Introduction:
To prevent the harmful effects of tobacco use and related inequalities in health, clinical guidelines for tobacco cessation have been developed. Primary healthcare (PHC) has an important role in providing tobacco cessation treatment since it has the main responsibility for health promotion in the Swedish healthcare system and most of the population has regular contact with PHC. Individuals from lower socioeconomic groups also visit PHC more often than those from higher socioeconomic groups. However, socioeconomically disadvantaged groups appear to face specific challenges in quitting their tobacco use and PHC providers have reported several barriers to work with tobacco cessation. In previous qualitative studies, Tobacco Cessation on Prescription, (TCP) is perceived as a useful tool that could facilitate a more structured and effective approach to tobacco cessation compared to current practices targeting socioeconomically disadvantaged groups in PHC. Findings also suggest that TCP may have an impact on patient and PHC provider behaviour, leading to decreased tobacco use among patients but this has previously not been evaluated. Therefore, we evaluated the effectiveness of TCP compared to standard treatment in socioeconomically disadvantaged areas in Swedish primary healthcare.

Material and Methods:
A pragmatic cluster randomized controlled trial, in 18 PHC centres in socioeconomically disadvantaged areas in Stockholm. Randomization was conducted at the PHC centre level using a computergenerated random allocation sequence.

Results:
Intervention group (n = 8) and control group (n = 10). At the PHC centres, 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).

Conclusions:
This first study evaluating the effectiveness of TCP suggests that it may be effective in achieving abstinence from tobacco use compared to standard treatment in vulnerable populations.