Smokeless tobacco initiation, use and cessation in South Asia: a qualitative assessment

Faraz Siddiqui, Ray Croucher, Fayaz Ahmad, Zarak Ahmed, Roshani Babu, Linda Bauld, Fariza Fieroze, Rumana Huque, Ian Kellar, Anuj Kumar, Silwa Lina, Maira Mubashir, Suzanne Tanya Nethan, Narjis Rizvi, Kamran Siddiqi, Prashant Kumar Singh, Heather Thomson, Cath Jackson

Research output: Contribution to journalArticlepeer-review


INTRODUCTION: Smokeless tobacco (ST) is a significant South Asian public health problem. This paper reports a qualitative study of a sample of South Asian ST users.

METHODS: Interviews, using a piloted topic guide, with 33 consenting, urban dwelling adult ST users explored their ST initiation, continued use and cessation attempts. Framework data analysis was used to analyse country specific data before a thematic cross-country synthesis was completed.

RESULTS: Participants reported long term ST use and high dependency. All reported strong cessation motivation and multiple failed attempts because of ease of purchasing ST, tobacco dependency and lack of institutional support.

CONCLUSIONS: Interventions to support cessation attempts amongst consumers of South Asian ST products should address the multiple challenges of developing an integrated ST policy, including cessation services.

IMPLICATIONS: This study provides detailed understanding of the barriers and drivers to ST initiation, use and cessation for users in Bangladesh, India and Pakistan. It is the first study to directly compare these three countries. The insight was then used to adapt an existing behavioural support intervention for ST cessation for testing in these countries.

Original languageEnglish
JournalNicotine and Tobacco Research
Early online date12 Apr 2021
Publication statusE-pub ahead of print - 12 Apr 2021


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