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  • 1. I. Section/SIG Name: Community and Preventive Dentistry II. Councilor/Chair (SIG only) Contact Information Dr. Vladimir Spolsky, DMD, MPH Associate Professor Public Health and Community Dentistry UCLA School of Dentistry Phone: 310-825-9238 Fax: 310-206-2688 Email: III. 2007-2008 Section/SIG Activities Describe section/SIG activities and projects during the past year. Take this opportunity to highlight innovative activities and projects. Note projects with a national scope and/or collaborative work with other sections, organizations, and institutions. A. List the Section/SIG activities: • Newsletter (either electronic or print): yes/no o Frequency: • Community of Interest: established or on-going • Project Pool Submission: yes/no • Project Pool Submission funded: yes/no o If yes: Title: • Meetings/programs: o Regional: yes/no  Collaboration with: o National: yes/no  Collaboration with: o ADEA Annual Session  Collaboration with: Co-sponsored by Section on Pediatric Dentistry. B. What reflects the best example of your Section/SIG activities? During the last few years, the Section on Community and Preventive Dentistry has had an outstanding success at the association and national levels through: 1) successful annual programs, 2) corporate sponsorship of annual programs, 3) success with Pool Project funding, and 4) Inter-disciplinary collaboration with other health professions through the Taskforce or the Association of Teachers of Preventive Medicine (ATPM). A summary of Section’s impact and achievements:
  • 2. Until now, the section has sponsored/co-sponsored three projects that received funding from Project Pool Funds • Current Status of Dental Public Health Faculty in the U.S. Dental Schools • Soft Drinks and Dental health: Development of an Educational Material • Development of a Smoking Cessation Training Program in a Dental School Settings (A summary of this project can be found at the end of this report) The first project resulted in two peer-reviewed publications in the Journal of Public Health Dentistry and about 5 poster presentations at the meetings of the American Dental Education Association and National Oral health Conference. The second project resulted in an outstanding DVD which was shown to the Council of Sections during 2006 annual meeting in Orlando The section’s collaborative work with the other health professions through the Association of Teachers of Preventive Medicine (ATPM), continue to bring national visibility to the section as well as the ADEA. The collaborative work has so far resulted in a symposium at the AADR/ADEA meeting in Baltimore (2005) and Round Table Luncheon Discussions at the National Oral Health Conference (2004, 2005 and 2006). Additional information about this collaborative work is available from the following published articles and the ADEA website: • • Allan J, et al. Clinical Prevention and Population Health: Curriculum Framework for Health Professions. American Journal of Preventive Medicine 2004; 27(5): 471-6. • Riegelman RK, et al. Why a clinical Prevention and Population Health Curriculum Framework? American Journal of Preventive Medicine 2004; 27(5): 477. • Carmona RH. Healthy People Curriculum Taskforce: A Commentary by the Surgeon general. American Journal of Preventive Medicine 2004; 27(5): 478-9. • Carey TS, Roper WL. Clinical Prevention and Population Health: Getting There from Here American Journal of Preventive Medicine 2004; 27(5): 480-1. The 2007 ADEA House of Delegates endorsed this project. IV. Membership and Attendance Access the section membership list and reference the “Members’ Forum Attendance Roster” provided in the section/SIG information packet to report the following: A. Total membership for the section as of March 2008: B. Total attendance at the section’s 2008 Members’ Forum: 33 -2-
  • 3. V. Section Structure (submitted separately) A. List current contact information for the Section/SIG officer. B. Describe section structure—other than the four officers—if one exists. Provide information about regional, national, and international networks. If deemed appropriate: list additional contact information for reference. The immediate past chair will serve as a mentor to the newly elected secretary. VI. Financial Status Each year prior to the Annual Session, ADEA compiles a list of all corporations, organizations, and foundations that support ADEA activities and programs for publication in the House of Delegates Manual. This compilation is the basis for honoring these sponsors at the Annual Session. This information related to section activities is gathered from your section annual report. If the section receives no external financial support, note “N/A.” Include the following information: A. Current Section Balance: B. Organizations (and contact persons) providing financial support for section activities: Kerry Maguire, DDS, MSPH Director, Professional Advocacy Tom’s of Maine 302 Lafayette Center Kennebunk, ME 04043 C. Purpose of the support (program, reception, newsletter, etc.), number of participants and recipients, and other details: Refreshments and snacks during Members’ Forum. D. The type of funding: donation or gifts-in-kind, and amount of funding. The section received a donation of Eight Hundred Dollars. VII. Meeting Minutes (copy/paste Word document into the field) American Dental Education Association Annual Meeting Community and Preventive Dentistry Section Dallas, Texas 75207 Business Meeting Minutes March 31, 2008 Call to Order -3-
