%)
dental clinics, which was the most common, followed by“past smoking experience and smoking cessation experience” for 187 (46.8%) clinics. Meanwhile, “evaluation oflevel of nicotine addiction” was mentioned by 42 (10.5%)
dental clinics, “calculation of the cumulative number of cig-

J. Natl. Inst. Public Health, 69 (1) : 2020

Current status and issues of smoking cessation efforts in dental clinics in Japan: Tobacco control based on interprofessional collaboration
arettes smoked” by 63 (15.8%), and the “for non-smokers,
the status of passive smoking” by 85 (21.3%), which were
all low values. However, the values were significantly higher for dental clinics working in collaboration than those who
were not. The main support was “the impact smoking has
on the oral cavity area” for 374 (93.5%) dental clinics, which
was the most common, followed by “the effect (changes/
improvement) that smoking cessation has on the oral cavity
area” for 244 (61.0%) clinics. Meanwhile, “specific smoking
cessation methods” were mentioned by only 80 (20.0%)
clinics.
Concerning the status of problems encountered whenproviding smoking cessation support at dental clinics, 185(46.3%) answered “present” and 215 (53.8%) “absent.” Theproblems were “smoking cessation is not included in thereimbursement of medical fees (it cannot be added as insurance points)” for 124 (67.0%) dental clinics, which was themost common, followed by “patient reaction (deteriorationof relationships, rejection or resistance towards smoking
cessation support)” for 101 (54.6%), “time cannot be allocated to smoking cessation support (it is difficult to secure
time for smoking cessation support)” for 82 (44.3%), and“inadequate smoking cessation skills (the training of employees before and after graduation is inadequate)” for 64(34.6%), in that order.
4. Status of collaboration on smoking cessation
In total, 47 (11.8%) dental clinics responded that collaborative support on smoking cessation was “present” and 353(88.3%) answered that it was “absent.” For those dental
clinics implementing collaborative support, “outpatient departments that provide smoking cessation treatment” wasmentioned by 43 (91.5%), which was the most common,
followed by “administrative” by 8 (17.0%), “pharmacies”
by 7 (14.2%), in that order. With regard to the professions
providing collaborative support, it was “physicians” for43 (91.5%) dental clinics, which was the highest, followedby “pharmacists” for 10 (21.3%), “school dentists” for 6(12.8%), in that order. The main content of collaborative
support efforts was the “introduction of outpatient departments that provide smoking cessation treatment” for 43(91.5%) dental clinics, which was the most common, followed by “placarding and displaying smoking cessation-related materials and displays in the examination room” for
18 (38.3%), “explanations of nicotine-replacement products
and pharmacy introductions” for 15 (31.9%), “acceptanceof requests for smoking cessation from other institutions”
for 8 (17.0%), and “documenting information on smoking
cessation on the clinic’s website” for 3 (6.4%), in that order. The results of the multiple logistic regression analysis
showed that the factors affecting smoking cessation basedon interprofessional collaboration, and for which the model2
χ -test and the various variables were significant (p<0.01),
were “specific smoking cessation methods” in the main
support content, “calculation of the cumulative number ofcigarettes smoked” in the content understood through interviews, and the target patient “patients who have alreadystarted smoking cessation” (Table 4).
For what dental clinics need to promote smoking cessation based on region, the response “free description” wasobtained from 176 (44.0%) dental clinics. Responses not
related to the study questions, abstract expressions, andresponses with an unclear meaning were excluded, and assuch, responses from 162 dental clinics were included in
the analysis set. From these 162 descriptions, 217 recorded
units were analyzed and classified based on the similarityof significant contents. Then, 14 categories were formed(the name of the category is shown in square brackets[ ]), including [collaboration with medical departments,
physicians, medical institutions, and medical associations],[collaboration with the administration], and[constructionof a system for introducing outpatient departments thatprovide smoking cessation treatment]. The concordance
rates of the categories were 79% and 85%, showing thereliability assurance of the categories (Table 5). The [collaboration with medical departments, physicians, medical
institutions, and medical associations] category was formed
from the descriptive units of “collaboration with medical departments,” “collaboration with physicians,” “collaboration
with medical facilities and so on.” [collaboration with theadministration] was formed from descriptive units such as“collaboration with the administration,” “collaboration with

Table 4 Factors affecting interprofessional collaboration on smoking cessation

Main support content – Specific smoking cessation methods

Partialregression
coefficient-1.40795% confidence interval of the odds ratio

P -value

Odds ratio

Lower limit

Upper limit

0.000

0.245

0.124

0.483

Content understood through interviews–
For smokers, calculation of the cumulative number of cigarettes smoked-0.760

0.043

0.468

0.224

0.976

Targeted individuals–Patients who have already started smoking cessation-0.702

0.044

0.496

0.250

0.982

Model χ2-test p <0.01
Discrimination value 87.8%

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77

TANO Rumi, MIURA Hiroko, AOYAMA Hitoshi, OZAKI Tetsunori, TAMAKI Yoh, YOKOYAMA Tetsuji
the local government,” and “collaboration with health centers.” [construction of a system for introducing outpatient
departments that provide smoking cessation treatment]
was formed from descriptive units such as “introduction ofan outpatient departments that provide smoking cessation
treatment,” “system for introducing an outpatient departments that provide smoking cessation treatment,” and “information sharing with outpatient departments that provide
smoking cessation treatment.”

