Motivation 2 Quit (M2Q): Tobacco Cessation on Prescription, (TCP) – A promising method

Background: To tackle effects of tobacco use and related inequalities in health, clinical guidelines for tobacco cessation are developed. Primary healthcare (PHC) has the main responsibility for health promotion and prevention in Sweden, most of the population has regular contact with PHC. Individuals from lower socioeconomic groups visit PHC more often than those from higher socioeconomic groups. Socioeconomically disadvantaged groups (SDGs) face specific challenges quitting tobacco use and PHC providers reported several barriers with tobacco cessation. In Sweden, prescription approaches are used in PHC to promote patients physical activity. In previous studies, TCP was perceived as a useful tool facilitating a more structured and effective approach to tobacco cessation compared to current practices targeting SDG in PHC. Findings also suggest that TCP may have an impact on patient and PHC provider behavior, leading to decreased tobacco use among patients but this has previously not been rigorously evaluated. Therefore, the effectiveness of TCP compared to standard treatment in Swedish PHC was assessed. Methods: A pragmatic cluster randomized controlled trial, in 18 PHC centers in socioeconomically disadvantaged areas (SDAs) in Stockholm. Randomization was conducted at the PHC center level using a computer-generated random allocation sequence. Results: PHC centers were randomized to the intervention group (n = 8) and control group (n = 10). At the PHC centers, 250 patients (TCP n = 188, standard treatment n = 62) were recruited. There was a statistically significant effect of TCP compared to standard treatment for the outcomes 7-day abstinence at 6 months (OR adjusted 5.4, 95% CI 1.57 to 18.93) and 3-month continued abstinence at 6 (OR adjusted 6.4, 95% CI 1.30 to 31.27) and 12 months follow-up (OR adjusted 7.8, 95% CI 1.25 to 48.82). Main conclusions: TCP can be effective in achieving abstinence from tobacco use compared to standard treatment in SDAs.