Knowledge, attitude and practice about tobacco cessation among dental students: a single center study

Knowledge, attitude and practice about tobacco cessation among dental students: a single center study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Knowledge, attitude and practice about tobacco cessation among dental students: a single center study Rohit Agrawal, Mayur Mishra, Devanshu Chaudhary, Arpit Patel This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8102254/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Tobacco use remains a leading cause of preventable morbidity and mortality in India, responsible for approximately 1.35 million deaths annually. Dental professionals are in a strategic position to play a crucial role in tobacco cessation through patient counselling. This study aimed to assess the knowledge, attitude, and practice (KAP) regarding tobacco cessation counselling among dental students. Methods: A cross-sectional, online questionnaire-based survey was conducted among 198 dental students, including final-year undergraduates, interns, and postgraduates, at the Government Dental College and Hospital, Jamnagar, from December 2024 to January 2025. A pre-validated questionnaire assessed KAP domains. Data were analyzed using SPSS v20.0, with ANOVA and Tukey’s HSD tests to compare mean scores across groups. Results: Postgraduate students showed the highest mean scores in knowledge (9.1), attitude (4.91), and practice (5.00), followed by interns and final-year students, with statistically significant differences (p < 0.001). Participants cited behavioral management, communication, and time constraints as major challenges. Awareness of structured counselling models such as the 5A’s and 5R’s was limited. Conclusion: While dental students exhibited a positive attitude toward tobacco cessation, practical implementation was lacking. Incorporating structured cessation training into dental curricula and enhancing institutional cessation centers is essential to strengthen their role in tobacco control. Introduction Tobacco use remains one of the leading preventable causes of morbidity and mortality worldwide. India, being the second-largest consumer and producer of tobacco, accounts for nearly 1.35 million deaths annually, which translates to approximately 3,500 deaths per day. 1 To address this growing concern, the National Tobacco Control Programme (NTCP), under the Ministry of Health and Family Welfare, has prioritized the establishment of Tobacco Cessation Centres (TCCs) that provide free pharmacotherapy and counselling services at district hospitals. 2 Initiated during India’s 11th Five-Year Plan (2007–08), the NTCP focuses on enhancing tobacco awareness, enforcing the Cigarettes and Other Tobacco Products Act (COTPA), strengthening cessation support, and aligning national strategies with the World Health Organization Framework Convention on Tobacco Control (WHO-FCTC). 3 Furthermore, to curb the rising use of alternative nicotine delivery systems, the Prohibition of Electronic Cigarettes Act (PECA), 2019 bans the manufacture, trade, storage, and use of electronic nicotine delivery systems (ENDS) in India. Since its inception, the government has made notable progress through advocacy, ratification of the FCTC, and large-scale surveys such as the Global Youth Tobacco Survey (GYTS) and the Global Adult Tobacco Survey (GATS). 2 Despite the existence of various tobacco cessation programs in India, their reach remains limited, and a significant portion of the population continues to lack access to these services. This gap highlights the need for wider community-based and clinical interventions. Findings from GATS-2 (2016–17), conducted across 30 states and two Union Territories, revealed that approximately 52% of tobacco users were willing to quit. 4 However, the reach of evidence-based cessation support by healthcare professionals remains limited. Many users attempt to quit independently, often failing to maintain abstinence even for a month. Alarmingly, a small proportion of smokers (4.1%) switch to smokeless tobacco as a misguided cessation strategy, underscoring significant gaps in awareness and professional guidance. 1 Dentists, being among the first healthcare professionals to come in direct contact with individuals who use tobacco, are in a unique position to identify such users during routine dental examinations. This provides an excellent opportunity to initiate tobacco cessation counseling and motivate patients toward quitting. However, this potential can only be effectively utilized if dentists possess adequate knowledge, attitude, and skills related to tobacco cessation methods. Therefore, empowering dental professionals through proper training and awareness programs can play a crucial role in bridging the gap between tobacco use and cessation support, ultimately contributing to improved public health outcomes. Dental professionals are uniquely positioned to contribute to the prevention, early detection, and management of tobacco dependence. With the rapid expansion of dental institutions across India over the past two decades, curricula have evolved to reflect changing disease patterns and technological advancements. However, structured training in tobacco cessation remains inadequate, and dental students often lack sufficient exposure to counselling techniques and intervention strategies. Despite their potential to play a key role in patient education and behavioural modification, there is limited published research assessing the knowledge, attitudes, and practices (KAP) of dental students regarding tobacco cessation counselling, particularly in Gujarat. Understanding their preparedness is essential to design targeted educational interventions and to strengthen the role of dental professionals in India’s national tobacco control efforts. AIM To evaluate the knowledge, attitudes, and practices regarding tobacco cessation counselling among dental students. METHODOLOGY A cross-sectional, online questionnaire-based study was conducted over a period of one month (December 2024 – January 2025) at the Government Dental College and Hospital, Jamnagar. The ethical clearance (in accordance with the Declaration of Helsinki) for the study was obtained from the Internal Review Board (IRB)of the Institutional Ethics Committee of the Government Dental College and Hospital, Jamnagar. Inclusion Criteria Postgraduate students from 1st to 3rd year Final-year undergraduate students and interns Exclusion Criteria Students who did not provide consent or were unwilling to participate in the study Sampling Method and Data Collection A non-probability convenience sampling method was employed. Total 198 participants were recruited for