IV. Discussion
This study aimed to elucidate the status of and problems
with smoking cessation with a focus on interprofessional
collaboration. Dental clinics who publicized that they implemented smoking cessation through their dental association
were the target subjects. Managing dentists had many
years of professional service, and though the size of theclinics was not large based on the number of employees.
For individuals whose smoking status could be understood,
smoking cessation was promoted for at least 5 min forpatients with periodontal disease. However, collaboration
with other professions was inadequate. For dental clinics topromote tobacco control measures based on collaboration
with multiple professions, training for dental healthcare
personnel to improve their smoking cessation skills is necessary. Furthermore, the need to position tobacco control in
dentistry and build a scientific rationale for its efficacy wasdemonstrated.
1. Characteristics of the respondents and dental clinics
Of the respondents, 91.5% were male, 76.6% were in
their 50s or 60s, and 69.5% had ≥30 years of professional
service. The number of founders or owners of clinics (87.0%
male and 13.0% female) based on the 2016 national statistics and the male/female ratio showed no notable difference
from the present study. According to the 2016 national

survey [13], those in their 50s (33.4%) and 60s (26.8%)
accounted for approximately 60% of clinic founders; therefore, the age group of the respondents in this study washigh and their professional service was long. For dental
clinics managed by the respondents, the number of employees including part-time employees was 3–5, which was thehighest, while 5 or fewer employees were present at morethan 60% of the clinics. Based on the number of employees,
the size of the dental clinics was not large. Moreover, dental
clinics that had been in operation for ≥20 years accounted
for approximately 80%, showing that these dental clinics
have been performing dental therapy in the region for many
years.
2. Implementation of smoking cessation support
As for the learning methods to acquire knowledge andskills for implementing smoking cessation efforts, it became evident that 49.0% of dental clinic staff read books
and published articles, while 39.3% participated in workshops and seminars. Meanwhile, for 30.8% of the dental
clinics, “no specific learning method” was conducted. In
addition, dental clinics not involved in collaboration withother professions showed a significant lack of learning. A
Western randomized controlled trial confirmed that training
in smoking cessation not only increased the rate at whichsmoking cessation was implemented, but the cessation
rate of smokers receiving support also increased significantly [13]. In particular, e-learning, which is a methodof education and learning using information transmission
technology, has been reported to be useful as training for
those giving guidance on smoking cessation and treatment[14]; however, it was being used by less than 10% of thedental clinics in the present study. Therefore, in the future,learning that incorporates e-learning programs is necessary
to improve the skills of dental healthcare personnel. It isessential for dental clinics to promote the smoking cessation program so that dentists and dental hygienists should

Table 5 W hat dentistry requires to promote smoking cessation based on regional
collaboration
1
2
3
4
5
6
7
8
9
10
11
12
13
14

78

Category
Recorded units (%)
Collaboration with medical departments, physicians, medical institutions, and medical associations
50(23.0)
Collaboration with the administration
42(19.4)
Construction of a system for introducing outpatient departments that provide smoking cessation treatment32(14.7)
Collaboration with schools, school dentists, and school physicians20(9.2)
Increased level of knowledge on smoking cessation in dentistry18(8.3)
Preparation of public relations medium
9(4.1)
Collaboration with enterprises and groups
9(4.1)
Calculation of health insurance points
8(3.7)
Collaboration with medical departments, pharmacists, pharmacies, and pharmacy associations
7(3.2)
Holding workshops, seminars, etc.
7
(3.2)
Establishment of laws and regulations
4(1.8)
Movement toward the media and mass communication
4(1.8)
Collaboration with health examinations and tests
4(1.8)
Participation in events
3(1.4)
Total recorded units
217(100.0)J. Natl. Inst. Public Health, 69 (1) : 2020

