Awareness, use and future interest in cytisine for smoking cessation in adults who smoke or have quit within the past year in the UK: A mixed-methods study

Background and aims: Cytisine is an effective smoking cessation pharmacotherapy introduced in the UK in 2024. Assessing awareness, use, and interest is essential to assess its potential role in smoking cessation. We examined cytisine awareness and use among people who smoked in the past year, and interest in and factors influencing future use among people who currently smoke. Methods: An explanatory sequential mixed-method design study conducted between April-July 2025 in the UK; 193 people reporting past-year smoking (mean-age = 37.7,SD = 13.4) completed an online survey, and 16 participated in semi-structured interviews. Logistic regression examined correlates of cytisine awareness and interest in future use. Interviews were analysed thematically using the COM-B framework to explore perceived barriers and facilitators to cytisine use. Results: = 169), 71.6% reported interest in future use. The most endorsed factors encouraging future use were confidence in cytisine's helpfulness (52.7%) and safety (46.7%). Awareness was associated with past-year quit attempts (aOR = 3.21,95%CI 1.09-9.51), and fewer cigarettes/day (aOR = 0.89,95% CI 0.80-0.98). Interest in future use was associated with past-year quit attempts (aOR = 3.88,95%CI 1.70-8.88). Interviews highlighted a need for more information on cytisine, concerns about its effectiveness, side effects and dosing, and the role of healthcare guidance and social influences in shaping interest in future use. Conclusions: Despite low awareness and use of cytisine, interest in future use is high. Addressing informational and practical barriers could support wider cytisine uptake.