the study. Data was collected using a pre-designed and pre-validated questionnaire which was distributed online. Participants were invited to take part in the study through a secure link. After providing digital (virtual) informed consent, each participant was asked to complete a self-administered online questionnaire, which was designed to assess the knowledge, attitude, and practice (KAP) of dental students regarding Tobacco Cessation Counselling (TCC). Questionnaire Design The questionnaire consisted of four main sections: Consent and Demographic details Knowledge domain Attitude domain Practice domain, followed by a few open-ended questions for qualitative input The demographic section included details such as year of study and gender and the consent. The knowledge domain comprised 10 questions measured on a five-point Likert scale and multiple choice questions (mcq) to assess students’ awareness of the harmful effects of tobacco, readiness for involvement in tobacco cessation counselling, and understanding of various cessation methods. Additionally, three close-ended multiple-choice questions were included to evaluate theoretical knowledge. The attitude domain used a five-point Likert scale to gauge the students’ willingness to participate in tobacco cessation activities. The practice domain focused on identifying gaps in implementing TCC and was assessed using an ordinal scale and mcq. The questionnaire concluded with two open-ended questions to capture additional suggestions and opinions from participants. Both open- and close-ended responses were incorporated. Most of the responses were recorded using Likert and Glickmann scales. Validity and Reliability of the Instrument The questionnaire was validated, and the examiners were trained and calibrated in the Department of Public Health Dentistry. A pilot study was conducted among 20 participants who met the inclusion and exclusion criteria to ensure clarity and feasibility of the instrument. For test–retest reliability, the same participants were asked to complete the questionnaire on two separate occasions to assess its reproducibility. The internal consistency of the questionnaire, measured using Cronbach’s alpha, was found to be excellent. Data Collection Procedure Data was collected online using Google Forms. Participants were provided with the investigators’ phone numbers and email IDs to clarify any doubts regarding the questionnaire or the study process. A trained clinician evaluated all the responses to ensure completeness and accuracy. STATISTICAL ANALYSIS : The collected data was initially entered and organized using Microsoft Excel for data cleaning and validation. Subsequently, the dataset was imported into the Statistical Package for the Social Sciences (SPSS) version 20.0 (IBM Corp., Armonk, NY, USA) for detailed statistical analysis. Descriptive statistics such as frequency, percentage, mean, and standard deviation were computed to summarize the data. Inferential statistical tests, including the Chi-square test and other relevant analyses, were applied to determine the association between variables. The level of statistical significance was set at p < 0.05 , indicating a 5% probability of error. Results This study comprised a total of 200 participants . Table 1 present the distribution of participants, while Table 1 also summarizes their responses to knowledge, attitude, and practice (KAP) questions. Knowledge As shown in Table 2, there was a statistically significant difference in mean knowledge scores among final-year students, interns, and postgraduate students (F = 965.1, p = 0.00001). Postgraduate students scored the highest (9.1 ± 0.1–0.9), followed by interns (8.4 ± 0.3–0.45), and final-year students (7.8 ± 0.5–0.7). Tukey’s HSD test confirmed significant pairwise differences among all groups (p < 0.001). Attitude As shown in Table 3, attitude scores also differed significantly among the groups (F = 35.91, p = 0.0001). The highest mean attitude score was observed among postgraduate students (4.91), followed by interns (4.36) and final-year students (3.48). Post-hoc analysis revealed significant differences between all group pairs (p < 0.001). Practice: As shown in Table 4, the mean practice scores varied significantly among the three groups (F = 40.975, p = 0.00001). Postgraduate students again demonstrated the highest score (5.00), followed by interns (4.72) and final-year students (4.30). Tukey’s HSD test indicated that all pairwise comparisons were statistically significant (p < 0.001). Overall, the findings reveal a progressive improvement in knowledge, attitude, and practice from final-year students to interns and postgraduates , highlighting the positive impact of higher education and clinical experience on professional competence. Discussion Globally, India is recognized for providing comprehensive coverage of tobacco cessation through its infrastructure and resources developed over the last two decades. Nevertheless, its current tobacco burden remains worrying due to an increase of approximately two million new initiators and 5.87% tobacco-related deaths annually. 5 The attention to tobacco cessation (TCs) has increased globally through WHO initiatives such as the Framework Convention on Tobacco Control (FCTC) and MPOWER. In India, the National Tobacco Control Programme (NTCP), the National and three Regional Quitlines, the mCessation program, along with several apex national institutes, professional dental bodies, and other stakeholders, have facilitated easier access to cessation support. However, the proportion of former users remains dismally low—below 2% at the population level. 6 The Government of India has taken the initiative to establish Tobacco Cessation Centers (TCCs) in every dental college across the country. 5 The ultimate goal of the Government of India is to reduce the morbidity and mortality associated with tobacco use. Guidelines have been provided for the functioning of TCCs within dental colleges, and it is the responsibility of every institution to increase awareness about TCC activities among staff members and dental students. 