Adapting a behavioural support intervention for smokeless tobacco cessation in South Asians

Lead Research Organisation: University of York

Abstract

Smokeless tobacco is a product containing tobacco, placed in the mouth or nose but not burned at the time of use. Consumed by approximately 300 million people worldwide, smokeless tobacco use leads to heart disease, stroke, and cancer of the mouth, oesophagus and pancreas. Its use is particularly common and considered socially acceptable among people of South Asian-origin including those living in the UK. According to latest research, behavioural counselling helps people addicted to smokeless tobacco in quitting. However, this research, mainly conducted in the US and European populations, is of little relevance to South Asians who use more addictive and hazardous products. Moreover, smokeless tobacco use among South Asians has strong socio-cultural dimensions, which need to be considered in behavioural counselling. Counsellors in the UK commonly modify their advice when offering behavioural counselling to smokeless tobacco users of South Asian-origin. However, there are variations in practice, and no standard protocol or any evidence for the effectiveness of an adapted approach.
We aim to identify the modification required in behavioural counselling to make it more effective, feasible and acceptable to South Asians in supporting them to quit smokeless tobacco. We will first get a group of experts to propose required modifications in the counselling sessions. We will then offer these to smokeless tobacco users in two health facilities in the UK and in Pakistan respectively.

Technical Summary

Around 300 million people worldwide consume smokeless tobacco. Considered to be a part of the culture, its use is particularly common in people of South Asian-origin1. A quarter of adults in India and Bangladesh and a fifth in Pakistan use smokeless tobacco. Also popular in the South Asian diaspora; one in five Bangladeshi women in the UK is a regular user. In addition to cardiovascular diseases, smokeless tobacco use leads to oral, oesophageal, and pancreatic cancers.
A recent Cochrane review suggests that behavioural support interventions are likely to be effective in smokeless tobacco cessation. However, studies in this review were mainly conducted in the US and European populations who, compared to South Asians, use less addictive and less hazardous products (e.g. moist snuff). Moreover, its consumption among South Asians has strong socio-cultural dimensions, which need to be considered in behavioural support interventions. The cessation advisors in the UK, offering behavioural support to smokeless tobacco users of South Asian-origin commonly modify their advice according to what they perceive appropriate. However, there are variations in practice, no standard treatment protocol for a culturally adapted intervention and no evidence for its effectiveness.
We aim to identify the modifications required to a behavioural support intervention in order to make it more effective, feasible, and acceptable for South Asians in smokeless tobacco cessation. We will adapt, test and refine the intervention in three phases. An expert panel will agree on the required adaptations. We will then assess the feasibility, adherence and acceptability of the adapted intervention. The intervention will be delivered by four cessation advisors to 32 participants (smokeless tobacco users) at two different sites (UK and Pakistan). We will audiotape and analyse 96 behavioural support sessions, interview 16 participants and four advisors to assess feasibility, adherence and acceptability. Findings will inform any further modifications.
 
Title Resource Photography 
Description Professionally choreographed photographs were taken to be included on the resource. This was to provide a visual element for those receiving intervention using the resource to particularly benefit those participants that have low literacy levels. 
Type Of Art Image 
Year Produced 2014 
Impact NA 
 
Description Adoption of BISCA educational materials by four services in London, Leicester, Leeds and Bradford.
Geographic Reach National 
Policy Influence Type Influenced training of practitioners or researchers
URL https://www.york.ac.uk/healthsciences/research/public-health/archive/adapting-behavioural-support-in...
 
Description Addressing Smokeless Tobacco and building Research capacity in south-Asia (ASTRA)
Amount £1,999,999 (GBP)
Funding ID 17/63/76 
Organisation NIHR Evaluation, Trials and Studies Coordinating Centre (NETSCC) 
Sector Academic/University
Country United Kingdom
Start 04/2018 
End 03/2021
 
Title BISCA survey tool 
Description Baseline survey tool to assess consumption and addiction levels of smokeless tobacco use 
Type Of Material Physiological assessment or outcome measure 
Year Produced 2015 
Provided To Others? Yes  
Impact It has been incorporated in future research protocols. 
 
Title Baseline questionnaire 
Description A baseline questionnaire is completed by all participants recruited to the study about SLT use. This includes a general information, the dependency scales (OSSTD, FTND-ST), withdrawal symptoms scale (MPSS), 'craving' scale (QSU-brief) and Motivation to quit scale 
Type Of Material Physiological assessment or outcome measure 
Provided To Others? No  
Impact NA 
 
Title Behavioural support resource 
Description A resource has been developed to provide behavioural support to users of SLT. Cessation advisors use the resource with participants to assess the deliverability, fidelity and feasibility of the intervention. 
Type Of Material Physiological assessment or outcome measure 
Provided To Others? No  
Impact Consistent method and delivery of information by cessation advisors to SLT clients. 
 