Current status and issues of smoking cessation efforts in dental clinics in Japan: Tobacco control based on interprofessional collaboration
be able to support patients to support smoking cessation attheir specific health guidance sessions. Smoking cessationinterventions with a short duration have been reported tocontribute to individuals quitting smoking [15]. Specifically,a smoking cessation intervention of within 3 min increased
the smoking cessation rate significantly [16]. With limited
human resources and time restrictions, the “short time”
emphasized in the United States smoking cessation intervention guidelines [16] could be of use in the practice ofsmoking cessation promotion in dental treatment in Japan.
The significance of smoking cessation support at dental
institutes has been demonstrated so far in several reports
describing successful cases of smoking cessation support
leading to the prevention of oral diseases [17]. In this study,
the reason given for implementing smoking cessation
efforts was “smoking is linked with dental disease” for
91.8% of the dental clinics, followed by “smoking cessation
is important and necessary in dentistry” for 58.0%. The
most common subjects of smoking cessation efforts were
patients undergoing dental treatment for periodontal disease (in 69.8% of the dental clinics) followed by smokers
interested in quitting smoking (in 60.8%). Given the facts
that the link between periodontal disease and smoking has
been established [18] and that the prevalence of periodontal
disease in Japan is high [19], the promotion of smoking cessation as part of periodontal treatment and management isimportant. In Japan, where opportunities for smoking cessation intervention are limited, expanding smoking cessation
efforts to all smokers through the use of dental treatment
has been proposed [20]. In the future, apart from individuals
wishing to quit smoking and those who attend a dental clinic for treatment, smoking cessation intervention from theviewpoint of motivation for smoking cessation is necessary.
Moreover, details understood from a medical interview
or patient interview included present smoking status for
91.5% of dental clinics, while past history of smoking, history of smoking cessation, status of preparation for smoking
cessation, evaluation of nicotine addiction, calculation of
the cumulative number of cigarettes smoked, and status ofpassive smoking for non-smokers were ascertained for lessthan half of dental clinics. The content of the main support
was the impact of smoking on the oral cavity for 93.5% of
the dental clinics and the effect of smoking cessation on theoral cavity area for 61.0%. Meanwhile, support for specificmethods of smoking cessation was delivered by 20.0% of
the dental clinics. In order to promote smoking cessation
in a way that suits the condition of the subject, evaluation
items such as the behavior modification stage [21], which
is a condition of preparation for smoking cessation, historyof smoking cessation, evaluation of nicotine addiction, andcumulative number of cigarettes smoked are necessary [22].

Therefore, matters that must be understood when smoking
cessation is being promoted at a dental clinic are not only toconfirm the current smoking status, but are also linked withthe provision of specific support methods; hence, subject
evaluation is necessary.
In this study, approximately half of the dental clinics reported that they have had problems with promoting smoking cessation. The most common problem was the fact thatsmoking cessation is not included when calculating the reimbursement of medical fees, which was the case for 67.0%
of respondents; that was followed by patients’ reactions for
54.6% of the respondents, and difficulty with securing timefor 44.3%. The rejection and resistance of patients towardsmoking cessation intervention are considered to be due tocognitive distortion associated with nicotine addiction [23].
The results of this survey revealed that many smoking cessation efforts are not being calculated in the reimbursementof medical fees, which is a problem in the performance ofsuch efforts. It has been reported that the top reason why
periodontists in Japan do not promote smoking cessation is
because “it has no insurance points.” [24] From that fact,also, there is a demand for the positioning of tobacco control
in dentistry, validation of its effectiveness, and for a scientific rationale to be built.
3. Status of collaboration on smoking cessation
Based on the results of this study, few dental clinics arepromoting smoking cessation in collaboration with otherprofessions, and those in such collaborations are cooperating with physicians through introductions to outpatient
departments that provide smoking cessation treatment. In
addition, collaboration on smoking cessation was affectedby support for continued smoking cession, understanding
the cumulative number of cigarettes smoked, and intervention that provides specific methods of smoking cessation.
With regard to what is required by dental clinics to promote smoking cessation based on regional collaboration,
the top-ranking items were [collaboration with medical
departments, physicians, medical institutions, and medical
associations] and [construction of a system for introducing
outpatient departments that provide smoking cessation
treatment]. From the above, we understood that collaboration with professions other than dentistry on smoking
cessation efforts in dental clinics is presently inadequate,
and importance is attached to cooperation with medical
departments. Considering that the involvement of multiple
types of medical healthcare in tobacco control increases theeffectiveness of smoking cessation [25], the problems in thecurrent smoking cessation system are related to nurturing
dental healthcare personnel for the purpose of fulfilling thefunctions of the dental clinics, establishing collaboration