7 The present study assessed knowledge, attitude, and practice (KAP) regarding tobacco cessation among dental students, revealing statistically significant differences across groups. Postgraduate students demonstrated the highest mean knowledge (9.1 ± 0.1–0.9), attitude (4.91), and practice (5.00) scores, followed by interns (knowledge 8.4 ± 0.3–0.45; attitude 4.36; practice 4.72) and final-year students (knowledge 7.8 ± 0.5–0.7; attitude 3.48; practice 4.30), with all pairwise comparisons significant (p < 0.001) (Tables 2 – 4 ). These findings indicate a progressive improvement in KAP with higher education and clinical exposure. Despite this, final-year students and interns struggled with the 5A’s and 5R’s counseling model, while postgraduates showed lower confidence regarding pharmacotherapy. Undergraduates reported limited patient exposure, and participants identified behavioral management, communication, time management, and follow-up as the most challenging aspects of tobacco cessation counseling. Nevertheless, all groups displayed a positive attitude toward cessation, with postgraduates interested in pharmacotherapy and undergraduates keen to enhance behavioral and communication skills. Most participants were aware of the harmful effects of tobacco and familiar with basic cessation methods. However, awareness about specific approaches such as the 5A’s, 5R’s, 4D’s, and use of a smoke analyser was moderate to low across groups. Interns and PGs showed comparatively better knowledge than final-year students. Participants exhibited a positive attitude toward tobacco cessation, with most agreeing that it is the responsibility of dental professionals and an essential part of comprehensive dental care. Almost all participants agreed that stringent legislation should be implemented to prohibit public smoking, that media plays a significant role in promoting tobacco use, and that the size of warning labels on tobacco products should be increased. A considerable proportion believed that banning cigarette use in public places is an effective tobacco control measure. Furthermore, since many physicians lack adequate knowledge of smoking cessation strategies, nearly all respondents emphasized that smoking cessation education should be incorporated into the core curriculum of all health professional training programs. In practice, screening and counselling were commonly reported by all groups, though follow-up and referral practices were more frequent among interns and PGs. The mean number of patients counselled was highest among PGs, indicating greater practical exposure. Overall, while attitude was favorable, knowledge and practice require further strengthening through focused training and clinical application. These finding of knowledge, attitude and practise were in accordance with the study done by Sukhogi JR. 8 The same finding were found in the study done by Albert D in USA. 9 In response to open-ended questions, most participants reported that behavior management was the most challenging aspect of tobacco cessation counseling, followed by communication, time management, and patient follow-up. They expressed a strong interest in enhancing their skills in behavior management and communication, while postgraduate students were particularly keen on gaining more knowledge regarding pharmacotherapy and drug prescription. Dentists play a pivotal role in the early detection and prevention of tobacco-related diseases, as the oral cavity often exhibits the first signs of tobacco use. Possessing adequate knowledge of tobacco cessation is essential for dentists to effectively counsel patients, motivate behavioral change, and provide evidence-based interventions. Since dentists frequently interact with tobacco users during routine check-ups, they are in an ideal position to identify at-risk individuals and integrate cessation advice into dental practice. However, inadequate training and limited awareness of cessation strategies often restrict their contribution to tobacco control efforts. Therefore, strengthening dentists’ knowledge and skills in tobacco cessation is crucial for improving patient outcomes and reducing the overall burden of tobacco-related morbidity and mortality. A Tobacco cessation Center set up in a Dental College could be of great help in the primary prevention of oral cancer and can bring a drastic increase in quit rates. Proper counseling skills once nurtured in young under-graduates can boost the tobacco-free India campaign. 10 These results highlight the critical need to integrate structured tobacco cessation training into dental curricula, strengthen TCCs, and conduct regular workshops and continuing dental education programs focusing on counseling models, behavioral management, communication, and pharmacotherapy skills. ,11,12 Equipping dental professionals with adequate knowledge and practical skills in tobacco cessation is essential for improving patient outcomes and reducing the burden of tobacco-related morbidity and mortality in India Researchers have emphasized the need to introduce structured advice and training programs for healthcare professionals in tobacco cessation counselling. 9 , 10 However, it has also been observed that positive attitudes toward smoking cessation among experts do not always translate into effective clinical practice. This gap may be attributed to challenges in applying existing knowledge and converting positive intentions into routine practice. Further multi-institutional research is warranted to gain deeper insights into the organizational implementation of tobacco cessation interventions in India. In conclusion , empowering dental professionals with adequate knowledge and practical skills in tobacco cessation will significantly contribute to reducing tobacco-related morbidity and mortality and improving overall public health outcomes. Declarations Conflict of Interest: Nil Ethics approval and consent to participate: The ethical clearance (in accordance with the Declaration of Helsinki) for the study was obtained from the Internal Review Board (IRB)of the Institutional Ethics Committee of the Government Dental College and Hospital, Jamnagar. Informed written consent was obtained from the participants. Consent for publication: Not applicable. Availability of data and materials: The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Competing interests: None. The manuscript has been read and approved by all the authors, that the requirements for authorship as stated earlier in this document have been met, and that each author believes that the manuscript represents honest work. Funding: None Authors' contributions: 1. Dr. Rohit: Concept and design of study, interpretation of data; Drafting the article or revising it critically for important intellectual content; and Final approval of the version to be published. 2. Dr. Mayur: Design of study, Collection of data, interpretation of data; Drafting the article. 3. Dr. Devanshu: Design of study, Collection of data, interpretation of data. 4. Dr. Arpit: Drafting the article or revising it critically for important intellectual content; and Final approval of the version to be published Acknowledgements: None References World Health Organization. Tobacco – India [Internet]. Geneva: WHO21. Gupta R, Pednekar MS, Kumar R, Goel S. Tobacco cessation in India-Current status, challenges, barriers and solutions. Indian J Tuberc. 