Helping members of the South Asian community quit smokeless tobacco

8042217-feature-asianWhen figures revealed a rise in the number of cases of oral cancer in Bradford and Airedale last year, health chiefs decided that urgent action was needed to highlight the dangers of smokeless tobacco to the local South Asian community.

Although smoking is the cause of 90 per cent of all oral cancer cases, chewing tobacco can also trigger the cancer, as well as other problems such as serious tooth decay, heart attack and stroke, and problems in pregnancy.

The practice is common among many in the South Asian community, with many users believing that products such as gutkha and paan masala can be used safely as a mouth freshener and digestive.

The products traditionally contain a mix of areca nut, betel leaf, various flavourings and spices along with tobacco.

They are readily available, poorly regulated, and are increasing in popularity among people of South Asian origin in England, according to the South Asian Health Foundation.

Dr Kiran Patel, Chief Executive of the charity, says: “The use of smokeless tobacco products, such as paan masala, is popular among members of the South Asian population in England and has shown to be on the increase.

“It is often seen as acceptable by members of the South Asian communities who are often unaware of the dangers associated with the use of such products.”

The use of these smokeless tobacco products is thought to be one of the main reasons why South Asian women are nearly 4 times more likely to develop oral cancers than women from other ethnic groups in England.

The team at Bradford and Airedale Primary Care Trust worked on a pilot project with Bangladeshi, Gujerati and Pakistani communities in Bradford and Keighley in West Yorkshire to tackle this problem and address the lack of awareness around the dangers of chewing tobacco.

Prevalent across England

But the problem is not just restricted to Bradford and is prevalent in South Asian communities across England, according to The South Asian Health Foundation.

The problem occurs in South Asian communities across England, with the highest proportion of self-reported use of chewing tobacco products among Bangladeshi women (19 per cent), followed by Bangladeshi men (9 per cent), Indian men (4 per cent) and Pakistani men (2 per cent).

However, in some localities the prevalence may be even higher. For example, a study that investigated under-reporting among Bangladeshi women found that 15 per cent of women did not report that they used smokeless tobacco when they did in fact use it. Findings from the Health Survey for England suggested similar levels of under-reporting.

Children and young people have also been found to be users of smokeless tobacco. A study carried out among Bangladeshi people aged 12-18 years in east London found high levels of regular paan use, for both the tobacco-containing and tobacco-free forms.

Particularly striking was the finding that only a third of these young people knew of the association between tobacco-containing paan and cancer.

First NICE guidance

NICE has now published guidance to help health services across England follow the lead set in Bradford and tackle smokeless tobacco use among the South Asian population.

The guidance sets out advice for directors of public health, dentists, GPs, nurses, pharmacists, specialist tobacco cessation services, as well as community and faith leaders and youth workers.

NICE recommends assessing local need to get a clear picture of the extent of the problem in the local area, any specific issues, and the tobacco cessation services currently in place.

It is important to work with local South Asian voluntary and community organisations to understand the specific concerns and needs of local South Asian communities in relation to smokeless tobacco.

The guidance suggests using existing local South Asian information networks, including culturally specific TV and radio channels, and traditional sources of heath advice within South Asian communities to disseminate information on smokeless tobacco.

It also recommends using venues and events that members of local South Asian communities frequent, such as educational establishments or prayer groups, to publicise, provide or consult on cessation services with them.

Any material on smokeless tobacco cessation should refer to the products using the names people use locally; provides information about the risks associated with smokeless tobacco and the availability of services to help people quit; and dispels any myths and misconceptions about smokeless tobacco.

Smoking cessation services should be commissioned that are tailored specifically to the South Asian population or to specific groups such as South Asian women, speakers of specific language or people who use a certain type of smokeless tobacco product.

Dentists and GPs can play a key role by asking their patients if they use smokeless tobacco, using the names that the various products are known by locally.

If a patient uses smokeless tobacco, they should be made aware of the health risks. Dentists and GPs should use a brief intervention to advise them to stop and refer people who want to quit to local specialist tobacco cessation services.

Putting all of these recommendations into practice is something that Dr Patel believes will really help to encourage members of the South Asian community to stop using smokeless tobacco

“This new guidance from NICE as an important step in raising awareness of the dangers of smokeless tobacco use and promoting ways to help encourage and support people to stop using smokeless tobacco.”

26 September 2012

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Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.