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Background and aims: Smokeless tobacco (ST) use in South Asia is high, yet interventions to support its cessation are lacking. We tested the feasibility of delivering interventions for ST cessation in South Asia. Design: We used a 2 × 2 factorial design, pilot randomized controlled trial with a duration of 26 weeks, including baseline and follow‐up (6, 12 and 26 weeks) assessments. Setting: Two primary health‐care facilities each in Dhaka (Bangladesh) and Karachi (Pakistan) and a walk‐in cancer screening clinic in Noida (India) took part. Participants: Adult daily ST users willing to make a quit attempt within 30 days. Of 392 screened, 264 participants [mean age: 35 years, standard deviation = 12.5, 140 (53%) male] were recruited between December 2020 and December 2021; 132 from Bangladesh, 44 from India and 88 from Pakistan. Interventions: Participants were randomized to one of three treatment options [8‐week support through nicotine replacement therapy (NRT, n = 66), a behavioural intervention for smokeless tobacco cessation in adults (BISCA, n = 66) or their combination (n = 66)] or the control condition of very brief advice (VBA) to quit (n = 66). Measurements Recruitment and retention, data completeness and feasibility of intervention delivery were evaluated. Biochemically verified abstinence from tobacco, using salivary cotinine, was measured at 26 weeks. Findings Retention rates were 94.7% at 6 weeks, dropping to 89.4% at 26 weeks. Attendance in BISCA pre‐quit (100%) and quit sessions (86.3%) was high, but lower in post‐quit sessions (65.9%), with variability among countries. Adherence to NRT also varied (45.5% Bangladesh, 90% India). Data completion for key variables exceeded 93% among time‐points, except at 26 weeks for questions on nicotine dependence (90%), urges (89%) and saliva samples (62.7%). Among follow‐up time‐points, self‐reported abstinence was generally higher among participants receiving BISCA and/or NRT. At 26 weeks, biochemically verified abstinence was observed among 16 (12.1%) participants receiving BISCA and 13 (9.8%) participants receiving NRT. Conclusions: This multi‐country pilot randomized controlled trial of tobacco cessation among adult smokeless tobacco users in South Asia demonstrated the ability to recruit and retain participants and report abstinence, suggesting that a future definitive smokeless tobacco cessation trial is viable. [ABSTRACT FROM AUTHOR]

Introduction: The prevalence of waterpipe tobacco smoking (WPTS) is increasing worldwide. The aims of this study were (a) to evaluate the psychometric properties of the Lebanon Waterpipe Dependence Scale (LWDS-11), and (b) to assess, estimate, and identify factors associated with waterpipe tobacco dependence symptoms among U.K. male adult resident waterpipe tobacco smokers. Methods: A total of 180 waterpipe tobacco smokers were recruited during random visits to 7 outlets serving waterpipe tobacco. Data were collected via face-to-face interviews using the WPTS module of the Global Adult Tobacco Survey and the LWDS-11. Descriptive statistics, exploratory psychometric, univariate, and Poisson regression analysis were employed. Results: Participants’ M/SD age was 29.46/±9.41 years, Arabic ethnicity accounted for 58.3%, and 53.9% had completed more than secondary education. Psychometric analyses for the LWDS-10, after removing 1 item from the generic scale, revealed Cronbach’s alpha coefficient = 0.74. About 47% of the sample demonstrated waterpipe tobacco dependence. Being Arab (p = .040, OR = 2.63, 95% CI = 1.05–6.62), smoking waterpipe daily in the past (p = .003, OR = 2.13, 95% CI = 1.30–3.49), and an increase in length in the last session of WPTS (p = .044, OR = 1.15, 95% CI = 1.00–1.32) were identified as risk factors for waterpipe tobacco dependence. Conclusions: This study demonstrated the potential of LWDS-11 and revealed 2 domains: positive and negative reinforcement and physiological dependence. Results indicated that waterpipe tobacco smokers in the United Kingdom demonstrated tobacco dependence symptoms, which were associated with socio-behavioral factors. Generalizability of these findings and their implications in public health are yet to be investigated. [ABSTRACT FROM PUBLISHER]