2021;68S:S80-S85. doi: 10.1016/j.ijtb.2021.08.027. Epub 2021 Aug 25. PMID: 34538397 Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India. National Tobacco Control Programme [Internet]. New Delhi: Government of India. Assessed on https://r.search.yahoo.com/_ylt=AwrKGJJ3l uxoQQIAUJy7HAx.;_ylu=Y29sbwNzZzME cG9zAzEEdnRpZAMEc2VjA3Ny/RV=2/RE= 1761545080/RO=10/RU=https%3a%2f%2 fwww.dghs.mohfw.gov.in%2f/RK=2/RS=Cw EnLC9OgguSKDtKQOUetCe3QuY- Goel S, Tripathy JP, Singh RJ, Lal P. Tobacco control policies in India: implementation and challenges. Indian J Public Health. 2013 Mohanty VR, Raghavendran G, Aruna DS. Role of dental institutions in tobacco cessation in India: current status and future prospects. Asian Pac J Cancer Prev. 2013;14(4). Gupta R, Aghi MB, Gupta A, Bhatt G, Goel S. Strategic Initiatives to Improve Tobacco Cessation Delivery in India. Indian J Community Med. 2022 Jul-Sep;47(3):328-331. doi: 10.4103/ijcm.ijcm_1399_21. Epub 2022 Oct 10. PMID: 36438508; PMCID: PMC9693939. Government of India. Establishment of Tobacco Cessation Centers in Dental Institutes – An integrated approach. (Operational guidelines 2018). Assessed on https://ntcp.mohfw.gov.in/assets/document/ Guideline-manuals/Operational%20Guidelines%20for %20Establishing%20Tobacco%20Cessation%20 Centres%20in%20Medical%20Institutions.pdf Patel R R.,Parikh H, Shah H, Vyas HH, 5.Dr. Amitkumar V. Patel, Patel VB. Knowledge of Tobacco Cessation Center establishment in Dental Colleges among postgraduate students and interns of Private Dental College of North Gujarat: a survey.Cuest.fisioter.2025.54(3):1056-1061 Sukhabogi JR, Chandrashekar BR, Kumar GS, Harita N. Assessment of knowledge, attitude, and practices and motivation to quit tobacco habits in relation to age and educational status among male tobacco users visiting a Government Dental College Hospital, India. Ind Psychiatry J. 2019 Jul-Dec;28(2):203-210 Albert D, Ward A, Ahluwalia K, et al. Addressing tobacco in managed care: a survey of dentists knowledge, attitudes, and behaviors. American Journal of Public Health. 2002;92(6):997-1001. Salman K, Azharuddin M, Ganesh R. Attitude of Dental Students Towards Tobacco Cessation Counselling in Various Dental Colleges in Tamil Nadu, India. Int J Sci Stud. 2014;2(4):20-4 Gupta, Swati; Srivastava, Nikhil1; Goel, Sumit; Kamarthi, Nagaraju; Malik, Sangeeta; Sharma, Abhinav; Bhalla, Khushboo. Tobacco cessation center in a dental college: An 8 year institution-based study. Journal of Cancer Research and Therapeutics 19(3):p 808-812, Apr–Jun 2023. | DOI: 10.4103/jcrt.jcrt_22_22 Pathak S, Shivalingesh KK, Mir H, Srivastava D, Saleem A, Kushwaha A. Knowledge, Attitude and Practice Regarding Tobacco Cessation Methods among the Dental Professionals of Bareilly International University: A Cross-sectional Study. Int Healthc Res J. 2021;5(8)OR1-OR6. Tables Tables are available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files TABLES.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8102254","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":591162073,"identity":"036732b5-9109-469f-b5c5-527003b43048","order_by":0,"name":"Rohit Agrawal","email":"","orcid":"","institution":"Government Dental College and Hospital Jamangar","correspondingAuthor":false,"prefix":"","firstName":"Rohit","middleName":"","lastName":"Agrawal","suffix":""},{"id":591162074,"identity":"149aeb66-c477-4eb8-86cb-d611186028ac","order_by":1,"name":"Mayur Mishra","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAzklEQVRIiWNgGAWjYBADOTb2BiBlYEG8FmM+ngMgLRLEa0mcJ5EAoonQott+xky6csc2xjbJ51c3/CiQYOBv707Aq8XsTI6Z5Nkzt5nZpHPKbvYAHSZx5uwG/FoOALU0tt1mA2pJu8ED1GIgkUtAy/k3YC08bJJn0m7+IUrLDYgtEmwS7MduE2fLjWfFlkAtBmw8OWy3ZQwkeAj75XzyxptALfXz248/u/nmj40cf3svfi0MDBwGUAYPmMFDQDkIsD9AZ4yCUTAKRsEoQAUA5mBGpvI/5WYAAAAASUVORK5CYII=","orcid":"","institution":"Government Dental College and Hospital Jamangar","correspondingAuthor":true,"prefix":"","firstName":"Mayur","middleName":"","lastName":"Mishra","suffix":""},{"id":591162075,"identity":"afd30f12-ac3d-46a0-980f-e55f7c6260f3","order_by":2,"name":"Devanshu Chaudhary","email":"","orcid":"","institution":"Government Dental College and Hospital Jamangar","correspondingAuthor":false,"prefix":"","firstName":"Devanshu","middleName":"","lastName":"Chaudhary","suffix":""},{"id":591162076,"identity":"42592391-d47c-4561-89b2-5dda895caf32","order_by":3,"name":"Arpit Patel","email":"","orcid":"","institution":"Government Dental College and Hospital Jamangar","correspondingAuthor":false,"prefix":"","firstName":"Arpit","middleName":"","lastName":"Patel","suffix":""}],"badges":[],"createdAt":"2025-11-13 06:38:32","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8102254/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8102254/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":103569004,"identity":"0dcdee5e-1b00-444f-9a08-631d88b3e7da","added_by":"auto","created_at":"2026-02-27 07:42:08","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":477090,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8102254/v1/7cd97679-ec40-4c8b-8fb4-10f0634a44ec.pdf"},{"id":102753173,"identity":"d91a5230-8ce6-4984-9eed-885b51799637","added_by":"auto","created_at":"2026-02-16 09:34:06","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":24557,"visible":true,"origin":"","legend":"","description":"","filename":"TABLES.docx","url":"https://assets-eu.researchsquare.com/files/rs-8102254/v1/170657b6a0cb1e8ad064641f.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eKnowledge, attitude and practice about tobacco cessation among dental students: a single center study\u003c/p\u003e","fulltext":[{"header":"Introduction","content":" \u003cp\u003eTobacco use remains one of the leading preventable causes of morbidity and mortality worldwide. India, being the second-largest consumer and producer of tobacco, accounts for nearly 1.35\u0026nbsp;million deaths annually, which translates to approximately 3,500 deaths per day.\u003csup\u003e1\u003c/sup\u003e To address this growing concern, the National Tobacco Control Programme (NTCP), under the Ministry of Health and Family Welfare, has prioritized the establishment of Tobacco Cessation Centres (TCCs) that provide free pharmacotherapy and counselling services at district hospitals.\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eInitiated during India\u0026rsquo;s 11th Five-Year Plan (2007\u0026ndash;08), the NTCP focuses on enhancing tobacco awareness, enforcing the Cigarettes and Other Tobacco Products Act (COTPA), strengthening cessation support, and aligning national strategies with the World Health Organization Framework Convention on Tobacco Control (WHO-FCTC).