Jackson, Sarah; Brown, James; Buss, Vera; Shahab, Lion; (2024) Prevalence and real-world effectiveness of popular smoking cessation aids in England. JAMA network open (In press).

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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 by socioeconomic position.// Design: Data were drawn from the Smoking Toolkit Study, a monthly cross-sectional household survey, 2006-2024.// Setting: England.// Participants: 25,094 adults (≥16y) who reported trying to quit smoking in the past year.// 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 (‘quit success’). 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; faceto-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 quit success 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 quit success 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 associated with higher odds of quit success among those from less advantaged (OR=1.59[1.19-2.14]) but not more advantaged socioeconomic positions (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: In this cross-sectional study, we 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.

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