BACKGROUND AND AIMS: Swap to Stop is a government scheme to promote smoking cessation. Local authorities in England were given e-cigarette (vape) starter kits to provide alongside behavioural support in a wide range of settings. This study evaluated (i) scheme uptake by region of England, (ii) proposed delivery settings and the type and length of support, (iii) proposed targeting of priority populations and (iv) product-cost per 4-week quit.

DESIGN, SETTING AND PARTICIPANTS: From October 2023 to October 2024, local authorities submitted 218 expressions of interest (EOIs) to participate in Swap to Stop. We analysed a sample of 115 (53%) EOIs and associated cost information provided by the Department of Health and Social Care. NHS Quarterly Returns data (April 2024-September 2024) provided 4-week quit rates.

MEASUREMENTS: Outcomes were the number of kits requested per adult who smokes in each region of England, the proposed delivery settings and the type and length of support and proposed targeting of priority populations categorised as 'specific' (exclusive to certain populations) or 'targeted' (accessible to all but targeting particular groups). Product-cost per 4-week quit was estimated from the 4-week quit rates and product cost.

FINDINGS: Regional uptake varied, from 39 kits per 100 people who smoke in the Southwest to 5 per 100 in the Midlands. Most EOIs (75.7%) proposed supplying kits via existing local government funded stop smoking services, followed by physical health care settings (37.4%). A proposed duration of supply of 4 weeks was the most common (48.7%). Thirty-two percent of the EOIs described specific services, including services exclusively for pregnant women (14.8%) and people experiencing deprivation (13.9%). Frequently targeted were socioeconomically less advantaged groups (e.g. routine/manual workers, 57.4% of EOIs) and people with mental health conditions (36.5% of EOIs). The self-reported 4-week quit rate for those who received a kit was 34.3% and the average kit cost was £38.78 (the maximum cost was £40), giving an estimated product-cost per 4-week quit of £113.17, not including additional costs incurred by service providers.

CONCLUSIONS: Swap to Stop in England, a government scheme to promote smoking cessation through provision of free e-cigarette starter kits, demonstrated variation in both uptake and the types of services offering free vapes, yet the early quit rates, and consequently the product-cost per quit, were comparable to those observed in similar smoking cessation schemes. There is potential for further targeting of priority populations with increased investment to ensure people have the best chance of quitting.