\u003csup\u003e3\u003c/sup\u003e Furthermore, to curb the rising use of alternative nicotine delivery systems, the Prohibition of Electronic Cigarettes Act (PECA), 2019 bans the manufacture, trade, storage, and use of electronic nicotine delivery systems (ENDS) in India. Since its inception, the government has made notable progress through advocacy, ratification of the FCTC, and large-scale surveys such as the Global Youth Tobacco Survey (GYTS) and the Global Adult Tobacco Survey (GATS).\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eDespite the existence of various tobacco cessation programs in India, their reach remains limited, and a significant portion of the population continues to lack access to these services. This gap highlights the need for wider community-based and clinical interventions. Findings from GATS-2 (2016\u0026ndash;17), conducted across 30 states and two Union Territories, revealed that approximately 52% of tobacco users were willing to quit.\u003csup\u003e4\u003c/sup\u003e However, the reach of evidence-based cessation support by healthcare professionals remains limited. Many users attempt to quit independently, often failing to maintain abstinence even for a month. Alarmingly, a small proportion of smokers (4.1%) switch to smokeless tobacco as a misguided cessation strategy, underscoring significant gaps in awareness and professional guidance.\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eDentists, being among the first healthcare professionals to come in direct contact with individuals who use tobacco, are in a unique position to identify such users during routine dental examinations. This provides an excellent opportunity to initiate tobacco cessation counseling and motivate patients toward quitting. However, this potential can only be effectively utilized if dentists possess adequate knowledge, attitude, and skills related to tobacco cessation methods. Therefore, empowering dental professionals through proper training and awareness programs can play a crucial role in bridging the gap between tobacco use and cessation support, ultimately contributing to improved public health outcomes.\u003c/p\u003e \u003cp\u003eDental professionals are uniquely positioned to contribute to the prevention, early detection, and management of tobacco dependence. With the rapid expansion of dental institutions across India over the past two decades, curricula have evolved to reflect changing disease patterns and technological advancements. However, structured training in tobacco cessation remains inadequate, and dental students often lack sufficient exposure to counselling techniques and intervention strategies. Despite their potential to play a key role in patient education and behavioural modification, there is limited published research assessing the knowledge, attitudes, and practices (KAP) of dental students regarding tobacco cessation counselling, particularly in Gujarat. Understanding their preparedness is essential to design targeted educational interventions and to strengthen the role of dental professionals in India\u0026rsquo;s national tobacco control efforts.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eAIM\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTo evaluate the knowledge, attitudes, and practices regarding tobacco cessation counselling among dental students.\u003c/p\u003e"},{"header":"METHODOLOGY ","content":"\u003cp\u003eA cross-sectional, online questionnaire-based study was conducted over a period of one month (December 2024 \u0026ndash; January 2025) at the Government Dental College and Hospital, Jamnagar. The ethical clearance (in accordance with the Declaration of Helsinki) for the study was obtained from the Internal Review Board (IRB)of the Institutional Ethics Committee of the Government Dental College and Hospital, Jamnagar.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eInclusion Criteria\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003ePostgraduate students from 1st to 3rd year\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eFinal-year undergraduate students and interns\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eExclusion Criteria\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eStudents who did not provide consent or were unwilling to participate in the study\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eSampling Method and Data Collection\u003c/p\u003e \u003cp\u003eA non-probability convenience sampling method was employed. Total 198 participants were recruited for the study. Data was collected using a pre-designed and pre-validated questionnaire which was distributed online. Participants were invited to take part in the study through a secure link.\u003c/p\u003e \u003cp\u003e After providing digital (virtual) informed consent, each participant was asked to complete a self-administered online questionnaire, which was designed to assess the knowledge, attitude, and practice (KAP) of dental students regarding Tobacco Cessation Counselling (TCC).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eQuestionnaire Design\u003c/p\u003e \u003cp\u003eThe questionnaire consisted of four main sections:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eConsent and Demographic details\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eKnowledge domain\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eAttitude domain\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003ePractice domain, followed by a few open-ended questions for qualitative input\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003eThe demographic section included details such as year of study and gender and the consent.\u003c/p\u003e \u003cp\u003eThe knowledge domain comprised 10 questions measured on a five-point Likert scale and multiple choice questions (mcq) to assess students\u0026rsquo; awareness of the harmful effects of tobacco, readiness for involvement in tobacco cessation counselling, and understanding of various cessation methods. Additionally, three close-ended multiple-choice questions were included to evaluate theoretical knowledge.\u003c/p\u003e \u003cp\u003e The attitude domain used a five-point Likert scale to gauge the students\u0026rsquo; willingness to participate in tobacco cessation activities. The practice domain focused on identifying gaps in implementing TCC and was assessed using an ordinal scale and mcq. The questionnaire concluded with two open-ended questions to capture additional suggestions and opinions from participants.\u003c/p\u003e \u003cp\u003eBoth open- and close-ended responses were incorporated. Most of the responses were recorded using Likert and Glickmann scales.