  • 4. The annual meeting of the Community and Preventive Dentistry section was called to order the section chair, Christine Miller. The chair asked the section officers to introduce themselves. Likewise, she asked the members to introduce themselves and give a brief description of the activities in which they are involved. In Attendance Christine Miller Douglas M. Simmons Douglas S. Ramsay Mike Plankett Donna Warren-Morris Donna Grant-Mills Sue Humphrey Irene Bober-Moken Kerry Maguire Vladimir Spolsky Christine Hrynorenk Sena Narendran Jane M Steffensen Approval of Minutes The minutes from last year’s section meeting was read by the secretary and approved. Councilor Report Vladimir Spolsky presented the councilor’s report and stated that the Section on Community and Preventive Dentistry had another successful year. Med Portal The members engaged in a discussion about a new ADEA initiative, which will allow its members to publish through AAMC’s med portal. Several members presented ideas about how the section can use this resource. Election The chair conducted an election for the position of section secretary. Jane Steffensen was unanimously elected as the next secretary. In keeping with section policy, the current chair-elect ascended to the position of chair and the secretary ascended to the position of chair-elect. As a result, Sena Narendran became section chair and Douglas Simmons became section chair-elect. Dr. Vladmir Spolsky will continue as councilor since his term is not completed. Old Business Sena Narendran gave a report about previous awards to section from the Project Pool funds. We are currently waiting for a final report from the “Smoking Cessation Training Programs in Dental Schools” project. New Business -4-
  • 5. Prof. Christine Miller recommended that the immediate past chair serve as a mentor for the incoming secretary. Toward that end, she volunteered to mentor Jane Steffensen about the duties of the section secretary. Christine Miller also volunteered to restart the section’s newsletter. Sena Narendran recalled a time when the section officers would meet for breakfast after our annual meeting to begin planning for the next year’s meeting. As a follow-up to his musing, the section officers agreed to meet for breakfast Wednesday, May 2, 2008 at 8:45 am. The section adopted a policy that the chair-elect will be responsible for organizing the section program and the chair will be responsible for conducting the business meeting. In addition, the chair will be responsible for submitting the section’s reports. Adjournment The meeting was adjourned until the next annual meeting of ADEA. Minutes submitted by: Douglas M. Simmons VIII. Additional Comments or Suggestions to the Administrative Board Provide feedback to the COS Admin Board about section concerns, comments, or suggestions. - We would like to thank the Council of Section liaison (Dr. Michael Landers) for attending the section business meeting in Dallas. It was refreshing to have the liaison at the meeting after a gap of 2-3 years. - The previous version of the annual report template was user-friendlier than the current one; perhaps it’s better to eliminate the lines in the template. - It’s not appropriate to compute the mean/average for the first item on the evaluation form, as the item is not on a Likert scale. - It may be redundant to have the officers’ list in the annual report as it is already available on the section website; having said that the officers’ list has not yet been updated on the ADEA website. - The section should be free to decide as to who is responsible for the annual report and as a matter of fact the officer update form has a question to that effect. - The evaluation of the 2008 Members’ Forum by the participants was in general better than that of the overall meeting. - We would appreciate to have the deadline for the annual report to be on a working day and not during the weekend, as it used to be in the past. - Final report of the recently completed Project Pool Project sponsored by the Section on Community and Preventive Dentistry: Submitted by the Principal Investigator, Brenda Heaton “I. Introduction The need for dental professionals to take a more active role in translating the relationship between oral diseases and systemic conditions into clinical practice was identified through -5-
