If the current trend in the use of tobacco products continues unabated, the next half-century will see almost 450 million tobacco-related deaths worldwide. Cigarette smoking was responsible for an estimated 400,000 annual deaths in the United States from 1997 through 2001.¹ During the same period, more than 38,000 additional deaths annually were attributed to secondhand tobacco smoke. To combat this major cause of mortality, all health professionals are encouraged to participate in the identification of tobacco users, provide patients with current information about the health hazards associated with the use of tobacco, develop tobacco-use prevention strategies and implement cessation-counseling practices.

As put forth by the U.S. Department of Health and Human Services, a major goal for the nation’s health policy is to reduce smoking among adolescents to less than 16 percent and among adults to 12 percent by 2010.² Unless significant changes take place within the next five years, we will fall terribly short of these targets.

The most recent surveys of students (from 2004) indicate that 11.7 percent of middle school students (grades 6–8) and 28 percent of high school students (grades 9–12) reported having used one type of tobacco product within the preceding 30 days.³ Cigarettes were the tobacco product most commonly used by both groups, accounting for 8.1 percent of tobacco use among middle school students and 22.3 percent among high school students. Cigars were the tobacco product of choice among 5.2 percent of students in middle school, 12.8 percent in high school. More female than male students used cigarettes, while male students outnumbered female students in the use of cigars, smokeless tobacco and pipes. Unfortunately, no significant change in the use of tobacco products was noted when data from 2002 were compared with data from 2004.

These statistics are very worrisome, as most adults started their smoking habits as adolescents. Smoking among U.S. adults has declined from 24.7 percent of the population aged 18 years and older in 1997 to 23.2 percent in 2000, reaching 21.6 percent, or 45.4 million people, in 2003.⁴ The vast majority of current smokers indicate that they smoke every day. Looking at this trend, it is not likely that the goal of reaching 12 percent prevalence by 2010 will be accomplished.

Cigarette smoking among adults varies greatly across populations and subpopulations.⁴ The highest prevalence is found among American Indians/Alaska natives, among people whose highest educational degree is a General Educational Development diploma, among people aged 24 to 44 years and among adults living below the poverty level. In contrast, the lowest rates of current adult smokers are found among Asians and Hispanics, among people who have attained a graduate degree, among people older than 65 years of age and among adults living above the poverty level. These types of statistics are helpful when determining how limited resources are to be spent.

In this issue of The Journal, Hennrikus and colleagues⁵ examine the validity of using self-administered health history forms in dental offices to identify adolescent tobacco users. Several important findings were reported in this study.

In a telephone interview, slightly more than one-third of adolescents indicated that they had smoked tobacco in the previous 30 days, and a little more than one-half of these self-identified tobacco users reported themselves to be daily smokers. This was in stark contrast to the mere 12.9 percent who had indicated such behaviors on a health history form. Furthermore, only 8.9 percent of all subjects interviewed in the study indicated that an oral health care provider had talked to them about smoking. Unfortunately, this study suggests that tobacco use is underreported on health histories obtained in dental offices, and though the awareness of a patient’s tobacco use on the part of an oral health care provider led to advice about smoking, this occurred only infrequently.

In another study published in this issue of The Journal, Kunzel and colleagues⁶ examined the ability and willingness of general practitioners to get involved with smoking-cessation practices. This study demonstrated a general self-reported lack of knowledge among general practitioners regarding how to provide in-office smoking-cessation guidelines and behavioral support. Furthermore, the subjects did not view smoking-cessation counseling as central to their role as health care providers. They indicated, too, that they did not feel their colleagues or patients expected them to get involved with this type of activity. In the same study, a similar trend of lack of mastery of knowledge and behavioral practices also was articulated in regard to involvement in screening and monitoring diabetic patients. On the basis of these findings, the authors expressed the need to "expand the bounds of dental practice."

Better methods of identifying patients who use tobacco products need to be recognized or developed, and more knowledge and behaviorally based education should be instituted.

Both of these articles address concerns in the utilization of oral health care providers in smoking-cessation practices. Better methods of identifying patients who use tobacco products need to be recognized or developed, and more knowledge and behaviorally based education should be instituted.

The deleterious effects of tobacco use on oral and overall health are well-known. Further-more, the confounding effect of smoking as an explanation of the relationship and association between periodontal disease and various systemic conditions is another point of major interest to health care providers. The impact of oral health on overall well-being is undeniable, and the impact of the oral health care provider on overall health no longer is conditional. Embracing smoking-cessation activities as part of unabridged oral health care no longer should be a choice.