Australia's approach of heavily taxing cigarettes while failing to widely subsidise quit aids is working against those most in need of support, the authors of a University of Notre Dame paper claim.
Co-author Lisa Wood said she had spoken to heavy smokers who desperately wanted to quit, but were able to source illicit cigarettes cheaper than nicotine patches.
"Some people have said to me, 'if the government really wanted me to quit, then why is it so expensive to get the support?'" she told AAP.
"It's a mixed message."
Evidence shows the most effective quitting aids for heavy smokers are a combination of slow-acting nicotine replacement therapy, such as a patch, and fast-acting products like a mist or gum.
However, the only quit aid subsidised on Australia's pharmaceutical benefit scheme was a 12-week supply each year of patches, which was less than most heavy smokers would need to give up, Professor Wood said.
Someone using a combination of patches and either a nicotine gum or spray would pay more than $200 a month, while a packet of black-market cigarettes costs as little as $15.
Overall rates of smoking in Australia have fallen to about 10 per cent but are dramatically higher among some population groups.
They include people living with mental illness, alcohol and other drug dependence, those who have experienced trauma and people facing social and economic disadvantage - including almost 80 per cent of homeless people.
"The people most likely to still be nicotine dependent are also the least able to afford effective treatment," Prof Wood said.
Some were using vaping to give up smoking, Prof Wood said, but that often reinforced a nicotine dependence by providing an easy relief for cravings.
"I have had people say that they get more hooked on the vaping, so then go back to the cigarettes, or they're using both," she said.
The paper found Australia was well behind comparable countries in providing free or affordable access to evidence-based quitting aids.
The UK and Ireland provide free combination stop smoking medications, alongside behavioural support through nationwide services.
While some Australian states and territories have introduced programs to provide free quit aids, access remains uneven and dependent on where people live.
Equitable access to quitting support and medication was crucial in reducing Australia's smoking and vaping prevalence, Quit director Rachael Andersen said.
"Smoking still kills 66 Australians every day - that's 24,000 people every year," she said.
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