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eValidity and Reliability of the Instrument\u003c/p\u003e \u003cp\u003eThe questionnaire was validated, and the examiners were trained and calibrated in the Department of Public Health Dentistry. A pilot study was conducted among 20 participants who met the inclusion and exclusion criteria to ensure clarity and feasibility of the instrument.\u003c/p\u003e \u003cp\u003eFor test\u0026ndash;retest reliability, the same participants were asked to complete the questionnaire on two separate occasions to assess its reproducibility. The internal consistency of the questionnaire, measured using Cronbach\u0026rsquo;s alpha, was found to be excellent.\u003c/p\u003e \u003cp\u003e Data Collection Procedure\u003c/p\u003e \u003cp\u003eData was collected online using Google Forms. Participants were provided with the investigators\u0026rsquo; phone numbers and email IDs to clarify any doubts regarding the questionnaire or the study process. A trained clinician evaluated all the responses to ensure completeness and accuracy.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eSTATISTICAL ANALYSIS\u003c/span\u003e:\u003c/h2\u003e \u003cp\u003eThe collected data was initially entered and organized using Microsoft Excel for data cleaning and validation. Subsequently, the dataset was imported into the Statistical Package for the Social Sciences (SPSS) version 20.0 (IBM Corp., Armonk, NY, USA) for detailed statistical analysis. Descriptive statistics such as frequency, percentage, mean, and standard deviation were computed to summarize the data. Inferential statistical tests, including the Chi-square test and other relevant analyses, were applied to determine the association between variables. The level of statistical significance was set at \u003cb\u003ep\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/b\u003e, indicating a 5% probability of error.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThis study comprised a total of \u003cstrong\u003e200 participants\u003c/strong\u003e. Table 1 present the distribution of participants, while Table 1 also summarizes their responses to knowledge, attitude, and practice (KAP) questions.\u003c/p\u003e\n\u003ch3\u003eKnowledge\u003c/h3\u003e\n\u003cp\u003eAs shown in Table 2, there was a statistically significant difference in mean knowledge scores among final-year students, interns, and postgraduate students (F\u0026thinsp;=\u0026thinsp;965.1, p\u0026thinsp;=\u0026thinsp;0.00001). Postgraduate students scored the highest (9.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.1\u0026ndash;0.9), followed by interns (8.4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3\u0026ndash;0.45), and final-year students (7.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5\u0026ndash;0.7). Tukey\u0026rsquo;s HSD test confirmed significant pairwise differences among all groups (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\n\u003ch3\u003eAttitude\u003c/h3\u003e\n\u003cp\u003eAs shown in Table 3, attitude scores also differed significantly among the groups (F\u0026thinsp;=\u0026thinsp;35.91, p\u0026thinsp;=\u0026thinsp;0.0001). The highest mean attitude score was observed among postgraduate students (4.91), followed by interns (4.36) and final-year students (3.48). Post-hoc analysis revealed significant differences between all group pairs (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\n\u003cdiv id=\"Sec8\"\u003e\n \u003ch2\u003ePractice:\u003c/h2\u003e\n \u003cp\u003eAs shown in Table 4, the mean practice scores varied significantly among the three groups (F\u0026thinsp;=\u0026thinsp;40.975, p\u0026thinsp;=\u0026thinsp;0.00001). Postgraduate students again demonstrated the highest score (5.00), followed by interns (4.72) and final-year students (4.30). Tukey\u0026rsquo;s HSD test indicated that all pairwise comparisons were statistically significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\n \u003cp\u003eOverall, the findings reveal a \u003cstrong\u003eprogressive improvement in knowledge, attitude, and practice from final-year students to interns and postgraduates\u003c/strong\u003e, highlighting the positive impact of higher education and clinical experience on professional competence.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eGlobally, India is recognized for providing comprehensive coverage of tobacco cessation through its infrastructure and resources developed over the last two decades. Nevertheless, its current tobacco burden remains worrying due to an increase of approximately two million new initiators and 5.87% tobacco-related deaths annually.\u003csup\u003e5\u003c/sup\u003e The attention to tobacco cessation (TCs) has increased globally through WHO initiatives such as the Framework Convention on Tobacco Control (FCTC) and MPOWER. In India, the National Tobacco Control Programme (NTCP), the National and three Regional Quitlines, the mCessation program, along with several apex national institutes, professional dental bodies, and other stakeholders, have facilitated easier access to cessation support. However, the proportion of former users remains dismally low\u0026mdash;below 2% at the population level.\u003csup\u003e6\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe Government of India has taken the initiative to establish Tobacco Cessation Centers (TCCs) in every dental college across the country.\u003csup\u003e5\u003c/sup\u003e The ultimate goal of the Government of India is to reduce the morbidity and mortality associated with tobacco use. Guidelines have been provided for the functioning of TCCs within dental colleges, and it is the responsibility of every institution to increase awareness about TCC activities among staff members and dental students.\u003csup\u003e7\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThe present study assessed knowledge, attitude, and practice (KAP) regarding tobacco cessation among dental students, revealing statistically significant differences across groups. Postgraduate students demonstrated the highest mean knowledge (9.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.1\u0026ndash;0.9), attitude (4.91), and practice (5.00) scores, followed by interns (knowledge 8.4\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3\u0026ndash;0.45; attitude 4.36; practice 4.72) and final-year students (knowledge 7.