Toward equity in smoking cessation: evidence from Saudi Arabia's 2022 Global Youth Tobacco Survey through the Lens of Levesque's Access-to-Health-Care Framework.

Purpose: The 2022 Saudi Global Youth Tobacco Survey (GYTS) provided information on smoking status, quitting attempts, and help received for cessation among 6,983 eligible intermediate school students. Cessation services are available for free; however, still they are underutilized by smokers. Using data from the 2022 Saudi GYTS, this study examined the determinants of inequities in access to smoking cessation services and assessed the gap between policy intent and real-world access within the Saudi system. Patients and methods: A complex sample design analysis was used to assess access to smoking cessation services among youth while accounting for survey weighting, clustering, and stratification, using Levesque et al.'s framework, focusing on the demand side. Regression analysis was applied to control for confounders. Results: Subgroup analyses were conducted on 495 current tobacco users aged 13-15 years from the 2022 GYTS data, representing an estimated weighted population of approximately weighted Conclusion: Even though 23.1% reported receiving some form of help quitting, still 20.7% did not report quitting attempt. This pattern raises concerns with respect to passive service models that rely on individual willingness. Effective tobacco control efforts should go beyond passive service availability, integrating proactive, school-based cessation support, clear harm-awareness messaging, and outreach targeting especially uncertain older tobacco users' youth. Ensuring equitable access requires early, structured, and tailored interventions that can actively engage adolescents before they seek help. Findings underscore the importance of improving youth-centered cessation surveillance, access measurement, and service equity to better understand social and service-related barriers.