Smokeless tobacco products used by some people in South Asian communities are associated with serious health risks such as oral cancer and cardiovascular disease, according to latest NICE guidance. Many members of the South Asian community use smokeless tobacco products to freshen the breath or to aid digestion.
These products, which include paan or gutkha, are typically served as a mixture which is chewed and consists of betel leaf combined with areca nut, tobacco and spices. Research shows that particular groups within South Asian communities such as women, those in older age groups and people from Bangladeshi origin, are more likely to use these products.
However, many are not aware that using smokeless tobacco carries health risks such as cardiovascular disease, dental disease, nicotine addiction, problems in pregnancy, and oral cancer. South Asian women are almost four times more likely to have oral cancer as those from other groups. It is thought that the prevalence of smokeless tobacco among South Asian women is one of the main reasons for this increased likelihood.
NICE’s public health guidance on smokeless tobacco cessation for South Asian communities contains a number of recommendations to tackle its use and improve knowledge of its associated health risks. The recommendations are aimed a range of groups including directors of public health, clinical commissioning groups, dental public health consultants, and faith leaders and others involved in faith centres. NICE says local need should be assessed to determine the prevalence and incidence of smokeless tobacco use, the products used and the perceived level of health risk associated with the products. Organisations should collaborate with South Asian communities to plan, design, coordinate, implement and publicise activities to help them stop using smokeless tobacco.
NICE recommends that any materials on smokeless tobacco cessation should refer to the products using the names people use locally.
In addition, information about the risks associated with these products should be provided, as well as information about the availability of services to help people quit. The guidance also advises that dentists and GPs should use brief interventions to advise those using smokeless tobacco to stop.
Brief interventions include offering verbal advice, discussion, negotiation or encouragement, and typically take 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.
Professor Mike Kelly, Director of the NICE Centre for Public Health Excellence, said: “This guidance is an important opportunity to highlight the range of serious health risks associated with smokeless tobacco products, such as paan or gutkha, which are used by some people of South Asian origin.
“Often the people using these products aren’t aware that they contain tobacco, nor that they could be at greater risk of oral cancers or cardiovascular disease.
“There’s also low awareness of the health problems caused by these smokeless tobacco products within mainstream NHS services.”
He added: “We hope that this guidance will inform health professionals of the risks posed by these products, so they can take action by asking patients of South Asian origin if they use smokeless tobacco, making sure they are aware of the health risks, and where appropriate referring people for support to help them stop using these products.”
Dr Kiran Patel, Chief Executive of the South Asian Health Foundation, spoke to NICE about the use of smokeless tobacco on the South Asian community.
Dr Patel welcomed the guidance “as an important step in raising awareness of the dangers of smokeless tobacco use and promoting ways to help encourage and support people to stop using smokeless tobacco”.