OBJECTIVES Smoking remains a leading cause of preventable death, disproportionately affecting individuals in lower socio-economic groups. The effectiveness of nicotine replacement therapy (NRT) as a smoking cessation aid is well established; however, cost may act as a barrier to access. The aim of this study was to evaluate the impact of introducing universal NRT access on NRT uptake and smoking cessation.

STUDY DESIGN Retrospective cohort study.

METHODS Individuals were followed for twelve weeks following a quit attempt. Changes in NRT use and self-reported quit status were compared between service users before (January 2021-February 2023) and after (March 2023-December 2023) the introduction of fully subsidised NRT.

RESULTS The total number of participants was 19,717. There was a significant increase in NRT uptake among services users after the introduction of universal NRT access (59 % vs 40 %, p < 0.001) and higher quit rates at four (41 % vs 29 %, p < 0.001) and twelve (29 % vs 20 %, p < 0.001) weeks. NRT was significantly associated with smoking cessation at twelve (aOR 5.41, 95 % CI 4.99-5.86) weeks.

CONCLUSIONS This study confirms the effectiveness of NRT in a real world context and illustrates the benefits of universal access to this life saving medicine. Overcoming barriers to effective stop smoking care will be key to achieving tobacco endgame, especially for the most disadvantaged population groups. These findings support an urgent call for international policy makers to promote universal access to NRT as a central pillar of tobacco control efforts.