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

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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.