Smokeless tobacco a killer, NICE tells dentists

The National Institute for Health and Clinical Excellence (NICE) today (Wednesday 26 September) publishes final guidance on providing support for people in South Asian communities on stopping the use of smokeless tobacco products such as paan, gutka, shupari, and betel quid. 

Contrary to perceptions that these types of products are healthy or beneficial, they are in fact associated with serious health problems such as oral cancer, serious dental problems, heart attack and stroke, and problems in pregnancy.

The NICE public health guidance makes recommendations for tackling the use of these smokeless tobacco products which are typically available in South Asian communities in England. It’s thought that using these products is one of the main reasons why South Asian women are nearly four times more likely to develop oral cancers than women from other ethnic groups in England.  Smokeless tobacco use is often highest among older women of South Asian descent, but in some parts of the UK, a high percentage of young South Asians are also reported as using these products.

The NICE guidance recommendations include:

• In areas of identified need, commissioning a range of services to help South Asian people stop using smokeless tobacco, ensuring that local smokeless tobacco cessation services are coordinated and integrated with other tobacco control, prevention and cessation activities, as part of a comprehensive local tobacco control strategy

• Ensuring that any materials on smokeless tobacco cessation: refer to the products using the names people use locally; provide information about the risks associated with smokeless tobacco and the availability of services to help people quit; and challenge the perceived benefits of smokeless tobacco (for example, that it is an appropriate way to ease indigestion or dental pain, or that it helps freshen the breath)

• Ensuring that training for health, dental health and allied professionals (for example, community pharmacists) covers: the health risks associated with smokeless tobacco; the fact that smokeless tobacco may be used locally; and the local names used for smokeless tobacco products. Training should enable practitioners to recognise the signs of smokeless tobacco use and ensure that they can deliver a brief intervention and refer people to tobacco cessation services if they want to quit

• Advising that dentists, GPs, pharmacists, dental and GP practice nurses, midwives, health visitors and other health professionals should provide brief advice and referral, including recording the response to any attempts to encourage or help people to stop using smokeless tobacco in their patient notes (as well as recording whether they smoke).

Professor Mike Kelly, Director of the NICE Centre for Public Health Excellence, said: 'This guidance is an important opportunity to highlight the range of serious health risks associated with smokeless tobacco products, such as paan or gutkha, which are used by some people of South Asian origin.  Often the people using these products aren’t aware that they contain tobacco, nor that they could be at greater risk of oral cancers or cardiovascular disease.

'There’s also low awareness of the health problems caused by these smokeless tobacco products within mainstream NHS services. We hope that this guidance will inform health professionals of the risks posed by these products, so they can take action by asking patients of South Asian origin if they use smokeless tobacco, making sure they are aware of the health risks, and where appropriate referring people for support to help them stop using these products.'

Bilkis Hussain, smokeless tobacco advisor at the Leicestershire Partnership Trust and expert advisor to the NICE committee which produced the guidance, said: 'I’m based at a dental practice, and my focus is advising people from South Asian communities on the health risks of using smokeless tobacco products like paan. 

'This NICE guidance will therefore not only be very helpful in setting out how different health professionals can effectively tackle smokeless tobacco use in relevant populations in their care, but the guidance is also really important in raising wider awareness of this health issue and dispelling myths about smokeless tobacco being seen as beneficial. I hope that all health care professionals who work with South Asian communities will put the guidance recommendations into practice, to help improve the health of this population.'

The guidance is available at from 26 September.


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