Helping people of South Asian origin to stop using smokeless tobacco - NICE opens consultation on draft guidance

The National Institute for Health and Care Excellence (NICE) today (Thursday 23 February) opens a consultation on draft guidance intended to help people of South Asian origin to stop using smokeless tobacco products, such as Gutka, Pan Masala, Shupari, and Betel Quid.

The draft public health guidance makes provisional recommendations for tackling the use of smokeless tobacco products which are typically available in South Asian communities in England. Contrary to perceptions that these types of products are healthy or beneficial, they are in fact associated with serious health problems such as mouth and oral cancer, serious tooth decay, heart attack and stroke, and problems in pregnancy.

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. Smokeless tobacco use is often highest among older women of South Asian descent, but in some parts of the UK, a high percentage of young South Asians are also reported as using smokeless tobacco products.

Professor Mike Kelly, Director of the NICE Centre for Public Health Excellence, said: "Smokeless tobacco products, such as Pan Masala and Shupari, which are used by some people of South Asian origin, are associated with a range of serious health risks. However, often people aren't aware that these products contain tobacco, nor that they could be at greater risk of oral cancers or heart attack. Generally, awareness of the problems caused by this particular type of smokeless tobacco use is low within mainstream NHS services. As a result, there's a clear requirement to assess the needs of local communities and provide targeted support to help people of South Asian origin stop using these products.

"Amongst the provisional recommendations on how focussed help could be provided, this draft guidance advises that health professionals such as GPs, dentists, health visitors and midwives receive training to increase awareness of smokeless tobacco use. This would aim to help them recognise the symptoms linked to using the products, ensure that the person in their care is aware of the potential health risks, and offer advice on stopping smokeless tobacco use or refer people to cessation services.

"We look forward to receiving comments on our draft recommendations from health professionals, local government and communities to help inform the development of this guidance."

General points covered by the draft guidance include assessing local needs, working with local South Asian communities, planning and providing services, and providing brief advice and referral. Some of the specific draft recommendations are:

  • 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
  • Work with local South Asian communities to plan, design and coordinate activities to help them stop using smokeless tobacco
  • Ensure any material on smokeless tobacco cessation refers 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 (for example, that it is healthy and is an appropriate way to ease indigestion or oral pain, or that it helps freshen the breath)
  • Commission an appropriate mix and range of local smokeless tobacco cessation services for South Asians.

More information on the draft guidance consultation is available at The consultation closes on 24 April 2012.


Notes to Editors

About the draft guidance, 'Tobacco: helping people of South Asian origin to stop using smokeless tobacco'

1. Please contact the NICE Press Office for an embargoed copy of the draft guidance.

2. The draft recommendations are provisional and may change after consultation.

3. The phrase 'people of South Asian origin' is used in this guidance to mean people with ancestral links to Bangladesh, India, Nepal, Pakistan or Sri Lanka.

4. 'Smokeless tobacco' refers to any type of product containing tobacco that is placed in the mouth or nose and not burned and which is typically used in England by people of South Asian origin. Examples of products include Gutka (also known as Pan Masala, includes tobacco which is sucked or chewed); Khaini (sucked or chewed) and Nass (used nasally, sucked or chewed). Different products are used in different parts of the country. In addition, the term 'smokeless tobacco' is not always recognised by users. Sometimes they will be unaware that the products they use contain tobacco.

5. Smokeless tobacco products typically may contain other unhealthy ingredients such as areca nuts (a mildly euphoric stimulant, known to be addictive and carcinogenic - linked to oral cancers) and slaked lime (used to make cement, and treat acidic water), as well as flavourings and sweeteners.

6. Estimates vary on how much smokeless tobacco products are used by South Asian communities. The NHS Information Centre (2006) confirmed that Bangladeshis were the biggest users among this community in 2004, with 9% of men and 16% of women saying that they used these products. However, these figures may be an underestimate.

7. South Asian women were 3.7 times more likely to have oral cancer and 2.1 times more likely to have pharyngeal cancer compared with other women [Moles et al. 2008].

8. Research indicates that around 28% of Bangladeshi adolescents in one study in East London use smokeless tobacco products [Prabhu et al. 2001].

9. Around 85% of the smokeless tobacco products used by people of South Asian origin are sold without a regulatory health warning on the packet. Many are sold without a warning that they contain tobacco.

10. The draft recommendations have been made within the context of general health service provision for South Asian communities and the specific provision of local tobacco control initiatives. Wider tobacco control measures, for example, legislation, taxation, advertising regulation and the use of health warnings on products, are not covered.

About NICE

11. The National Institute for Health and Care Excellence (NICE) is the independent organisation responsible for providing national guidance and standards on the promotion of good health and the prevention and treatment of ill health.

12. NICE produces guidance in three areas of health:

  • public health - guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector
  • health technologies - guidance on the use of new and existing medicines, treatments, medical technologies (including devices and diagnostics) and procedures within the NHS
  • clinical practice - guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS.

13. NICE produces standards for patient care:

  • quality standards - these reflect the very best in high quality patient care, to help healthcare practitioners and commissioners of care deliver excellent services
  • Quality and Outcomes Framework - NICE develops the clinical and health improvement indicators in the QOF, the Department of Health scheme which rewards GPs for how well they care for patients

14. NICE provides advice and support on putting NICE guidance and standards into practice through its implementation programme, and it collates and accredits high quality health guidance, research and information to help health professionals deliver the best patient care through NHS Evidence.

This page was last updated: 23 February 2012

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