Abstract
IMPORTANCE: A wide range of medications, noncombustible nicotine products, behavioral support, and alternative treatments are available in England to help people stop smoking. Understanding their effectiveness outside of clinical trial settings can support informed decision-making. OBJECTIVES: To provide up-to-date estimates of the prevalence of different smoking cessation aids and associations with quit success and to explore moderation by socioeconomic position. DESIGN, SETTING, AND PARTICIPANTS: This survey study used data from the Smoking Toolkit Study, a monthly cross-sectional household survey, conducted from 2006 to 2024 in England, UK. Participants were individuals aged at least 16 years who reported trying to quit smoking in the past year. Analyses were conducted from July to November 2024. MAIN OUTCOMES AND MEASURES: The outcome variable was self-reported success in quitting smoking from the start of the most recent quit attempt up to the time of survey (hereafter, quit success). Independent variables were use (yes or no) of the following aids in the most recent attempt: nicotine replacement therapy (NRT), obtained via prescription or over-the-counter; varenicline; bupropion; electronic cigarettes (e-cigarettes); face-to-face behavioral support; telephone support; written self-help materials; websites; smartphone apps; hypnotherapy; Allen Carr's Easyway method; heated tobacco products (HTPs); and nicotine pouches. Covariates included sociodemographic characteristics and features of the quit attempt. RESULTS: A total of 25 094 participants (mean [SD] age, 38.7 [15.3] years; 51.5% [95% CI, 50.8%-52.2%] men) were included. In 2023 to 2024, the most used aids were e-cigarettes (40.2% [95% CI, 37.6%-42.8%]) and over-the-counter NRT (17.3% [95% CI, 15.3%-19.2%]); 40.8% (95% CI, 38.2%-43.4%) of quit attempts were unaided. While e-cigarette use was associated with higher odds of quit success after adjustment for use of other aids and covariates (odds ratio [OR], 1.95 [95% CI, 1.74-2.17]), use of over-the-counter NRT was not (OR, 1.03 [95% CI, 0.93-1.15]). Other aids positively associated with quit success were websites (used by 4.6% [95% CI, 3.5%-5.7%] in 2023-2024; OR, 1.43 [95% CI, 1.03-1.98]), prescription NRT (used by 4.5% [95% CI, 3.4%-5.5%] in 2023-2024; OR, 1.33 [95% CI, 1.12-1.58]), varenicline (used by 1.1% [95% CI, 0.5%-1.7%] in 2023-2024; OR, 1.80 [95% CI, 1.50-2.18]), and HTPs (used by 0.7% [95% CI, 0.3%-1.1%] in 2023-2024; OR, 2.37 [95% CI, 1.24-4.51]). Face-to-face behavioral support (used by 2.2% [95% CI, 1.5-2.9] in 2023-2024) was associated with higher odds of quit success among those from less advantaged (OR, 1.59 [95% CI, 1.19-2.14]) but not more advantaged (OR, 0.91 [95% CI, 0.65-1.29]) socioeconomic positions. There was not clear evidence of a benefit of any other aid, although some analyses were inconclusive. CONCLUSIONS AND RELEVANCE: This cross-sectional study found that while a range of effective smoking cessation aids are available in England, many people tried 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.