BACKGROUND-AIM:
Substantial disparities exist in the availability and use of smoking cessation services within the European Union (EU). Socioeconomic status is a well-established determinant of cessation outcomes; however, its influence on the choice of cessation methods, particularly in the context of emerging nicotine-containing products, remains poorly understood in the EU. This study aimed to examine recent trends and social determinants in the use of smoking cessation methods among current and former smokers in 26 EU Member States (MS) and the United Kingdom.

METHODS:
We analysed data from four Eurobarometer waves (2012-2020): wave 77.1 [2012, n=26751]; wave 82.4 [2014, n=27801]; wave 87.1 [2017, n=27901]; wave 93.2 [2020, n=28300], focusing on current smokers who had ever made a quit attempt and former smokers. Cessation methods were classified as clinically endorsed (e.g., pharmacotherapy, behavioural support), non-clinically endorsed (e.g., e-cigarettes, oral tobacco products), or unassisted. Weighted estimates described trends overall and by smoking status. Multilevel logistic regressions (individuals nested within country-year) modelled the use of each cessation method in relation to sociodemographic factors (e.g., sex, age, education, financial difficulty, and area of residence) and tobacco cessation treatment policies (TCTP) at the national level. Analyses were repeated for current and former smokers separately.

RESULTS:
Unassisted quitting among current and former smokers increased from 67.8% (95%CI: 66.9-68.7) to 72.4% (71.5-73.3) between 2012 to 2020. Use of clinically endorsed methods was consistently low, ranging between 15.1% (14.4-15.8) and 20.2% (19.4-20.1), while non-clinically endorsed methods peaked to 26.2% (25.3-27.1) in 2014 before falling to 15.0% (14.3-15.7) in 2020. While current smokers reported using assisted methods more often, most former smokers had quit unassisted. Leaving school at 16–19 years (vs ≤15: AOR=0.83, 95%CI: 0.77-0.90), financial difficulties (AOR=0.81, 0.77-0.86), and stronger treatment policies (high TCTP vs low: AOR=0.52, 0.28-0.99) predicted lower odds of unassisted quitting. Younger age (15-24 vs ≥55 years: AOR=2.17, 1.89-2.50) strongly predicted use of non-clinically endorsed methods.

CONCLUSIONS:
Evidence-based smoking cessation programs still have limited reach in the EU, as most smokers try to quit without help. Countries should encourage quitting and guarantee affordable access to evidence-based treatment, prioritise outreach to population subgroups with lower uptake of clinically endorsed methods, and implement appropriate regulation of non-clinically endorsed methods.