Smokeless Tobacco Initiation, Use, and Cessation in South Asia: A Qualitative Assessment

Abstract

Introduction Smokeless tobacco (ST) is a significant South Asian public health problem. This paper reports a qualitative study of a sample of South Asian ST users. Methods Interviews, using a piloted topic guide, with 33 consenting, urban dwelling adult ST users explored their ST initiation, continued use and cessation attempts. Framework data analysis was used to analyse country specific data before a thematic cross-country synthesis was completed. Results Participants reported long term ST use and high dependency. All reported strong cessation motivation and multiple failed attempts because of ease of purchasing ST, tobacco dependency and lack of institutional support. Conclusions Interventions to support cessation attempts amongst consumers of South Asian ST products should address the multiple challenges of developing an integrated ST policy, including cessation services. Implications This study provides detailed understanding of the barriers and drivers to ST initiation, use and cessation for users in Bangladesh, India and Pakistan. It is the first study to directly compare these three countries. The insight was then used to adapt an existing behavioural support intervention for ST cessation for testing in these countries.

Policy priorities for strengthening smokeless tobacco control in Bangladesh: A mixed-methods analysis

“…This may require the standardization of ST packs to ensure compliance with the current law of 50% pack warning. Despite a high disease burden associated with ST use, cessation services are not available for ST users in routine healthcare at public facilities in Bangladesh1 and integrated policy including cessation support is warranted 22 . Also, as per the participants in the present study, a dearth of research on effective contextual intervention and lack of evidence on supply chain control remain to be addressed in the country, and matches the findings of a recent study 23 .…”

Behaviour change intervention for smokeless tobacco (ST) cessation delivered through dentists within a dental setting: a feasibility study protocol

“…The intervention was piloted in four NHS Stop Smoking Services (Leicester, Leeds, Bradford and Tower Hamlets) in the UK (amongst ST users of South Asian origin) and in a community setting in Karachi, Pakistan and was found feasible and acceptable to deliver [ 16 ]. It has also been adapted to meet the needs and cultural context of ST users in Bangladesh, India and Pakistan [ 17 ].…”

“…Regarding gender, while we aim to interview female respondents, based upon evidence from previous research, we are not very optimistic on being able to do so. No female ST users were interviewed in a recent qualitative study on ST cessation in Peshawar [ 17 ]. While the use of ST is common, it is not common for women in Peshawar to disclose this.…”

“…It comprises 23 activities across three sessions. These include, providing information for raising awareness of ST harms and the benefits of quitting, boosting motivation and self-efficacy, and developing strategies to manage triggers, withdrawal symptoms, and relapse [ 16 , 17 ]. BISCA will be delivered by dentists in three sessions namely; pre-quit, quit and post-quit sessions.…”

“…The guide will explore the patients’ ST behaviour (initiation, continued use, cessation attempts) and factors influencing those behaviours. Questions are organized according to the three domains of COM-B model i.e., knowledge of the associated health risks from ST use and skills in managing triggers (capability), access to cessation support via healthcare and the role of other people (opportunity), views and emotions about ST use and cessation (motivation) [ 17 ]. Additionally, their views about the contents of BISCA and trial will be assessed as well.…”