Smokeless tobacco consumption in the South Asian population of Sydney, Australia: prevalence, correlates and availability MOHAMMAD SHAKHAWAT HOSSAIN 1 , KYPROS KYPRI 1 , BAYZIDUR RAHMAN 2 & ABUL HASNAT MILTON 1 1 School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Newcastle, Australia, and 2 School of Public Health and Community Medicine, University of New SouthWales, Sydney, Australia Abstract Aim. The aim of this study was to estimate the prevalence and identify correlates of smokeless tobacco consumption among the South Asian residents of Sydney, Australia. Methods. A cross-sectional survey was conducted using a pretested, self- administered mailed questionnaire among members of Indian, Pakistani and Bangladeshi community associations in Sydney. Results. Of 1600 individuals invited to participate, 419 responded (26%). Prevalence rates of ever consumption, more than 100 times consumption and current consumption were 72.1%, 65.9% and 17.1%, respectively. Men (74.3%) were more likely to ever consume than women (67.6%). Over 96% of consumers reported buying smokeless tobacco products from ethnic shops in Sydney. Current consumption of smokeless tobacco products was associated with country of birth: Indians (odds ratio 5.7, 95% confidence interval 2.3–14.5) and Pakistanis (odds ratio 3.1, 95% confidence interval 1.5–6.5) were more likely to be current consumers than Bangladeshis after adjusting for sociodemographic variables. For ever consumption, there was a positive association with age (P for trend = 0.013) and male gender (odds ratio 2.1, 95% confidence interval 1.5–3.1). Conclusions. Given the availability of smokeless tobacco and the high prevalence and potential adverse health consequences of consumption, smokeless tobacco consumption may produce a considerable burden of non-communicable disease in Australia.Effective control measures are needed, in particular enforcement of existing laws prohibiting the sale of these products. [Hossain MS, Kypri K, Rahman B, Milton AH. Smokeless tobacco consumption in the South Asian population of Sydney, Australia: prevalence, correlates and availability. Drug Alcohol Rev 2014;33:86–92] Key words: smokeless tobacco, chewing tobacco, Sydney, South Asian population. Introduction Nearly six million people die each year as a result of tobacco use [1,2].The World Health Organization esti- mates there were 100 million premature deaths globally due to tobacco use last century, and if the current trends in tobacco consumption continue, the death toll will be one billion this century [3]. Tobacco-related diseases are the leading cause of death in almost all countries [4]. To date, concern about tobacco con- sumption has centered mostly on smoking, and smoke- less tobacco consumption (STC) has rarely been the subject of scientific investigation in Australia. Use of smokeless tobacco products is increasing in South Asia [5–7], a major source of immigration to Australia. Some Scandinavian and US studies suggest that smokeless tobacco products, such as snus and snuff, are less harmful alternatives to smoking, but research evi- dence to support this contention remains inconclusive [6]. Many studies conducted in India, the UK and the USA indicate that STC causes cancer of the oral cavity [6,8–10], throat, head and neck [5,11]. It also increases the risk of pancreatic cancer, diabetes, metabolic disease and cardiovascular disease [6,9]. Additionally, STC is a risk factor for stroke, high cholesterol and adverse pregnancy outcomes [12–14]. STC is common among South Asian people, includ- ing women [13,15,16]. More than one-third of total tobacco consumption in South Asia is in the form of smokeless tobacco [13,15]. The World Health Organi- zation estimates there are nearly 250 million adult smokeless tobacco users in its South-East Asia region (including 26 million in Bangladesh), representing 90% of global smokeless tobacco consumers [5,17–20]. Correspondence to Dr Abul Hasnat Milton, School of Medicine and Public Health, Faculty of Health and Medicine,The University of Newcastle, NSW 2308, Australia.Tel: +61 2 4042 0525; Fax: +61 2 4042 0044; E-mail: milton.hasnat@newcastle.edu.au Received 1 April 2013; accepted for publication 10 September 2013. REVIEW Drug and Alcohol Review (January 2014), 33, 86–92 DOI: 10.1111/dar.12074 © 2013 Australasian Professional Society on Alcohol and other Drugs