  • 6. survey results published in the Journal of the American Dental Association [2005]. In particular, the study identified the role of dentists in promoting smoking cessation among their patients thereby promoting not only the overall health of their patients but also improving the health of the general public. However, according to the survey, more than half of the general dentists viewed smoking-cessation activities as peripheral to dentistry—a view likely barring them from performing such activities[1]. It is likely that this peripheral view is associated with the lack of smoking cessation curriculum that dentists experience during their formal education despite the fact that smokers are at higher risk for a number of oral problems including oral cancer, periodontal diseases, halitosis, tooth discoloration, and oral mucosal lesions not to mention the significant tolls on overall health and decrease in the quality and duration of life. The goal of this project was to assess what smoking cessation curriculum and training, if any, existed here at Boston University Goldman School of Dental Medicine and what students’ knowledge, attitudes and practices were with respect to their role in providing smoking cessation counseling. As a result, we were hoping to develop and test a curriculum plan infused with smoking cessation education. After a year since funding, the student surveys and curriculum evaluation have been completed and analyzed while curriculum development and testing is still forthcoming. The short term outcomes include a report of the knowledge, attitudes, and behaviors of dental students and faculty members and a unified and improved mechanism for providing smoking cessation training in dental schools. II. Project Implementation a. Student Survey The survey used for the Prevention and Cessation Education [PACE] program was modified to address the experiences and role of dental health professionals in fall of 2006. The modified survey was reviewed by Dr. Michelle Henshaw and Dr. Judith Jones, to ensure its appropriateness and completeness before being administered to the dental student body. The survey was administered to the entire dental student body, years 1 though 4, as opposed to what was outlined in the original proposal which identified only 2nd and 4th year students. This was done in order to provide an internal comparison group and also provided us with a “baseline” measure through the inclusion of first year students in their first semester of the dental school curriculum. Surveys were administered in courses which encouraged attendance or where attendance was mandatory. In all, 362 students completed the survey which was comprised of 109 first years, 61 second years, 88 third years and 104 fourth years. Survey administration was completed between October of 2006 and March of 2007 with an overall response rate of 79%. Data entry and cleaning was completed by a dental assistant and conducted over several months. b. Curriculum Evaluation In order to promote cooperation among the faculty, an email was sent out by the Associate Dean of Academic Affairs, Dr. Jeffrey Hutter, which identified the project director (Brenda Heaton), the purpose of the project and provided encouragement for completing the curriculum evaluation. Course directors were asked to provide the amount of time (in minutes) that is spent on tobacco related content within each of the different teaching categories such as didactic, skills training, applied skills, etc. They were further asked to identify the tobacco content, what materials and handouts, if any, were used and lastly whether or not the tobacco content -6-
  • 7. delivered in their course was evaluated via a test, exam or observation. Course directors were contacted via email from Dean Hutter three different times and also received follow-up telephone calls conducted by the Project Director as well as an Administrative Assistant. Recruitment of faculty participants occurred over a matter of about three months. In the end, only 29 of 44 or 66% of course directors participated. Given the nature of the courses directed by the non-responding faculty, it can be assumed that little, if any, tobacco content is included in those courses. c. Faculty survey The purpose of the faculty survey was to identify areas in which the institution may or may not be poised for curricular change. The faculty survey was completed by Dr. Judith Jones, Professor and Chair of General Dentistry and by the Associate Dean of Academic Affairs at the time, Dr. Jeffrey Hutter. III. Project Findings a. Student Survey In all, 362 students across all four dental school years completed surveys. The overall response rate, based on an expected class size of 115, was 79%. The mean age of all respondent was 25.65 years. Approximately half of the students in all classes were female. Among all respondents, 53% intended to enter into General Practice, 16% intended to go on to do a specialty and 29% indicated that they were not sure. Those intending to enter General Practice increased from 38% among