Condition category
Mental and Behavioural Disorders
Date applied
Date assigned
Last edited
Prospectively registered
Overall trial status
Recruitment status
No longer recruiting

Plain English Summary

Background and study aims
The aim of this study is to test whether a new method to help people quit their tobacco use is better than the methods currently offered by primary health care providers (i.e. family doctors) in Sweden. The method specifically targets primary healthcare centres in Stockholm where tobacco use is more common, where the local population are likely to be poorly paid, not be as well-educated and suffer from poorer health when compared to the general population. The study also aims to determine whether this new method is worth its cost.

Who can participate?
Adult Swedish or Arabic speaking patients with Swedish social security numbers and permanent resident permits, without cognitive impairment, who use tobacco on a daily basis, visit participating primary healthcare centres and who are not already undergoing treatment for tobacco cessation.

What does the study involve?
The primary healthcare centres participating in this study are assigned to either the intervention or control group. Participants who attend centres in the control group are given their usual treatment. This includes counselling and drug (nicotine replacement) therapy. Participants who attend centres in the intervention group are treated according to the “tobacco cessation on prescription” programme. The main difference between the treatment for this group and the control group is that the counselling and drug therapy services offered are individually prescribed. They are also given information on other ways to help them quit their tobacco use (for example, doing exercise and finding other ways to cope with withdrawal symptoms) and self-help resources (such as smartphone apps, web-based counseling and websites that have more information and support). All participants are followed up after 6 and 12 months to see whether they have quit their tobacco use.

What are the possible benefits and risks of participating?
Participants will be offered support to quit their tobacco use. Quitting tobacco use can be a stressful experience since it can cause short term withdrawal symptoms and psychological stress. However, counselling on coping strategies and therapies that can help ease withdrawal symptoms will be given to avoid discomfort for participants. Participants that successfully quit their tobacco use should experience an improvement in both short and long-term health and quality of life.

Where is the study run from?
14-20 primary healthcare centres located in socioeconomically disadvantaged areas in Stockholm County (Sweden)

When is the study starting and how long is it expected to run for?
January 2015 to June 2018

Who is funding the study?
1. Stockholm County Council (Sweden)
2. Skandia Life Insurance (Sweden)
3. The Public Health Agency of Sweden (Folkhälsomyndigheten) (Sweden)

Who is the main contact?
1. Miss Anne Leppänen (public)
2. Dr Tanja Tomson (scientific)

Trial website

Contact information



Primary contact

Miss Anne Leppänen


Contact details

Karolinska Institute (Karolinska Institutet)
Tomtebodavägen 18A
+46 (0)852 483 612



Additional contact

Dr Tanja Tomson


Contact details

Karolinska Institute (Karolinska Institutet)
Tomtebodavägen 18A
+46 (0)852 480 173

Additional identifiers

EudraCT number number

Protocol/serial number


Study information

Scientific title

Evaluating the effectiveness and cost-effectiveness of Tobacco Cessation on Prescription in Swedish primary healthcare targeting socioeconomically disadvantaged areas in Stockholm - the "Motivation 2 Quit" (M2Q) study, a cluster-randomised controlled trial



Study hypothesis

Compared to standard treatment tobacco cessation on prescription is an effective and cost-effective treatment in achieving 7-day abstinence from tobacco use at 6 months after intervention among tobacco users visiting primary healthcare centres located in socioeconomically disadvantaged areas in Stockholm.

Ethics approval

Regional Ethical Review Board in Stockholm, April 2015, ref: 2015/207-31

Study design

An interventional pragmatic cluster-randomised controlled trial.

Primary study design


Secondary study design

Cluster randomised trial

Trial setting

GP practices

Trial type


Patient information sheet

Not available in web format, please use the contact details below to request a patient information sheet




Participants are randomly allocated to either tobacco cessation on prescription or standard treatment according to which primary healthcare centre (PHC) they attend.

1. Tobacco cessation on prescription is defined as:
1.1. Tobacco cessation counselling (minimum 10 minutes) provided by a qualified healthcare professional in combination with
1.2. A prescription for individualised tobacco cessation treatment, including options for:
1.2.1. Further counselling (referral to healthcare provider with more competence or the Swedish Quit Smoking Line)
1.2.2. Pharmacotherapy (nicotine replacement therapy, varenicline, bupropion)
1.2.3. Other measures for tobacco cessation (physical activity and other strategies to cope with withdrawal symptoms)
1.2.4. Follow-up (by telephone or revisit)
1.2.5. Support for self-management (reference to mobile applications, web-based counselling and websites for more information and support). The approach will be individualised in the sense that providers will discuss the available treatment options, contraindications, preferences and other relevant circumstances with the patient and then decide together on which treatment alternative(s) suit the individual best.
3. Follow-up of the prescription by the prescriber on at least one occasion is also included in the intervention.

