5 Recommendations for research
The Public Health Interventions Advisory Committee (PHIAC) recommends that the following research questions should be addressed. It notes that 'effectiveness' in this context relates not only to the size of the effect, but also to cost effectiveness and duration of effect. It also takes into account any harmful/negative side effects.
5.1 What is the natural progression of disease for South Asian users of smokeless tobacco (for example, how prevalent is oropharyngeal cancer and periodontal disease among users)?
5.2 How prevalent is smokeless tobacco use among South Asian women who are pregnant and why? Is there a particular stage during pregnancy when smokeless tobacco is used? What impact does its use during pregnancy have on maternal and child health?
5.3 What are the similarities and differences between smokeless tobacco and smoked tobacco in terms of chemical content and the harm that it can cause? Should interventions to help people quit smokeless tobacco differ from those used for smoked tobacco?
5.4 How effective and cost effective are the following in terms of long-term (12 month) quit rates, and also for NHS standard, short-term quit rates (at 4 weeks and 6 months) for smokeless tobacco (confirmed by saliva cotinine test)?
5.4.1 Pharmacotherapy combined with behavioural support and delivered by health professionals compared to brief advice, behavioural support or pharmacotherapy alone.
5.4.2 Brief interventions (including brief advice) delivered by community members compared to brief interventions delivered by health professionals.
5.4.3 Tobacco cessation services (including outreach services) that specifically focus on smokeless tobacco, compared to smokeless tobacco support provided by general tobacco cessation services.
5.4.4 Training for health professionals (such as midwives, dentists and dental hygienists) to identify users of smokeless tobacco and raise awareness among them of the associated health risks.
5.4.5 How does the effectiveness and cost effectiveness of the above differ by: age, gender and ethnic origin of the recipient; the status of the person delivering the intervention; the way it is delivered; its frequency, length and duration; and the setting in which it is delivered?
5.5 Are there unintended consequences from encouraging people of South Asian origin to stop using smokeless tobacco (for example, do they experience more dental pain or start smoking more tobacco)?
5.6 How strong are the cultural motivations (stemming from religion, tradition, media, and advertising) to use smokeless tobacco among people of South Asian origin? How do they compare with the physical addiction to nicotine? How might this information help in designing smokeless tobacco cessation programmes that are culturally appropriate?
5.7 What components of an intervention or which general approaches work best in attracting people of South Asian origin to smokeless tobacco cessation services? How does this differ by age, gender and ethnic origin?
More detail on the gaps in the evidence identified during development of this guidance is provided in appendix D.