the first year students to 69% among the fourth years, from 15% to 22% for Specialty and 32% to 8% for those that were not sure. On average, males were twice as likely to intend on entering a specialty. Thirty percent of students reported having a smoking habit at some time in their lives while 70% reported having never smoked a cigarette. Courses The overwhelming majority of students reported having never been taught to do tobacco counseling in case-based discussion, simulated patient encounters, clinical skills course, nor web-based education exercises. Fourth year students reported more experience in general, but over half of the students still reported having never been taught in all of the above settings. The large majority (81%) also report that faculty has not instructed them on how to make a referral for smoking. However, the large majority of students report that they are interested in learning more about the health effects of tobacco, receiving tobacco cessation training and information on nicotine replacement therapy. Knowledge Overall, there was a minimal to moderate level of knowledge among students and this did not generally differ significantly across class year. Only 36% of students across all classes knew that smoking rates had decreased slightly since the 1990’s and 41% knew what percentage of smokers were seen by a dentist annually. Approximately one-third of students knew the health benefits of smoking cessation but 1st years were 30-68% more likely to identify the health benefits compared to other classes. Half of the students knew that Nicotine Replacement Therapy was twice as effective as cold turkey in terms of strategies for smoking cessation. Only 9% of students overall were able to identify the 5 A’s (ask, advise, assess, assist and arrange) from a group of choices but this differed significantly across grades; 9%, 2%, 26% and 8% for 1st through 4th years, respectively. Very few students were able to identify FDA and Public -7-
  • 8. Health Service-recommended treatments for smoking cessation from a group of choices. Of six appropriate choices, only 6% could identify all six, 6%, 12%, 23%, 39% and 14% for five, four, three, two and one of six, respectively. Attitudes In general, attitudes toward tobacco counseling did not differ significantly across class years. The large majority agreed that they were able to prevent some young patients from smoking, convince some patients to quit as well as to have an impact on smoking behaviors. Interestingly, however, 4th year students were the least likely to strongly agree with these statements. In contrast, fourth year students were twice as likely to agree or strongly agree that they could advise patients about the use of NRT compared to both 1st and 2nd years and 30% more likely than 3rd years. While they felt confident in their ability, they did not display the knowledge necessary to do so. There were negligible differences by student year in confidence levels for discussing smoking with children, adolescents, and their parents and in general and about half of the students tended to agree that they were capable and confident in doing so. Skills With regard to implementing the 5 A’s into practice, the majority of students reported poor skill levels as indicated in Table 1 (attached). Interesting to note is that 4th years reported significantly lower skill for ‘Advising’ and ‘Assessing’ than any other class year. Observation Rates for observation of smoking cessation activities conducted by a dentist were relatively low (see Table 2, attached). Large percentages of students have never seen a dentist take a smoking history or discuss smoking with his/her patient. Even more surprising is that there was still approximately half of the fourth years who reported never having seen a dentist counsel a child about smoking prevention, give tobacco counseling to a pregnant woman nor talk with a parent about environmental tobacco smoke. A remaining third of the fourth year class also reported having never seen a dentist take a smoking history and a quarter of them never observing a dentist counsel patients to quit smoking. Instruction Students were asked to recall if they had been taught a variety of tobacco counseling skills at least 4 times during their dental school experience. Fourth year students were three times as likely to have been instructed to take a patient’s smoking history than any other class year. However, 23% of them still reported having never been instructed to do so. Approximately half of the students reported having never been instructed to counsel a patient to quit smoking. Experience with this, however, did increase according to class year and 57% of fourth years reported having at least some instruction in regards to cessation counseling. The majority of students also reported having no instruction related to counseling children about smoking prevention, talking with patients about smoking in pregnancy and talking with a parent about environmental tobacco smoke. The overwhelming majority of students reported that they had not been taught to counsel a smoking parent at a pediatric appointment, how to use the 5A’s, how to appropriately prescribe -8-