Title Saliva cotinine 
Description Saliva sample taken from SLT users recruited to the study to measure regular use of SLT at baseline and 6 months follow-up. 
Type Of Material Biological samples 
Provided To Others? No  
Impact NA 
 
Description Agha Khan University 
Organisation Aga Khan University
Country Pakistan 
Sector Academic/University 
PI Contribution Provided the study materials, support with research set-up and operation.
Collaborator Contribution Study management committee and research activity facilitation in Karachi.
Impact NA
Start Year 2014
 
Description Bradford City Council 
Organisation Bradford Metropolitan District Council
Country United Kingdom 
Sector Public 
PI Contribution study management committee and research site
Collaborator Contribution study research committee and research site
Impact NA
Start Year 2014
 
Description Leeds Community Healthcare NHS Trust 
Organisation Leeds Community Healthcare NHS Trust
Country United Kingdom 
Sector Public 
PI Contribution Study Management Committee & recruitment activity
Collaborator Contribution Study Management Committee and research site
Impact N/A
Start Year 2011
 
Description Leicestershire Partnership NHS Trust 
Organisation Leicestershire Partnership NHS Trust
Country United Kingdom 
Sector Public 
PI Contribution Study management ommittee and research site
Collaborator Contribution Study management committee and research site
Impact NA
Start Year 2014
 
Description Public Health Department, Leeds City Council 
Organisation Leeds City Council
Department Public Health
Country United Kingdom 
Sector Public 
PI Contribution Developed joint proposals and written papers
Collaborator Contribution Our collaborators provided technical and financial assistance in developing and printing of the resource pack (intervention materials) which is being used at the intervention clusters by Muslim faith leaders.
Impact The intervention materials for this pilot trial have resulted from this collaboration.
Start Year 2008
 
Description Smokeless tobacco cessation in London resident communities of South Asian origin - a new collaboration 
Organisation Aga Khan University
Country Pakistan 
Sector Academic/University 
PI Contribution I am a co-investigator in this collaboration that this going to conduct a randomised controlled trial of pharmaceutical products to address smokeless tobacco addition among people of South Asian origin in London. A full application has been submitted to HTA after being shortlisted. Another application is currently being prepared to be submitted to CRUK
Collaborator Contribution This is a research collaborative group and everyone has contributed to the research proposal.
Impact A submitted full application to HTA to conduct a randomised controlled trial in the UK A submitted full application to CRUK
Start Year 2015
 
Description Smokeless tobacco cessation in London resident communities of South Asian origin - a new collaboration 
Organisation King's College London
Country United Kingdom 
Sector Academic/University 
PI Contribution I am a co-investigator in this collaboration that this going to conduct a randomised controlled trial of pharmaceutical products to address smokeless tobacco addition among people of South Asian origin in London. A full application has been submitted to HTA after being shortlisted. Another application is currently being prepared to be submitted to CRUK
Collaborator Contribution This is a research collaborative group and everyone has contributed to the research proposal.
Impact A submitted full application to HTA to conduct a randomised controlled trial in the UK A submitted full application to CRUK
Start Year 2015
 
Description Smokeless tobacco cessation in London resident communities of South Asian origin - a new collaboration 
Organisation Public Health Foundation of India
Country India 
Sector Public 
PI Contribution I am a co-investigator in this collaboration that this going to conduct a randomised controlled trial of pharmaceutical products to address smokeless tobacco addition among people of South Asian origin in London. A full application has been submitted to HTA after being shortlisted. Another application is currently being prepared to be submitted to CRUK
Collaborator Contribution This is a research collaborative group and everyone has contributed to the research proposal.
Impact A submitted full application to HTA to conduct a randomised controlled trial in the UK A submitted full application to CRUK
Start Year 2015
 
Description Smokeless tobacco cessation in London resident communities of South Asian origin - a new collaboration 
Organisation Queen Mary University of London
Country United Kingdom 
Sector Academic/University 
PI Contribution I am a co-investigator in this collaboration that this going to conduct a randomised controlled trial of pharmaceutical products to address smokeless tobacco addition among people of South Asian origin in London. A full application has been submitted to HTA after being shortlisted. Another application is currently being prepared to be submitted to CRUK
Collaborator Contribution This is a research collaborative group and everyone has contributed to the research proposal.
Impact A submitted full application to HTA to conduct a randomised controlled trial in the UK A submitted full application to CRUK
Start Year 2015
 
