Prevalence and real-world effectiveness of popular smoking cessation aids in England: a population-based study

Abstract

Importance: A wide range of medications, non-combustible nicotine products, behavioural support, and alternative treatments are available in England to help people stop smoking. Understanding their effectiveness in the real world can support informed decision-making. Objectives: To provide up-to-date estimates of the prevalence and real-world effectiveness of different smoking cessation aids and explore moderation of effectiveness by socioeconomic position. Design: Population-based survey, 2006-2024. Setting: England. Participants: 25,094 adults (>=16y) who reported having tried to quit smoking in the past year. Main outcomes and measures: The outcome variable was self-reported continuous abstinence from the start of the most recent quit attempt up to the time of survey. Independent variables were use (yes/no) of the following aids in the most recent attempt: nicotine replacement therapy (NRT) obtained on prescription or over-the-counter; varenicline; bupropion; e-cigarettes; face-to-face behavioural support; telephone support; written self-help materials; websites; smartphone apps; hypnotherapy; Allen Carr's Easyway method; heated tobacco products (HTPs); nicotine pouches. Covariates included sociodemographic characteristics and features of the quit attempt. Results: We analysed data from 25,094 participants (mean [SD] age = 38.7y [15.3]; 48.5% women). In 2023/24, the most used aids were e-cigarettes (40.2%) and over-the-counter NRT (17.3%); 40.8% of quit attempts were unaided. While e-cigarette use was associated with higher odds of abstinence after adjustment for use of other aids and covariates (OR=1.95 [1.74-2.17]), use of over-the-counter NRT was not (OR=1.03 [0.93-1.15]). Other aids positively associated with abstinence were websites (used by 4.6% in 2023/24; OR=1.43 [1.03-1.98]), prescription NRT (4.5%; OR=1.33 [1.12-1.58]), varenicline (1.1%; OR=1.80 [1.50-2.18]), and HTPs (0.7%; OR=2.37 [1.24-4.51]). Face-to-face behavioural support (used by 2.2% in 2023/24) was also associated with higher odds of abstinence among those from less advantaged (OR=1.59 [1.19-2.14]) but not more advantaged social grades (OR=0.91 [0.65-1.29]). There was not clear evidence of a benefit of any other aid, although some analyses were inconclusive. Conclusions and relevance: A range of effective smoking cessation aids are available in England, but many people try to quit using less effective forms of support or none at all. Quit success rates could be improved by encouraging people to use more effective methods.