Background:
Tobacco cessation interventions can substantially reduce tobacco-related morbidity. . . While we know 5 A is evidence based , its suitability for primary care (with minimum resources) has rarely been tested in low middle income countries. The present study aims to examine the effectiveness of tobacco cessation intervention on intention to quit among patients in primary care settings in two states India.

Methods:
A quasi-experimental study was conducted among 1382 patients visiting primary care facilities in two states of India. This study compared: the intervention arm comprising of intensive counseling (5As: Ask, Advice, Assess, Assist, Arrange) and the control arm comprising of routine advice by the physicians. Change in intention to quit in 30 days was the primary outcome measured at two time points (baseline and endline). Logistic regression model was applied using intention to treat principle with intention to quit as the primary outcome while adjusting for socio-demographic variables.

Results:
About half of the patients were willing to quit tobacco in 30 days. An increase of 37% was observed from baseline to end-line in intention to quit tobacco among patients in intervention units as compared to the 5% increase in control units. Patient who received tobacco cessation counseling were about three times more willing to quit tobacco use in intervention units as compared to those who received routine care in control units (intention to treat analysis; OR=2.85; CI=1.78-3.8; p value-0.00).

Conclusions:
The '5A' model used in the study for tobacco cessation can have a significant effect in motivating tobacco users to quit tobacco in primary care and may act as a viable option to be included in the routine care practices in primary care settings of India. More large scale studies and studies on the cost-effectiveness of the intervention should also be taken up in future.