Description Smokeless tobacco cessation in London resident communities of South Asian origin - a new collaboration 
Organisation University of Glasgow
Country United Kingdom 
Sector Academic/University 
PI Contribution I am a co-investigator in this collaboration that this going to conduct a randomised controlled trial of pharmaceutical products to address smokeless tobacco addition among people of South Asian origin in London. A full application has been submitted to HTA after being shortlisted. Another application is currently being prepared to be submitted to CRUK
Collaborator Contribution This is a research collaborative group and everyone has contributed to the research proposal.
Impact A submitted full application to HTA to conduct a randomised controlled trial in the UK A submitted full application to CRUK
Start Year 2015
 
Description Smokeless tobacco cessation in London resident communities of South Asian origin - a new collaboration 
Organisation University of Nottingham
Country United Kingdom 
Sector Academic/University 
PI Contribution I am a co-investigator in this collaboration that this going to conduct a randomised controlled trial of pharmaceutical products to address smokeless tobacco addition among people of South Asian origin in London. A full application has been submitted to HTA after being shortlisted. Another application is currently being prepared to be submitted to CRUK
Collaborator Contribution This is a research collaborative group and everyone has contributed to the research proposal.
Impact A submitted full application to HTA to conduct a randomised controlled trial in the UK A submitted full application to CRUK
Start Year 2015
 
Description Tower Hamlets stop tobacco project 
Organisation London Borough of Tower Hamlets
Country United Kingdom 
Sector Public 
PI Contribution study management committee and research site
Collaborator Contribution study management committee and research site
Impact NA
Start Year 2014
 
Title Behavioural support intervention for SLT cessation 
Description The SLT intervention resource was developed to help SLT users from the South Asian community quit tobacco use through behaviour change. The theoretical underpinnings as well support from cessation advisors. The initial resource is currently developed to be tested and refined. This resource is available in two formats, paper based educational resource and also in the form of a smart phone and tablet application. 
Type Preventative Intervention - Behavioural risk modification
Current Stage Of Development Initial development
Year Development Stage Completed 2014
Development Status Under active development/distribution
Impact NA 
 
Title BISCA app for smart phones and tablets 
Description This is an application for smart phones and tablets to be used by tobacco cessation advisors with people using smokeless tobacco to support them in quitting tobacco. 
Type Of Technology Webtool/Application 
Year Produced 2016 
Impact The product is just launched so any impacts are not yet available to report 
 
Description Bradford District Stop Smoking Service - Annual Network Conference & Update - 21.11.17 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Professional Practitioners
Results and Impact I (Kamran Siddiqi) was invited to speak at the Bradford District Stop Smoking Service - Annual Network Conference & Update - 21.11.17. It was attended by approximately 70 Stop Smoking Advisers from the region. I spoke and interacted with the audience for an hour taking them through the BISCA intervention. This sparked a lot of interest in the intervention which led to a demand for the intervention materials. I ran out of the 20 printed copies at the event and later on more were downloaded from our website. I got several requests afterwards to provide more copies of the intervention materials.
Year(s) Of Engagement Activity 2017
URL https://www.york.ac.uk/healthsciences/research/public-health/archive/adapting-behavioural-support-in...
 
Description Presentation of BICSA study at the UNION meeting 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact Approximately 100 people attended a symposium on smokeless tobacco at the International Union Against TB and Lung Diseases Conference in Cape Town. We presented the findings from this project. It raised a number of questions and opportunities for discussions. It also made it possible to collaborate with a few more partners at then meeting regarding SLT.
Year(s) Of Engagement Activity 2015
 
Description Presentation of BISCA study at SRNT conference 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Type Of Presentation keynote/invited speaker
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact The findings of the study were presented at the SRNT 2016 Annual Meeting, in Chicago, on March 2nd - 5th. The study was presented as part of a symposium titled "SMOKELESS TOBACCO CONSUMPTION, DISEASE BURDEN, DEPENDENCE, AND CESSATION: A
DIVERSE AND GLOBAL PERSPECTIVE". Audience comprised of a mix of researchers, academics, practitioners, post-graduate students and finders in tobacco cessation research.

The topic that was presented has helped raise the profile of research around second-hand smoking in particular and tobacco cessation in general.
Year(s) Of Engagement Activity 2016
URL http://c.ymcdn.com/sites/www.srnt.org/resource/resmgr/Conferences/2016_Annual_Meeting/Program/SRNT_2...