Adapting a behavioural support intervention for smokeless tobacco cessation in South Asians
Lead Research Organisation:
University of York
Department Name: UNLISTED
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.
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.
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.
Organisations
- University of York (Lead Research Organisation)
- University of Glasgow (Collaboration)
- UNIVERSITY OF NOTTINGHAM (Collaboration)
- Public Health Foundation of India (Collaboration)
- Leeds Community Healthcare NHS Trust (Collaboration)
- Bradford Metropolitan District Council (Collaboration)
- Leeds City Council (Collaboration)
- Indian Council of Medical Research (ICMR) (Collaboration)
- QUEEN MARY UNIVERSITY OF LONDON (Collaboration)
- Aga Khan University (Collaboration)
- London Borough of Tower Hamlets (Collaboration)
- LEICESTERSHIRE PARTNERSHIP NHS TRUST (Collaboration)
- KING'S COLLEGE LONDON (Collaboration)
People |
ORCID iD |
Kamran Siddiqi (Principal Investigator) |
Publications
Siddiqi K
(2015)
Global burden of disease due to smokeless tobacco consumption in adults: analysis of data from 113 countries
in BMC Medicine
Huque R
(2016)
Determinants of Salivary Cotinine among Smokeless Tobacco Users: A Cross-Sectional Survey in Bangladesh.
in PloS one
Siddiqi K
(2016)
Behaviour change intervention for smokeless tobacco cessation: its development, feasibility and fidelity testing in Pakistan and in the UK.
in BMC public health
Vidyasagaran AL
(2016)
Use of smokeless tobacco and risk of cardiovascular disease: A systematic review and meta-analysis.
in European journal of preventive cardiology
Siddiqi K
(2017)
Supporting the urban poor to quit tobacco: adding years to lives.
in Thorax
O'Neill N
(2018)
Which Behavior Change Techniques May Help Waterpipe Smokers to Quit? An Expert Consensus Using a Modified Delphi Technique.
in Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco
Mushtaq N
(2019)
Evaluation of tobacco dependence measures in South Asian smokeless tobacco users.
in Drug and alcohol dependence
Mehrotra R
(2019)
Smokeless tobacco control in 180 countries across the globe: call to action for full implementation of WHO FCTC measures.
in The Lancet. Oncology
Siddiqi K
(2019)
Smokeless tobacco: Why does it need special attention?
in Respirology
Siddiqi K
(2020)
Identification of Policy Priorities to Address the Burden of Smokeless Tobacco in Pakistan: A Multimethod Analysis.
in Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco
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 |
Title | Smokeless Tobacco - short film |
Description | A short film on smokeless tobacco to raise awareness among the general public |
Type Of Art | Film/Video/Animation |
Year Produced | 2019 |
Impact | 18000 views |
URL | https://youtu.be/QcAozHGxP3g |
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 | Public |
Country | United Kingdom |
Start | 03/2018 |
End | 03/2021 |
Description | NIHR Global Health Research Group on Addressing Smokeless Tobacco and building Research capacity in south Asia (ASTRA) at the University of York |
Amount | £1,999,998 (GBP) |
Funding ID | 17/63/76 |
Organisation | National Institute for Health Research |
Sector | Public |
Country | United Kingdom |
Start | 03/2018 |
End | 03/2022 |
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 | Charity/Non Profit |
PI Contribution | study management committee and research site |
Collaborator Contribution | study management committee and research site |
Impact | NA |
Start Year | 2014 |
Description | WHO FCTC Knowledge Hub on Smokeless Tobacco |
Organisation | Indian Council of Medical Research (ICMR) |
Department | National Institute of Cancer prevention and research |
Country | India |
Sector | Public |
PI Contribution | I invited our colleagues from the Knowledge Hub to partner with us and submit a NIHR Global Health research grant together. |
Collaborator Contribution | Contributed to the grant writing |
Impact | Submission to NIHR Global health programme |
Start Year | 2017 |
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 | Closing the Gap: Nicotine and Tobacco Research in High-Burden Low-Income Countries |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Other audiences |
Results and Impact | More than 300 people attended this preliminary talk during an international meeting. This led to much discussion and follow up collaborations. |
Year(s) Of Engagement Activity | 2021 |
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... |
Description | UNION webinar on Smokeless Tobacco: Prevalence, Policy and Future challenge |
Form Of Engagement Activity | A talk or presentation |
Part Of Official Scheme? | No |
Geographic Reach | International |
Primary Audience | Policymakers/politicians |
Results and Impact | A discussion on the Types, Health risks and Disease burden due to Smokeless Tobacco |
Year(s) Of Engagement Activity | 2020 |