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Smokeless tobacco cessation: South Asian communities overview

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Smokeless tobacco cessation: South Asian communities HAI

About

What is covered

This pathway covers interventions to help people of South Asian origin who are living in England to stop using smokeless tobacco products.
The phrase 'of South Asian origin' is used in this pathway to mean people with ancestral links to Bangladesh, India, Nepal, Pakistan or Sri Lanka.
People of South Asian origin are the focus, as they are the predominant users of smokeless tobacco products in England. Others who use these products may also benefit from the recommendations, as health professionals, as a result, will be more aware of how to identify and help them.
Some of the interventions may also help stop people from taking up the habit in the first place. For example, they may help young people who are experimenting with tobacco to give it up before they become addicted.
The recommendations have been made within the context of local tobacco control strategies, including the provision of local services and initiatives to prevent the uptake of tobacco and help smokers and other tobacco users to quit.
They should be implemented as part of other activities and services to address the general health needs of South Asian communities.
The pathway is for tobacco cessation services (including stop smoking services), health education and training services, health and wellbeing boards and health and social care practitioners. It is also for all those with public health as part of their remit, in particular, the health of South Asian communities.
It may also be of interest to local authority elected members, people who want to stop using smokeless tobacco, their families and other members of the public.

Updates

Updates to this pathway

11 March 2014 Minor maintenance updates.
24 January 2014 Minor maintenance updates.
31 May 2013 Minor maintenance updates.

Short Text

Tobacco: helping people of South Asian origin to stop using smokeless tobacco.

What is covered

This pathway covers interventions to help people of South Asian origin who are living in England to stop using smokeless tobacco products.
The phrase 'of South Asian origin' is used in this pathway to mean people with ancestral links to Bangladesh, India, Nepal, Pakistan or Sri Lanka.
People of South Asian origin are the focus, as they are the predominant users of smokeless tobacco products in England. Others who use these products may also benefit from the recommendations, as health professionals, as a result, will be more aware of how to identify and help them.
Some of the interventions may also help stop people from taking up the habit in the first place. For example, they may help young people who are experimenting with tobacco to give it up before they become addicted.
The recommendations have been made within the context of local tobacco control strategies, including the provision of local services and initiatives to prevent the uptake of tobacco and help smokers and other tobacco users to quit.
They should be implemented as part of other activities and services to address the general health needs of South Asian communities.
The pathway is for tobacco cessation services (including stop smoking services), health education and training services, health and wellbeing boards and health and social care practitioners. It is also for all those with public health as part of their remit, in particular, the health of South Asian communities.
It may also be of interest to local authority elected members, people who want to stop using smokeless tobacco, their families and other members of the public.

Sources

The NICE guidance that was used to create the pathway.
Smokeless tobacco cessation: South Asian communities. NICE public health guidance 39 (2012)

Quality standards

Quality statements

Effective interventions library

Effective interventions library

Successful effective interventions library details

Implementation

Commissioning

These resources include support for commissioners to plan for costs and savings of guidance implementation and meeting quality standards where they apply.
These resources will help to inform discussions with providers about the development of services and may include measurement and action planning tools.

Education and learning

NICE produces resources for individual practitioners, teams and those with a role in education to help improve and assess users' knowledge of relevant NICE guidance and its application in practice.

Service improvement and audit

These resources provide help with planning ahead for NICE guidance, understanding where you are now, and conducting improvement initiatives.

Pathway information

Updates to this pathway

11 March 2014 Minor maintenance updates.
24 January 2014 Minor maintenance updates.
31 May 2013 Minor maintenance updates.

Supporting information

Smokeless tobacco

The term 'smokeless tobacco' is used in this pathway to refer to any type of product containing tobacco that is placed in the mouth or nose and not burned. It does not include products that are sucked, like 'snus', or similar oral snuff productsAs defined in the European Union's Tobacco Product Directive. . (Under UK law it is an offence to supply tobacco for oral use unless it is intended to be smoked or chewedSee the Local Government Association's Niche Tobacco Products Directory website for further information. .)
The pathway covers a variety of smokeless tobacco products used by people of South Asian origin in England. The types used vary across the country but they can be divided into three main categories, based on their ingredients (see the BMJ research paper Global surveillance of oral tobacco products: total nicotine, unionised nicotine and tobacco-specific N-nitrosamines):
  • Tobacco with or without flavourants: misri India tobacco (powdered) and qimam (kiman).
  • Tobacco with various alkaline modifiers: khaini, naswar (niswar, nass) and gul.
  • Tobacco with slaked lime as an alkaline modifier and areca nut: gutkha, zarda, mawa, manipuri and betel quid (with tobacco).
Users do not always recognise the term 'smokeless tobacco'. Sometimes they will be unaware that the products contain tobacco (although the products are legally required to carry a health warningSmokeless tobacco products are required to carry the warning: 'This tobacco product can damage your health and is addictive' on the most visible surface of the packet. Refer to the Local Government Association's Niche Tobacco Products Directory website for further details.). That is why it is also necessary to refer to these products by the names used locally.
A number of the products contain areca nut, a mildly euphoric stimulant which is addictive and carcinogenic in its own right. (Any chewable products that do not contain tobacco are the responsibility of the Food Standards Agency. The Agency is currently working with UK Asian communities to provide guidance on how to minimise the risk from consuming products containing areca nut.)

Glossary

Brief interventions involve verbal advice, discussion, negotiation or encouragement, with or without written or other support or follow-up. They can be delivered by a range of primary and community care professionals. These interventions are often opportunistic, typically taking no more than a few minutes for basic advice, up to around 20 minutes for a more extended, individually-focused discussion. They may also involve a referral for further interventions or more intensive support.
Evidence shows that a brief intervention to help people quit smoking can be effective. The way a brief intervention to help smokers is delivered depends on a number of factors, including the person's willingness to quit, how acceptable they find the intervention and previous methods they have used. It may include one or more of the following:
  • simple opportunistic advice
  • an assessment of the person's commitment to quit
  • pharmacotherapy and/or behavioural support
  • self-help material
  • referral to more intensive support, such as to an evidence-based smoking cessation service.
See NICE's smoking pathway for more information on the general principles of tobacco cessation.
In this pathway, the term 'South Asian' means people with ancestral links to Bangladesh, India, Nepal, Pakistan or Sri Lanka.
In this pathway, 'Specialist tobacco cessation service' refers to evidence-based services that offer tobacco users support to help them quit (regardless of whether they smoke or use a smokeless variety). In England, services of this type are generally referred to as 'stop smoking services' or 'smoking cessation services', as they normally focus on people who smoke tobacco. However, a service might also brand itself as a generic tobacco cessation service, to emphasise a focus on more than one form of tobacco. For further details, see evidence-based stop smoking services and quitlines in NICE's smoking pathway.
Evidence-based services that offer tobacco users support to help them quit (regardless of whether they smoke or use a smokeless variety). In England, services of this type are generally referred to as 'stop smoking services' or 'smoking cessation services', as they normally focus on people who smoke tobacco. However, a service might also brand itself as a generic tobacco cessation service, to emphasise a focus on more than one form of tobacco. For further details, see evidence-based stop smoking services and quitlines in NICE's smoking pathway.

Paths in this pathway

Pathway created: September 2012 Last updated: March 2014

© NICE 2014

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