Smokeless tobacco cessation guidelines for health professionals in England

Abstract

Smokeless tobacco is used in the UK predominantly by members of the Indian, Pakistani and especially Bangladeshi communities. The most commonly used form is tobacco mixed with lime and additional psychoactive compounds, most notably areca nut. The resulting 'quid' is chewed or held in the mouth. Studies from Asia indicate that use of this kind of product is linked with an increased risk of oral cancers and possibly low birth-weight infants. There is little high quality research evaluating interventions to promote cessation of smokeless tobacco use, especially of the forms used in the UK. However, what evidence there is suggests that advice to stop coupled with behavioural support and counselling may increase long-term abstinence rates by some 5-10%. It seems appropriate therefore to recommend that dentists, GPs and other relevant health professionals should routinely assess and record smokeless tobacco use in patients belonging to relatively high prevalence groups, that they ensure that smokeless tobacco users know the potential health risks (as well as the health risks of smoking) and that they advise them to stop and keep a record of the outcome. Dental professionals should also examine the oral cavity of smokeless tobacco users for lesions when the opportunity arises. Patients expressing an interest in stopping should be referred to specialist smoking cessation services for behavioural support and specialists in areas of high smokeless tobacco use will need to ensure that they are sufficiently knowledgeable and their services sufficiently accessible to these users. There is insufficient evidence to recommend the use of nicotine replacement therapy or bupropion to aid smokeless tobacco cessation. Research is needed in the UK to quantify the personal and population health risks from smokeless tobacco, the benefits of stopping, the effectiveness of interventions aimed at promoting cessation and patterns of use, knowledge and attitudes of users. Cigarette dependence is recognised as a life-threatening disorder which responds to treatment in the form of behavioural support and medication. In the UK this has led to treatment services being made available as part of the National Health Service. 1 The blueprint for the operation of these services was a set of guidelines funded by the Health Development Agency. 2,3 While cigarette smoking is the most hazardous and prevalent form of tobacco use, consideration also needs to be given to other forms. This paper focuses on smokeless tobacco. It considers the prevalence of smokeless tobacco use in England and elsewhere, and its health effects. It examines evidence on how far smokeless tobacco use meets standard criteria for dependence and the effectiveness of interventions to promote cessation. Finally it makes recommendations for interventions by health professionals to encourage and aid cessation of smokeless tobacco use.The guidelines that comprise this paper were commissioned by the Health Development Agency for England. The development process was similar to that used ...

Tobacco use among South Asians: results of a community–university collaborative study

“…It should be noted that some products referred to as 'smokeless tobacco' can be prepared without tobacco such as pan masala without tobacco. However, it has been recognized that consumers and manufacturers use the term 'smokeless tobacco' inconsistently to refer to products that combine tobacco and areca nut as well as products that do not include tobacco (West et al 2004).…”

Current Pattern of Product Specific Smokeless Tobacco Use in Bangladesh

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Effectiveness and economic evaluation of self-help educational materials for the prevention of smoking relapse: randomised controlled trial

“…Compared with many other countries, the percentage of former smokers among ever-smokers (former or current) in adults is relatively high in England, about 57% for men and 51% for women. [4][5][6] Pharmacotherapy and behavioural support are effective in helping motivated smokers to stop smoking, [7][8][9][10] although relapse rates following these interventions are high. 11 Since 2001, a national network of NHS Stop Smoking Services has been established in England to provide behavioural support and pharmacotherapy to smokers who would like to quit.…”