Standard treatment is defined as:
Current treatment practices for tobacco cessation at the participating PHC in the control group and include different types of counselling and pharmacotherapy. The major difference between the trial conditions is how the counselling is administered (with or without a prescription form).

Participating PHC centres will be randomised with a 1:1 ratio to either intervention- or control conditions. Cluster-randomisation will be employed at the PHC centre level, meaning that all study participants recruited from a particular PHC centre will receive the same treatment (tobacco cessation treatment either with or without tobacco cessation on prescription).

Intervention type



Drug names

Primary outcome measures

Point prevalence of 7-day abstinence (total abstinence from tobacco use during the 7 days preceding follow-up) at 6 months after the intervention

Secondary outcome measures

1. Point prevalence of 7-day abstinence at 12 months after the intervention
2. Daily tobacco consumption (number of cigarettes), at 6 and 12 months after the intervention
3. Number of quit attempts and health-related quality of life (on a scale from 0-1 where 0 represents death and 1 represents perfect health) at 6 and 12 months after the intervention
4. Cost effectiveness, measured as the incremental cost per quality-adjusted life year

All outcomes will be based on self-reports from patient questionnaires.

Overall trial start date


Overall trial end date


Reason abandoned


Participant inclusion criteria

1. Swedish or Arabic speaking daily tobacco users with Swedish social security number and permanent resident permit
2. Over 18 years of age
3. Visiting participating primary health care centres in the study

Participant type


Age group




Target number of participants

14-20 primary healthcare centres with 43 participants from each centre

Participant exclusion criteria

1. Ongoing treatment for tobacco cessation
2. Cognitive impairment affecting ability to participate in the study on a voluntary basis

Recruitment start date


Recruitment end date



Countries of recruitment


Trial participating centre

Valsta Medical Centre (Valsta Vårdcentral)
Hammargatan 6
195 53

Trial participating centre

Norrtälje Northern Medical Centre (Norrtälje Norra Vårdcentral)
Lasarettsgatan 6
761 45

Trial participating centre

Hallstaviks Medical Centre (Hallstaviks Vårdcentral)
Carl Wahrens väg 24
763 34

Trial participating centre

Capio Primary Care Centre Hagsätra (Capio Vårdcentral Hagsätra)
Hagsätra torg 7B
124 73

Trial participating centre

Capio Primary Care Centre Wasa (Capio Vårdcentral Wasa)
Prästgårdsvägen 4
151 61

Trial participating centre

Cevita Care - Rimbo-Edsbro family doctors (Husläkarna Rimbo-Edsbro)
762 31

Trial participating centre

Capio Primary Care Centre Skogås (Capio Vårdcentral Skogås)
Melodivägen 6
142 40

Trial participating centre

Capio Primary Care Centre Vårberg (Capio Vårdcentral Vårberg)
Vårbergstorget 5
127 43

Sponsor information


Karolinska Institute (Karolinska Institutet) (Sweden)

Sponsor details

Tomtebodavägen 18A

Sponsor type




Funder type


Funder name

Stockholms Läns Landsting

Alternative name(s)

Stockholm County Council

Funding Body Type

government organisation

Funding Body Subtype

government non-federal



Funder name

Skandia Life Insurance (Livförsäkringsbolaget Skandia)

Alternative name(s)

Funding Body Type

Funding Body Subtype


Funder name

The Public Health Agency of Sweden (Folkhälsomyndigheten)

Alternative name(s)

Funding Body Type

Funding Body Subtype


Results and Publications

Publication and dissemination plan

We intend to publish the study protocol during the spring of 2016 and the study results in the beginning of 2018. The cost-effectiveness analysis is expected to be published in 2019. In addition to publications in scientific journals, the results will be disseminated to the scientific community through presentations at national and international conferences. The results will also be disseminated to study participants, funders, policy makers and the general public through oral presentations, written reports and popular scientific summaries.

Intention to publish date


Participant level data

Not expected to be available

Results - basic reporting

Publication summary

2016 results in:

Publication citations

Additional files

Editorial Notes

26/10/2017: Internal review. 19/09/2016: Publication reference added. 03/06/2016: The Public Health Agency of Sweden (Folkhälsomyndigheten) was added as a funder.