Table 2

Themes identified in interviews with 11 North Carolina general dentists, corresponding to national guidelines and policies on tobacco cessation implementation in health care

Guideline 1: Implement a tobacco user identification system in every clinic.
 1. Dental practices have systems to identify tobacco usersTobacco use was asked at every recare appointment but was not conceptualized or talked about as a vital sign.
Subtheme: Patient questionnaires identified tobacco users at each visit.
 2. Inconsistent smoke-free workforceWe have staff who smoke.
We have no staff who smoke.
 3. Considering ENDS products (electronic cigarettes)There was interest (and some implementation) of inclusion of ENDS products in tobacco use identification systems.
Guideline 2: Provide education, resources, and feedback to promote provider intervention.
 4. Lack of tobacco cessation training opportunities for staffWhile continuing education included oral pathology relating to tobacco use, there was none reported relating to tobacco cessation.
 5. Consistent presence of self-help materialsPamphlets and brochures were available.
 6. Limited use of QuitlineNo dentists reported using the fax-to-quit service of the Quitline;
Quitline referrals were present but not consistent across practices.
 7. Smoking cessation is a primary care provider’s jobDentists and their staff consistently reported encouraging patients interested in quitting to speak with their primary care provider.
Subtheme: Not comfortable prescribing smoking cessation medications/pharmacotherapy.
Guideline 3: Dedicate staff to provide tobacco dependence treatment and assess the delivery of this treatment in staff performance evaluations.
 8. “I guess that’s me”Dentists described themselves as having ultimate responsibility for these activities and did not have a designated point person.
 9. Consistently smoke-free indoorsConsistent reporting of no tobacco use inside the practice.
Subtheme: Vaping not always addressed in policies, but interest in updating policies.
 10. Inconsistently smoke-free groundsSmoking was inconsistently banned in outdoor areas of the practices.
5 As
 11. Consistent asking, assessing, and advisingDentists consistently asked, assessed, and advised their patients to quit using tobacco products.
 12. Limited assisting and arrangingLimited assistance and arranging were consistently reported by the dentists.