School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK.
School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.
BMC Public Health. 2024 Aug 8;24(1):2156. doi: 10.1186/s12889-024-19360-6.
Smoking continues to be the single largest cause of preventable disease and death and a major contributor to health inequalities. Dental professionals are well placed to offer behavioural support in combination with pharmacotherapy to increase smoking cessation rates across the population. We aimed to assess the trends and socioeconomic inequalities in the dental attendance of adult smokers in Scotland from 2009 to 2019 and examine the potential population reach of dental settings for smoking cessation interventions.
A secondary analysis was conducted of combined Scottish Health Surveys (SHeS) from 2009/11, 2013/15 and 2017/19. 'Recent' dental attendance (within the past two years) was the focus and descriptive analysis examined attendance of self-reported smokers compared to non-smokers and stratified by the area-based Scottish Index of Multiple Deprivation (SIMD) and individual socioeconomic measures (income, education, and occupation). Generalised linear models were used to model recent attendance in non-smokers relative to smokers adjusted by the socioeconomic measures, for each of the survey cohorts separately. Absolute differences and risk ratios were calculated with 95% Confidence Intervals (CI).
Recent dental attendance was generally high and increased in both smokers (70-76%) and non-smokers (84-87%) from 2009/11 to 2017/19 and increased across all SIMD groups. After adjustment for sociodemographic variables, the adjusted Risk Difference (aRD) for recent attendance between non-smokers and smokers was 8.9% (95% CI 4.6%, 13.2%) by 2017/19. Within smokers, recent attendance was 7-9% lower in those living in the most deprived areas compared to those living in the least deprived areas over the three surveys.
SHeS data from 2009 to 2019 demonstrated that a high and increasing proportion of smokers in the population attend the dentist, albeit slightly less frequently than non-smokers. There were large inequalities in the dental attendance of smokers, to a lesser extent in non-smokers, and these persisted over time. Dental settings provide a good potential opportunity to deliver population-level smoking cessation interventions, but smokers in the most deprived groups and older age groups may be harder to reach. Consideration should be given to ensure that these groups are given appropriate proportionate support to take up preventive interventions.
吸烟仍然是可预防疾病和死亡的最大单一原因，也是导致健康不平等的主要因素。牙科专业人员非常适合提供行为支持，结合药物治疗，以提高整个人群的戒烟率。我们旨在评估 2009 年至 2019 年苏格兰成年吸烟者的牙科就诊趋势和社会经济不平等，并研究牙科环境在戒烟干预方面的潜在人群覆盖范围。
对 2009/11、2013/15 和 2017/19 年苏格兰健康调查（SHeS）进行二次分析。“近期”牙科就诊（在过去两年内）是重点，描述性分析比较了自我报告的吸烟者与非吸烟者的就诊情况，并按基于地区的苏格兰多重剥夺指数（SIMD）和个体社会经济措施（收入、教育和职业）进行分层。分别使用广义线性模型对每个调查队列中调整社会经济措施后的非吸烟者相对于吸烟者的近期就诊情况进行建模。计算绝对差异和风险比，并计算 95%置信区间（CI）。
近期牙科就诊率总体较高，吸烟者（70-76%）和非吸烟者（84-87%）均从 2009/11 年至 2017/19 年增加，并在所有 SIMD 组中增加。调整社会人口统计学变量后，2017/19 年非吸烟者和吸烟者之间近期就诊的调整风险差异（aRD）为 8.9%（95%CI 4.6%，13.2%）。在吸烟者中，与生活在最贫困地区的人相比，生活在最贫困地区的人近期就诊率低 7-9%，这在三次调查中均如此。
2009 年至 2019 年的 SHeS 数据表明，尽管吸烟人群中定期看牙医的比例略低于不吸烟者，但定期看牙医的比例较高且呈上升趋势。吸烟者的牙科就诊率存在较大不平等，不吸烟者的不平等程度较小，但这种情况随着时间的推移而持续存在。牙科环境为提供人群层面的戒烟干预提供了一个很好的潜在机会，但最贫困群体和年龄较大的吸烟者可能更难接触到。应考虑确保为这些群体提供适当的比例支持，以接受预防干预。