Abstract: Ethnopharmacological relevance: Khat is a natural psychostimulant that has pharmacological effects similar to that of amphetamine. The behaviour of khat chewing is embedded within a cultural context. Meanwhile khat chewing is associated with psychological and physiologically burden, as a ‘dependence producing'' substance. Aims of the study: To assess the applicability of the construct of substance dependence syndrome (DSM-IV, 1994) to khat chewing and to examine psychosocial and behavioural correlates of this syndrome including tobacco use. Materials and methods: A sample of 204 khat chewers was recruited during random visits to khat sale outlets. A face to face interview that assessed socio-demographic, psychosocial dependence, substance dependence syndrome and behavioural characteristics was conducted. Descriptive, exploratory psychometric and multivariate analyses were employed. Results: Approximately a third (31%) of khat chewers reported symptoms consistent with dependence syndrome including increased khat chewing (13%) and cessation attempts (19%) while 17% reported withdrawal symptoms including depression (61%), increase in appetite (74%) and interrupted sleep (58%). Thirty-eight percent reported continued khat chewing despite impacts on their health. Psychometric assessment of the DSM-IV criteria for khat chewing dependence identified two factors; factor 1 consisted of bio-behavioural items and factor 2 withdrawal items, accounting for 67% of the variance and Cronbach''s alpha coefficient at 0.78. In multivariate logistic regression modelling, there was an association between intensity of psychological khat dependence (SDS-Khat) and nicotine dependence with the likelihood of exhibiting khat chewing dependence syndrome (p=0.0005, OR=1.51, 95%CI=1.33–1.71; p=0.043, OR=2.87, 95%CI=1.03–7.98, respectively). Conclusions: The substance dependence syndrome criteria are applicable to khat chewing and associated with increased intensity of nicotine and psychological khat dependence. The applicability of khat dependence syndrome and exploration of its dimensions and associated factors should be extended in future research. Concurrent validation of these findings using specific objective measures for self-report khat chewing is also recommended. [Copyright &y& Elsevier]

Aim To evaluate smokeless tobacco cessation in communities of South Asian origin. Design Multi-centre prospective cohort study. Setting Three tobacco cessation services offering specialist smokeless tobacco cessation outreach clinic support to South Asians ( Bangladeshi, Indian and Pakistani) resident in England. Participants A total of 239 South Asian participants seeking to stop smokeless tobacco use between November 2010 and December 2011. Measurements Socio-demographics, tobacco use and dependence, self-reported abstinence at 4 weeks and satisfaction measures. Findings Participants' mean age was 45 [standard deviation ( SD) = 13] years, were predominantly female (76%), of Bangladeshi origin (74%), either home carers (53%) or not working (29%). Sixty-three per cent were recruited from community locations, 21% through a clinical contact and 16% through friends and family. Mean daily number of smokeless tobacco intakes was 10 ( SD = 7) and the mean dependence score was 4.5 ( SD = 1.9). Sixty-three per cent of participants achieved continuous abstinence 4 weeks after quitting. Using nicotine replacement therapy ( NRT) versus not using it [ OR = 3.47, 95% confidence interval ( CI): 1.25, 9.62] and below median (≤8) daily smokeless tobacco intakes ( OR = 1.91, 95% CI: 1.07, 3.40) predicted successful abstinence. Conclusion South Asian smokeless tobacco users resident in England accessing services to help them stop appear to have short-term success rates comparable with smokers attending stop-smoking services, with higher success rates being reported by those using nicotine replacement therapy. [ABSTRACT FROM AUTHOR]

