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Oral tobacco use
Kawaldip Sehmi
Abstract
Smokeless tobacco use in the UK presents special public
health and cessation treatment challenges to the health
professionals and tobacco control agencies. The bio-behavioural
models used in smoking cessation and the tobacco control
measures adopted in controlling cigarette demand, supply
and exposure do not transfer over easily to the psychological,
physiological, socio-cultural, economic and other civil
society (social capital) influences that prompt initiation
of smokeless tobacco use, progression to nicotine addiction
and then cessation.
The public health challenge is that producers of cigarettes
have to declare their ingredients and limit their addictive
and harm causing agents in their product (nicotine, tar
and CO) but the manufacturers of smokeless tobaccos do
not. This is compounded further as the health impact of
some of the additives in combination with extracts of
tobacco has not been appreciated or assessed properly.
Areca nut as an additive in tobacco presents special challenges.
The cessation treatment challenge is one of assessing
the level of nicotine addiction and behavioural dependence
in a user. This has an impact upon prescribing the right
pharmocotherapy and appropriate behavioural therapy. In
smokers this has been largely settled by the use of Karl
Fagerström's and other tests to determine addiction
levels and then using guidelines on smoking cessation
treatment efficacy to prescribe the right product and
therapies.
QUIT has looked at three communities and their smokeless
tobacco use. They are:
Gujarati Community - use of Mawa
Punjabi Community - use of Gutkha
Bangladeshi Community - use of Tobacco Paan
Kawaldip Sehmi
Director of Health and Equality, QUIT
k.sehmi@quit.org.uk
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