Evaluation of the effectiveness of brief counseling for tobacco cessation during dental care in Sweden

INTERVENTION: Randomized 1:1 allocation of 30 dental clinics and 460 patients thereof to intervention (brief motivational advice) or control (usual care). The intervention consists of a manualized brief motivational counseling developed by a chartered psychologist on behalf of the Swedish National Institute for Public Health, including referral to second‐level tobacco cessation services. The brief counseling is based on a modified version of the 5 A (ask, advise, assess motivation, assist, arrange). The counseling will be delivered by either a dentist or a dental hygienist to consenting consecutive patients in the intervention group during an ordinary visit. The approximate duration of the counseling will be about 5 minutes and will end with the offer of referral to a second‐level cessation service, such as specialized cessation counseling at the health care district or telephone Quit‐Line. The control condition consists of 'usual care', i.e. the praxis followed in the corresponding clinic to advise patients to quit tobacco, if any. No effort will be made to standardize this condition. An investigation carried out among the clinics prior to inclusion in the trial showed a low proportion of clinics with guidelines and training of personnel on tobacco cessation. Patients in both groups will answer a structured questionnaire at time 0 (recruitment) and 6 months after (follow‐up), encompassing information on own tobacco use as well as on selected psycho‐social predictors of tobacco use. CONDITION: Smoking and smokeless tobacco cessation ; Mental and Behavioural Disorders ; Mental and behavioural disorders due to use of tobacco PRIMARY OUTCOME: Point prevalence of total abstinence from tobacco (no use of tobacco in the 7 days preceding the follow‐up survey) 6 months after recruitment SECONDARY OUTCOME: 1. Prevalence of sustained abstinence from tobacco during the 3 months preceding the survey; 2. Proportion of patients reporting cutting tobacco consumption by at least 50% at follow‐up compared to baseline; 3. Proportion of patients reporting quit attempts (at least 24 hours abstinence from tobacco) during the past 6 months; 4. Number of quit attempts INCLUSION CRITERIA: 1. Attend dental care during the study period 2. Age between 18 and 75 3. Daily smokers and/or smokeless tobacco users (used tobacco in all of the preceding 30 days) 4. Continued tobacco use for at least 1 year 5. Provide informed consent