Smokeless tobacco cessation in South Asian communities: a multi-centre prospective cohort study Ray Croucher 1 , Siddharth Shanbhag 1 , Manu Dahiya 1 , Saba Kassim 1 , Julia Csikar 2 & Louise Ross 3 Institute of Dentistry, Bar ts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK, 1 NHS Bradford & Leeds, Bradford, UK 2 and Leicestershire Partnership NHS Trust, Leicester, UK 3 ABSTRACT Aim To evaluate smokeless tobacco cessation in communities of South Asian origin. Design Multi-centre prospec- tive cohort study. Setting Three tobacco cessation services offering specialist smokeless tobacco cessation outreach clinic support to South Asians (Bangladeshi, Indian and Pakistani) resident in England. Participants A total of 239 South Asian participants seeking to stop smokeless tobacco use between November 2010 and December 2011. Measurements Socio-demographics, tobacco use and dependence, self-reported abstinence at 4 weeks and satisfac- tion measures. Findings Participants’ mean age was 45 [standard deviation (SD) = 13] years, were predominantly female (76%), of Bangladeshi origin (74%), either home carers (53%) or not working (29%). Sixty-three per cent were recruited from community locations, 21% through a clinical contact and 16% through friends and family. Mean daily number of smokeless tobacco intakes was 10 (SD = 7) and the mean dependence score was 4.5 (SD = 1.9). Sixty-three per cent of participants achieved continuous abstinence 4 weeks after quitting. Using nicotine replacement therapy (NRT) versus not using it [OR = 3.47, 95% confidence interval (CI): 1.25, 9.62] and below median (8) daily smokeless tobacco intakes (OR = 1.91, 95% CI: 1.07, 3.40) predicted successful abstinence. Conclusion South Asian smokeless tobacco users resident in England accessing services to help them stop appear to have short-term success rates comparable with smokers attending stop-smoking services, with higher success rates being reported by those using nicotine replacement therapy. Keywords Cessation, inequalities, prospective cohort study, smokeless tobacco, South Asians. Correspondence to: Ray Croucher, Institute of Dentistry, Barts andThe London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark Street, London E1 2AT, UK. E-mail: r.e.croucher@qmul.ac.uk Submitted 13 February 2012; initial review completed 25 February 2012; final version accepted 28 August 2012 INTRODUCTION Smokeless tobacco is defined as any product containing tobacco that is placed in the mouth or nose and not burned [1]. The smokeless tobacco products used most often in England are the paan quid with tobacco (PQT), gutkha and khaini [2]. These products contain the core ingredients of tobacco leaf or processed tobacco (zarda), slaked lime as an alkalinity regulator and areca nut, which has itself been classified by the International Agency for Research on Cancer (IARC) as carcinogenic [3]. England is a member of the European Union (EU) and is required to follow its tobacco regulation requirements [4]. These regulations distinguish between ‘tobacco pro- ducts’ (whether smoked or chewed) and ‘tobacco for oral use’, which is sucked. Swedish snus is considered a tobacco ‘for oral use’ and is sold only in Sweden and other non-EU Scandinavian countries. As a tobacco ‘product’ the use of smokeless tobacco in England is allowed, although largely restricted to South Asians from the Indian, Pakistani and especially Bangladeshi communi- ties, which together make up 4.5% of the population [5]. More members of the UK resident Pakistani and Bangla- deshi communities suffer poor health than the general population, as almost two-thirds of these communities live in low-income households [6]. Smokeless tobacco products used by these communi- ties in England are widely available, despite not meeting the current EU regulatory requirements for tobacco products [4], most particularly with respect to ingre- dient disclosure, pack identification codes and health RESEARCH REPORT doi:10.1111/j.1360-0443.2012.04085.x © 2012 The Authors, Addiction © 2012 Society for the Study of Addiction Addiction, 107 (Suppl. 2), 45–52