The feasibility and efficacy of tobacco use prevention in orthodontics.

SMILES PLUS was the first study to extend the clinician-delivered logic model to prevention of tobacco use among adolescents. This multi-site trial with 154 participating offices, based on social learning theory and a behavioral ecological model, was designed to test whether orthodontists can prevent preteens from initiating smoking. The study found that orthodontists do not automatically adhere to anti-tobacco prevention services. Social learning variables can enhance both adherence to counseling guidelines and content of counseling to increase prevention effects. Providing financial incentives, tracking prescriptions, prompting positive feedback from patients, and adopting anti-tobacco counseling models in the office are likely to enhance anti-tobacco preventive services. Training orthodontists to be comfortable when advising nonsmoking youth not to start and to use social consequences to justify youth avoidance of tobacco might increase adherence to protocols and make their counseling more powerful. Adolescent smokers prior to intervention were more likely to start other risky behaviors later. Preventing tobacco use may halt additional risk behaviors and thereby reduce morbidity/mortality even more than expected from tobacco control alone. New and refined clinical trials should be conducted to determine the most effective interventions for adolescent tobacco control by clinicians.