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.5\u0026ndash;0.7; attitude 3.48; practice 4.30), with all pairwise comparisons significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Tables\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). These findings indicate a progressive improvement in KAP with higher education and clinical exposure. Despite this, final-year students and interns struggled with the 5A\u0026rsquo;s and 5R\u0026rsquo;s counseling model, while postgraduates showed lower confidence regarding pharmacotherapy. Undergraduates reported limited patient exposure, and participants identified behavioral management, communication, time management, and follow-up as the most challenging aspects of tobacco cessation counseling. Nevertheless, all groups displayed a positive attitude toward cessation, with postgraduates interested in pharmacotherapy and undergraduates keen to enhance behavioral and communication skills.\u003c/p\u003e \u003cp\u003eMost participants were aware of the harmful effects of tobacco and familiar with basic cessation methods. However, awareness about specific approaches such as the 5A\u0026rsquo;s, 5R\u0026rsquo;s, 4D\u0026rsquo;s, and use of a smoke analyser was moderate to low across groups. Interns and PGs showed comparatively better knowledge than final-year students.\u003c/p\u003e \u003cp\u003e Participants exhibited a positive attitude toward tobacco cessation, with most agreeing that it is the responsibility of dental professionals and an essential part of comprehensive dental care. Almost all participants agreed that stringent legislation should be implemented to prohibit public smoking, that media plays a significant role in promoting tobacco use, and that the size of warning labels on tobacco products should be increased. A considerable proportion believed that banning cigarette use in public places is an effective tobacco control measure. Furthermore, since many physicians lack adequate knowledge of smoking cessation strategies, nearly all respondents emphasized that smoking cessation education should be incorporated into the core curriculum of all health professional training programs.\u003c/p\u003e \u003cp\u003eIn practice, screening and counselling were commonly reported by all groups, though follow-up and referral practices were more frequent among interns and PGs. The mean number of patients counselled was highest among PGs, indicating greater practical exposure. Overall, while attitude was favorable, knowledge and practice require further strengthening through focused training and clinical application. These finding of knowledge, attitude and practise were in accordance with the study done by Sukhogi JR. \u003csup\u003e8\u003c/sup\u003e The same finding were found in the study done by Albert D in USA.\u003csup\u003e9\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e In response to open-ended questions, most participants reported that behavior management was the most challenging aspect of tobacco cessation counseling, followed by communication, time management, and patient follow-up. They expressed a strong interest in enhancing their skills in behavior management and communication, while postgraduate students were particularly keen on gaining more knowledge regarding pharmacotherapy and drug prescription.\u003c/p\u003e \u003cp\u003eDentists play a pivotal role in the early detection and prevention of tobacco-related diseases, as the oral cavity often exhibits the first signs of tobacco use. Possessing adequate knowledge of tobacco cessation is essential for dentists to effectively counsel patients, motivate behavioral change, and provide evidence-based interventions. Since dentists frequently interact with tobacco users during routine check-ups, they are in an ideal position to identify at-risk individuals and integrate cessation advice into dental practice. However, inadequate training and limited awareness of cessation strategies often restrict their contribution to tobacco control efforts. Therefore, strengthening dentists\u0026rsquo; knowledge and skills in tobacco cessation is crucial for improving patient outcomes and reducing the overall burden of tobacco-related morbidity and mortality.\u003c/p\u003e \u003cp\u003eA Tobacco cessation Center set up in a Dental College could be of great help in the primary prevention of oral cancer and can bring a drastic increase in quit rates. Proper counseling skills once nurtured in young under-graduates can boost the tobacco-free India campaign.\u003csup\u003e10\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eThese results highlight the critical need to integrate structured tobacco cessation training into dental curricula, strengthen TCCs, and conduct regular workshops and continuing dental education programs focusing on counseling models, behavioral management, communication, and pharmacotherapy skills.\u003csup\u003e,11,12\u003c/sup\u003e Equipping dental professionals with adequate knowledge and practical skills in tobacco cessation is essential for improving patient outcomes and reducing the burden of tobacco-related morbidity and mortality in India\u003c/p\u003e \u003cp\u003eResearchers have emphasized the need to introduce structured advice and training programs for healthcare professionals in tobacco cessation counselling. \u003csup\u003e9\u003c/sup\u003e,\u003csup\u003e10\u003c/sup\u003e However, it has also been observed that positive attitudes toward smoking cessation among experts do not always translate into effective clinical practice. This gap may be attributed to challenges in applying existing knowledge and converting positive intentions into routine practice. Further multi-institutional research is warranted to gain deeper insights into the organizational implementation of tobacco cessation interventions in India.\u003c/p\u003e \u003cp\u003e \u003cb\u003eIn conclusion\u003c/b\u003e, empowering dental professionals with adequate knowledge and practical skills in tobacco cessation will significantly contribute to reducing tobacco-related morbidity and mortality and improving overall public health outcomes.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eConflict of Interest:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNil\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe ethical clearance (in accordance with the Declaration of Helsinki) for the study was obtained from the Internal Review Board (IRB)of the Institutional Ethics Committee of the Government Dental College and Hospital, Jamnagar. Informed written consent was obtained from the participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone. \u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eThe manuscript has been read and approved by all the authors, that the requirements for authorship as stated earlier in this document have been met, and that each author believes that the manuscript represents honest work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e1. \u0026nbsp; \u0026nbsp; \u0026nbsp;Dr. Rohit: Concept and design of study, interpretation of data; Drafting the article or revising it critically for important intellectual content; and Final approval of the version to be published.