ABSTRACT Aim To identify predictors of short-term smokeless tobacco cessation in Bangladeshi women resident in the United Kingdom. Design Prospective cohort study. Setting A tobacco cessation service offering culturally tailored smokeless tobacco cessation support. Participants A total of 419 Bangladeshi women chewing paan with tobacco. Measurements Demographics, tobacco use and dependence and cessation attempt process and outcomes. Findings Client mean age was 48.92 [95% confidence interval (CI) 47.5, 50.34] years and the mean area social deprivation score was 3.65 (95% CI 3.33, 3.97). Mean daily smokeless tobacco intakes, as paan, was 9.96 (95% CI 9.22, 10.7); 69.8% were recruited from primary care, 78.8% received behavioural support and nicotine replacement therapy (NRT) and the remainder behavioural support alone. Self-reported 4-week continuous abstinence was 58.3%, predicted by NRT use [odds ratio (OR) = 4.93, 95% CI 2.02, 12.00], community recruitment (OR = 1.84, 95% CI 1.01, 3.35) and relatively lower social deprivation (IMD) score (OR = 1.98, 95% CI 1.18, 3.33). Conclusion Bangladeshi women in the UK attending clinics to help cessation of paan with tobacco appear to be more likely to be successful in the short term if they use nicotine replacement therapy, are recruited via the community and have relatively lower levels of social deprivation. [ABSTRACT FROM AUTHOR]

BackgroundLittle is known of paan quid with tobacco (PQT), a hand-made mixture of smokeless tobacco, areca nut, lime and flavourings in a betel leaf, despite its wide use in south Asian communities. This study has explored the price, tobacco types, brands and ingredient weights in vendor assembled PQT in London (England).MethodsThis cross-sectional study identified 31 commercial outlets selling PQT. Outlet staff were invited to assemble PQT for purchase. Individual ingredients were identified and weighed using a calibrated scale. Free nicotine availability was assessed in the laboratory. The data were analysed using frequencies, means, t test and Pearson correlations. Significance was set at p<0.05.Results73 samples were assembled and purchased. Mean total PQT weight was 10.06 g (95% CI 9.26 to 10.86). Mean price was £1.43 (range £0.50–3.50), which varied by location (p=0.001). The most common smokeless tobacco type was zarda (64.4%). Mean tobacco weight was 0.65 g (95% CI 0.56 to 0.76) and the mean lime weight was 0.58 g (95% CI 0.41 to 0.75). While other ingredients did not vary, tobacco and lime mean weights varied by location (p=0.01). Tobacco and lime weights correlated positively (r=0.427, p=0.01). The pH of the tobacco and lime mix varied between 12.2 and 12.5, indicating 99% free nicotine availability.ConclusionsVendor assembled PQT shares similar ingredients but varies by assembly locality, price and tobacco and lime weights. Tobacco and lime weights were balanced to ensure optimal free nicotine availability and dependency potential. [ABSTRACT FROM AUTHOR]

Abstract: Ethnopharmacological relevance: Khat chewing amongst the UK communities originating from Yemen and the East African coast is suggested to create dependency through its main stimulant components (cathinone, norephedrine and norpseudoephedrine) on the central nervous system. Aims of the study: To validate self-reported khat chewing behaviours by measuring levels of cathinone, norephedrine and norpseudoephedrine in saliva and to explore their associations with self-reported khat chewing dependency. Materials and methods: Face-to-face interviews were conducted amongst 30 male UK-resident khat chewers. Saliva samples were collected from each participant and high-performance liquid chromatography (HPLC) employed to extract and quantify the levels of the biomarkers. Results: The mean (SD) for cathinone and the composite norephedrine and norpseudoephedrine levels were 33.93 (±39.20) and 29.28 (±26.32)μg/mL respectively. These biomarkers were significantly associated (p ≤0.05) with khat chewing dependency. Conclusions: Validation of self-reported khat chewing is possible. Khat chewing dependency correlates significantly with biomarker levels in saliva. Replication is required. [Copyright &y& Elsevier]