  • 9. nicotine replacement therapy, how to assess nicotine dependence in children, how to employ culturally competent strategies and how to include family members when they are talking about smoking and this did not deviate significantly across class years. b. Curriculum Evaluation From participating course directors, a total of 495 minutes, 8.25 hours of tobacco related content was reported to be included across the four year curriculum. Courses which included tobacco related content included Molecular Genetics, Pathology, Professional Ethics, Oral Diagnosis and Radiology, Preventive Dentistry, Behavioral Sciences, Preclinical Occlusion, and Pharmacology. Preventive Dentistry and Oral Pathology logged the most minutes of time dedicated to tobacco, but only Preventive Dentistry covered topics related to smoking cessation. All but Pharmacology and Oral Pathology, which are taught in the third year, are taught in the first two years of the dental school curriculum, prior to a student engaging in any patient clinical activities. No tobacco content was reported in the fourth year. Most all tobacco content was delivered via power point slides and on occasion evaluated through exams. In the 120 minutes spent in Oral Pathology, the course director reported that during clinical consultations with students, they may require a tobacco consult, but the majority of students will not experience this. c. Faculty Survey The faculty survey revealed that topics related to smoking cessation have not yet been included in competencies nor expected skills to be learned during clinical rotations. However, faculty responses indicate favorable attitudes towards implementing change into the curriculum. Additional work on identifying barriers to implementing change is forthcoming with other school authorities. IV. Challenges Project implementation encountered several challenges in each of the phases outlined below. a. Student Survey For both second and fourth year students, because of the nature of their curriculum schedule, it was difficult to identify an ideal opportunity for surveying the entire class. Therefore, participation suffered in both of these class years. Additionally, in both second and fourth year groups, “Advanced Standing” students were present in the classroom being surveyed and their responses were therefore included with no way to separate them out. This was not originally anticipated and therefore, responses from both advanced standing students and traditional pre- doctoral students are included in the findings. b. Curriculum Evaluation A detailed explanation of the expectations of the course director when completing the evaluation was included in the emailed letter from the Associate Dean of Academic Affairs. However, course directors rarely adhered to the items requested of them and thus resulted in a lot of missing information in terms of the details of tobacco related content. Additionally, as mentioned before, it was very difficult to get the faculty participation despite the Dean’s -9-
  • 10. overwhelming support of the project. Data collection for this portion of the project also therefore took much longer and required more man power then originally anticipated. c. Curriculum Development It was anticipated that upon preliminary findings, which were just completed in Fall of 2007, that a meeting would be held with the curriculum committee and other key stake holders to discuss opportunity for improvement and to begin to discuss approaches to curriculum development and implementation. Despite the fact the BUGSDM does have a curriculum committee, it has not held a meeting in the last year and one half and therefore a venue for this discussion has not been available. As a result, the additional phases outlined in the original proposal have been momentarily stalled. V. Next steps Data analysis exploring predictors of student attitudes, knowledge and other correlations will continue to be conducted. Data from the Boston University School of Medicine will be used to provide a comparison and included in the final report of the student survey results which will be presented to the Dean. It is my understanding that the curriculum committee will be meeting before the end of the next quarter and I hope to have a presence at that meeting to begin the next phase of this project. VI. Conclusion In recent years, there has been a growing awareness that healthcare professionals, particularly dental care providers, have the unique ability and responsibility to reach out to the American public in an attempt to curb smoking and its devastating effects. In order for dentists to provide optimal smoking cessation counseling to patients, it is crucial to develop an appropriate curricular approach during pre-doctoral training.” - 10 -