A systematic review on the social context of smokeless tobacco use in the South Asian population: implications for public health

Objectives: Smokeless tobacco (SLT) is an addiction resulting in serious health problems including cancers. The social context around SLT use among South Asians was reviewed to help inform interventions for its prevention and cessation.

Study design: Systematic review.

Methods: Electronic databases were searched to identify studies examining the social context of SLT use. As heterogeneous qualitative, quantitative and mixed method studies were included, meta-analysis was not appropriate.

Results: Of 428 studies identified, 17 were reviewed. These studies were conducted in India, Nepal, Pakistan and the UK between 1994 and 2009. SLT use among South Asians was culturally widely acceptable due to its association with socializing, sharing and family tradition (100% in Anwar et al.'s study). Other reasons for use were addiction, easy accessibility, low cost and lack of prohibitive legislation. SLT users had limited awareness of its association with oral cancer (29.3% in Ahmed et al.'s study); however, there was a distinct lack of knowledge regarding other health effects, such as cardiovascular disease (0.85%). Users attempted to quit (32.7% in Prabhu et al.'s study) but success was low (8.2%).

Conclusions: Cessation programmes for South Asians should address cultural acceptance, limited knowledge of health effects, inadequate legislation and controls, scarce social support and insufficient SLT cessation services.