\u003c/p\u003e\n\u003cp\u003e2.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Dr. Mayur: Design of study, Collection of data, interpretation of data; Drafting the article.\u003c/p\u003e\n\u003cp\u003e3.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Dr. Devanshu: Design of study, Collection of data, interpretation of data.\u003c/p\u003e\n\u003cp\u003e4.\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Dr. Arpit: Drafting the article or revising it critically for important intellectual content; and Final approval of the version to be published\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWorld Health Organization. Tobacco \u0026ndash; India [Internet]. Geneva: WHO21. Gupta R, Pednekar MS, Kumar R, Goel S. Tobacco cessation in India-Current status, challenges, barriers and solutions. Indian J Tuberc. 2021;68S:S80-S85. doi: 10.1016/j.ijtb.2021.08.027. Epub 2021 Aug 25. PMID: 34538397\u003c/li\u003e\n\u003cli\u003eDirectorate General of Health Services, Ministry of Health \u0026amp;amp; Family Welfare, Government of India. National Tobacco Control Programme [Internet]. New Delhi: Government of India. Assessed on https://r.search.yahoo.com/_ylt=AwrKGJJ3l\nuxoQQIAUJy7HAx.;_ylu=Y29sbwNzZzME\ncG9zAzEEdnRpZAMEc2VjA3Ny/RV=2/RE=\n1761545080/RO=10/RU=https%3a%2f%2\nfwww.dghs.mohfw.gov.in%2f/RK=2/RS=Cw\nEnLC9OgguSKDtKQOUetCe3QuY-\u003c/li\u003e\n\u003cli\u003eGoel S, Tripathy JP, Singh RJ, Lal P. Tobacco control policies in India: implementation and challenges. Indian J Public Health. 2013\u003c/li\u003e\n\u003cli\u003eMohanty VR, Raghavendran G, Aruna DS. Role of dental institutions in tobacco cessation in India: current status and future prospects. Asian Pac J Cancer Prev. 2013;14(4).\u003c/li\u003e\n\u003cli\u003eGupta R, Aghi MB, Gupta A, Bhatt G, Goel S. Strategic Initiatives to Improve Tobacco Cessation Delivery in India. Indian J Community Med. 2022 Jul-Sep;47(3):328-331. doi: 10.4103/ijcm.ijcm_1399_21. Epub 2022 Oct 10. PMID: 36438508; PMCID: PMC9693939.\u003c/li\u003e\n\u003cli\u003eGovernment of India. Establishment of Tobacco Cessation Centers in Dental Institutes \u0026ndash; An integrated approach. (Operational guidelines 2018). Assessed on https://ntcp.mohfw.gov.in/assets/document/\nGuideline-manuals/Operational%20Guidelines%20for\n%20Establishing%20Tobacco%20Cessation%20\nCentres%20in%20Medical%20Institutions.pdf\u003c/li\u003e\n\u003cli\u003ePatel R R.,Parikh H, Shah H, Vyas HH, 5.Dr. Amitkumar V. Patel, Patel VB. Knowledge of Tobacco Cessation Center establishment in Dental Colleges among postgraduate students and interns of Private Dental College of North Gujarat: a survey.Cuest.fisioter.2025.54(3):1056-1061\u003c/li\u003e\n\u003cli\u003eSukhabogi JR, Chandrashekar BR, Kumar GS, Harita N. Assessment of knowledge, attitude, and practices and motivation to quit tobacco habits in relation to age and educational status among male tobacco users visiting a Government Dental College Hospital, India. Ind Psychiatry J. 2019 Jul-Dec;28(2):203-210\u003c/li\u003e\n\u003cli\u003eAlbert D, Ward A, Ahluwalia K, et al. Addressing tobacco in managed care: a survey of dentists knowledge, attitudes, and behaviors. American Journal of Public Health. 2002;92(6):997-1001.\u003c/li\u003e\n\u003cli\u003eSalman K, Azharuddin M, Ganesh R. Attitude of Dental Students Towards Tobacco Cessation Counselling in Various Dental Colleges in Tamil Nadu, India. Int J Sci Stud. 2014;2(4):20-4\u003c/li\u003e\n\u003cli\u003eGupta, Swati; Srivastava, Nikhil1; Goel, Sumit; Kamarthi, Nagaraju; Malik, Sangeeta; Sharma, Abhinav; Bhalla, Khushboo. Tobacco cessation center in a dental college: An 8 year institution-based study. Journal of Cancer Research and Therapeutics 19(3):p 808-812, Apr\u0026ndash;Jun 2023. | DOI: 10.4103/jcrt.jcrt_22_22\u003c/li\u003e\n\u003cli\u003ePathak S, Shivalingesh KK, Mir H, Srivastava D, Saleem A, Kushwaha A. Knowledge, Attitude and Practice Regarding Tobacco Cessation Methods among the Dental Professionals of Bareilly International University: A Cross-sectional Study. Int Healthc Res J. 2021;5(8)OR1-OR6.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-8102254/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8102254/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground:\u003c/h2\u003e \u003cp\u003eTobacco use remains a leading cause of preventable morbidity and mortality in India, responsible for approximately 1.35\u0026nbsp;million deaths annually. Dental professionals are in a strategic position to play a crucial role in tobacco cessation through patient counselling. This study aimed to assess the knowledge, attitude, and practice (KAP) regarding tobacco cessation counselling among dental students.\u003c/p\u003e\u003ch2\u003eMethods:\u003c/h2\u003e \u003cp\u003eA cross-sectional, online questionnaire-based survey was conducted among 198 dental students, including final-year undergraduates, interns, and postgraduates, at the Government Dental College and Hospital, Jamnagar, from December 2024 to January 2025. A pre-validated questionnaire assessed KAP domains. Data were analyzed using SPSS v20.0, with ANOVA and Tukey\u0026rsquo;s HSD tests to compare mean scores across groups.\u003c/p\u003e\u003ch2\u003eResults:\u003c/h2\u003e \u003cp\u003ePostgraduate students showed the highest mean scores in knowledge (9.1), attitude (4.91), and practice (5.00), followed by interns and final-year students, with statistically significant differences (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Participants cited behavioral management, communication, and time constraints as major challenges. Awareness of structured counselling models such as the 5A\u0026rsquo;s and 5R\u0026rsquo;s was limited.\u003c/p\u003e\u003ch2\u003eConclusion:\u003c/h2\u003e \u003cp\u003eWhile dental students exhibited a positive attitude toward tobacco cessation, practical implementation was lacking. Incorporating structured cessation training into dental curricula and enhancing institutional cessation centers is essential to strengthen their role in tobacco control.\u003c/p\u003e","manuscriptTitle":"Knowledge, attitude and practice about tobacco cessation among dental students: a single center study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-16 09:13:47","doi":"10.21203/rs.3.rs-8102254/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"15f55c65-0756-445b-86a9-88bef260a73a","owner":[],"postedDate":"February 16th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-27T07:39:08+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-16 09:13:47","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8102254","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8102254","identity":"rs-8102254","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}