J. Natl. Inst. Public Health, 69 (1) : 2020

79TANO Rumi, MIURA Hiroko, AOYAMA Hitoshi, OZAKI Tetsunori, TAMAKI Yoh, YOKOYAMA Tetsuji
with medical departments that have an outpatient department that provides smoking cessation treatment, andexploring various comprehensive measures of implementation.
4. Limitation
This study has some limitations, such as the fact that thestatements on the current status and problems of dental
clinics were based on responses obtained at a recovery rateof 40%, so the situation in dental clinics that did not respond
could not be explored. In addition, there were no items in
the questionnaire on the motivation and consciousness ofdental healthcare personnel towards smoking cessation. As
such, the correlation of the current status with the subjective evaluation could not be included in the discussion. In
the future, it is necessary to encourage dental clinic managers to provide responses during the reply period taking
into consideration the timing, period, etc., in which they caneasily do so. The inclusion of a subjective evaluation in thesurvey items is a research issue.
This study aims at promoting a smoking cessation program targeting all patients receiving dental treatments,
regardless of the presence/absence of smoking habit, ages,
the purpose of their visit, the presence/absence of smoking
experience, or oral diseases. However, the subject of “allpatients” was somewhat too broad as a selection item in thequestionnaire survey we conducted in this study, which leftroom for a different interpretation. It should be mandatory
to define “all patients” more specifically in the future survey.
However, the actual status of smoking cessation efforts
in dental clinics was revealed in this study, and the fact thatknowledge that will contribute to the investigation of tobacco control based on interprofessional collaboration has beenobtained is of great significance.

coverage in the future.

Acknowledgment
The participation of the subjects in this study are greatly
appreciated and acknowledged.
This study was supported by the 8020 Research Grant
for fiscal 2018 from the 8020 Promotion Foundation. Adopted number: 18-6-18

Conflict of interests
The authors have stated explicitly that there are no conflicts of interest in connection with this article.

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80

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TANO Rumi, MIURA Hiroko, AOYAMA Hitoshi, OZAKI Tetsunori, TAMAKI Yoh, YOKOYAMA Tetsuji＜資料＞
日本の歯科医療機関における禁煙支援に関する現状と課題―多職種連携に基づくたばこ対策―

田野ルミ 1），三浦宏子 2），青山旬 3），尾﨑哲則 4），玉置洋 5），横山徹爾 1）1）

国立保健医療科学院生涯健康研究部

2）

国立保健医療科学院国際協力研究部

3）

栃木県立衛生福祉大学校

4）

日本大学歯学部医療人間科学分野

5）

国立保健医療科学院医療・福祉サービス研究部

抄録
日本の歯科医療機関で行われている禁煙支援の現状を把握し，多職種連携によるたばこ対策を推進
するうえでの課題を検討することを目的とした．歯科医師会のホームページ上で禁煙支援を行っていることを公開している歯科医療機関の院長を対象に，禁煙支援に関する質問票調査を，無記名，郵送法で2018年10月から同年11月に実施した． 1,020歯科医療機関への発送に対して返送のあった406施設（回収率40.0％）のうち，有効回答である400施設分を解析対象とした．分析は，基礎集計，連携の有無別にみた二変量解析および多変量解析を行い，有意水準は 5 ％未満とした．回答者の69.5％は歯科医師としての就業が30年以上であり，64.8％の施設において就業者数が 5 名以下だった．91.5％が現在の喫煙状況を把握し，69.8％が歯周病等の治療を目的に受診した患者を禁煙支援の対象としていた．
1回の診療時，患者 1 名あたり禁煙支援に平均 5 分以上かけている施設が62.0％で，93.5％が喫煙と歯科口腔領域との関連を主眼とした支援をしていた．禁煙支援を実施するうえで問題があると回答した施設が46.3％で，その内容で最も多かったのは「禁煙支援が診療報酬に算定されない」で67.0％を占めた．一方で，禁煙支援に関する学習を特にしていない施設が30.8％であり，禁煙支援の実施に問題があると回答した施設の34.6％が「禁煙支援のスキルが不十分」をあげた．歯科以外と連携をして禁煙支援を実施している施設は11.8％にとどまり，そのうち91.5％が禁煙外来との連携をもち，医師と協働で行っていた．多職種連携に基づく禁煙支援に影響を与える要因は，主な支援内容の「具体的な支援方法」，把握事項の「累積喫煙本数の算出」，対象患者が「禁煙中」だった（p <0.01）．禁煙支援を実施している歯科医療機関の院長は就業年数が長く，主に現在の喫煙状況を踏まえ，歯科疾患や歯科口腔領域と喫煙との関連に着目した禁煙支援を，患者 1 名あたり 5 分以上かけて行っていた．歯科以外と連携をして禁煙支援を行っている施設は少なく，今後は禁煙支援に関する技能向上のための修学の促進と，歯科におけるたばこ対策の制度の拡充に向けたエビデンスの構築が必要である．
キーワード：歯科医療機関，禁煙支援，内容分析，多職種連携

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J. Natl. Inst. Public Health, 69 (1) : 2020