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Smokeless tobacco products, supply chain and retailers’ practices in England: a multimethods study to inform policy
  1. Faraz Siddiqui1,
  2. Talib Khan2,
  3. Anne Readshaw1,
  4. Ray Croucher1,
  5. Martin Dockrell3,
  6. Cath Jackson1,
  7. Mona Kanaan1,
  8. Jim McCambridge1,
  9. Ann McNeill4,
  10. Steve Parrott1,
  11. Aziz Sheikh5,
  12. Kamran Siddiqi1
  1. 1 Department of Health Sciences, University of York, York, North Yorkshire, UK
  2. 2 Interpretation and Translation services, National Health Service England, Leeds, Worcestershire, UK
  3. 3 Alcohol, Drugs and Tobacco, Public Health England, London, UK
  4. 4 UK Centre for Tobacco Control Studies, National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
  5. 5 Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
  1. Correspondence to Dr Faraz Siddiqui, Department of Health Sciences, University of York, York YO10 5DD, North Yorkshire, UK; faraz.siddiqui{at}


Background In England, many people of South Asian origin consume smokeless tobacco (ST). ST use can lead to oral cancer, which is disproportionately high in South Asians. Our aims were to assess the compliance of ST product retailers with statutory regulations and to explore the supply chain of ST.

Methods We undertook a multimethods study between August 2017 and July 2019 in five English boroughs with a high proportion of ethnic South Asians. We purchased ST products and conducted field surveys with ST retailers at point of sale. Qualitative interviews were conducted with ST retailers and suppliers. ST packs were assessed for regulatory compliance, while quantitative and qualitative data triangulated information on retailers’ practices and the ST supply chain.

Results We collected 41 unique ST products, which included dry snuff, naswar, gutka, chewing tobacco and zarda. ST products were not registered, and demonstrated low compliance with health warning (14.6%) and packaging (56.1%) requirements. ST availability in surveyed boroughs was high (38.2%–69.7%); dry snuff, naswar and zarda were most commonly available. ST retailers demonstrated limited knowledge of regulations, and one-third were found to advertise ST at point of sale. Qualitative insights revealed illicit supply and distribution networks, as well as ST production in discreet locations.

Conclusion ST products are widely available in England, yet non-compliant with statutory regulations. In order to safeguard consumers, in particular ethnic South Asians, stronger efforts are needed to regulate the supply chain of ST at both national and international levels.

  • non-cigarette tobacco products
  • disparities
  • surveillance and monitoring
  • advertising and promotion

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  • Correction notice This article has been corrected since it first published. The provenance and peer review statement has been included.

  • Contributors KS (principal investigator) along with AM, AR, AS, JM and SP (coinvestigators) designed the original study and provided inputs throughout the project period. FS coordinated all project activities, prepared and presented progress reports, undertook quantitative and qualitative data analysis and prepared the manuscript drafts. TK conducted the piloting and all the field activities. CJ was involved in the refinement of the qualitative interview guide and developed the qualitative framework; she also guided the qualitative analysis and write-up. MK refined the quantitative analysis and results. RC and MD were involved in organising and conducting stakeholder engagement workshops. All of the listed authors reviewed and approved the final manuscript draft.

  • Funding The study was funded by a Cancer Research UK Tobacco Advisory Group (CRUK-TAG) (grant number C40275/A23873).

  • Competing interests AM is a National Institute for Health Research (NIHR) senior investigator.

  • Provenance and peer review Not commissioned; externally peer reviewed.