Research shows the mass distribution of free nicotine replacement therapy (NRT) is a high-impact, population-level strategy for smoking cessation; but underrepresentation of younger, and/or lighter, smokers challenges generalisability of findings to young adult smokers.

This naturalistic study examined how and with what effect young adult smokers used free nicotine patches provided through a mass mailout programme.

In total, 5,025 eligible 18–29 year-old smokers who accessed an online ordering platform received self-help materials and an 8-week course of patches matched to their consumption level (<10 cigarettes per day (cpd); ≥10 cpd). No other behavioural support occurred. Whether participants used patches correctly and achieved 30-day continuous abstinence at 6-month follow-up were assessed.

Among 694 participants with complete data: 89% used some patches; 8% used the patches correctly for 8 weeks; 31.0% (95% confidence interval (CI) = 27.6, 34.7) achieved abstinence. Adjusted logistic regression analysis showed the highest odds of abstinence was associated with the correct use of patches (odds ratio = 2.8, 95% CI = 1.5, 5.1).

Mass distribution of free patches may be an effective public health measure for supporting younger, lighter smokers to attempt cessation, reduce consumption, or achieve abstinence. Emphasising why and how to use NRT for the entire treatment course may enhance outcomes.