Kamran Siddiqi Professor in public health University of York Why do ST users need Help with quitting 3 Cotinine levels among tobacco users Smokeless tobacco only mean 117 dips per day 200 users Bangladesh ID: 915628
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Slide1
Smokeless Tobacco (ST) Cessation
Kamran Siddiqi
Professor in public health
University of York
Slide2Slide3Why do ST users need Help with quitting?
3
Slide4Cotinine levels among tobacco users
Smokeless tobacco only (mean 11.7 dips per day) - 200 users Bangladesh
m
ean FTND-ST = 4.7
m
ean cotinine = 361 ng/ml
(Huque et al 2016)
Cigarettes only (mean 10.7 per day) - 207 users in Europemean FTND = 1.7median cotinine = 113 ng/ml(Etter J-F et al 2000)
4
Slide5Courtesy of Prof. Robert West
The battle
between
resolve and urge to
use tobacco
Urge to
use tobacco
Time
When the urge is stronger than resolve
and
tobacco is available
, a lapse will occur
Resolve
Strength of urge
Slide6The role of treatment is to keep these lines as far apart as possible
Urge to
use tobacco
Time
Resolve
Strength of urge
Courtesy of Prof. Robert West
Slide7Global tobacco use
7
Slide8Global tobacco use
8
ST
ST
ST
Slide9Cessation s
tudies
(Cochrane reviews)
9
Slide1010
ST
ST
ST
ST
ST
ST
ST
ST
ST
ST
ST
ST
Global
ST use
Slide1111
ST
ST
ST
ST
ST
ST
ST
ST
ST
ST
ST
ST
Global
ST use
Slide12Why ST cessation studies?
South Asia
ST
product profile, user characteristics and behavioural determinants are different from
the US
ST
products can be highly alkaline, enhancing nicotine absorption and addictivenessA strong
socio-cultural dimension to ST use12
Slide13ST cessation - evidence
13
Slide14ST cessation - evidence
14
Slide15ST cessation - evidence
R
ecommends
behavioural support only and excludes use of pharmacotherapies, but
recommends
research to assess these
15
Slide16Behavioural support Intervention for Smokeless tobacco Cessation in south Asians (BISCA)
Slide1717
Collaborators
Aga Khan University/
National Alliance Tobacco Control
Local NHS sites in the UK
Co-authors
Omara Dogar,
Rukhsana Rashid, Cath Jackson, Ian Kellar, Nancy O’Neill, Maryam Hassan, Furqan Ahmed, Mohammad Irfan, and Javaid Khan FundingMRC Scheme
Slide1818
Study aim
Development of a bespoke Behavioural Change Intervention (BCI) to help south Asians in quitting ST and its evaluation in Pakistan and the UK
Slide19Development of BCI
19
Identification and selection of ST determinants and relevant behaviour change techniques (BCTs)
Literature review
Expert consensus-Nominal Group Technique (NGT)
Generation of culturally appropriate activities
Expert consensus
Post-hoc refinement of the resourceExpert consensus (2 further meetings)
ST
Determinant
Linked BCTs
Activities
Lack of information on the constituents of SLT products (unaware that the product contains tobacco)
Lack of information on the health effects of SLT productsProvide information on consequences of tobacco and tobacco cessationInformation about health consequencesSalience of consequencesExplain that product contains tobaccoProvide information about the harmful ingredients in tobacco
Slide20Study settings/participants
20
Sites
Intervention (pre-quit, quit , post-quit)
Participants (32
clients, 9
advisors)
Cotinine testing- baseline and 6 months
Slide21Fidelity to deliver BCI
21
Fidelity index (Adherence and Quality)
Observation of client-advisor interactions
Coding of audio-recorded observations
Activities
Scale
Score
Provide
information about the harmful ingredients in tobacco
0= not implemented
1= partially implemented
2= fully implemented
Slide22The BCI resource
22
Structure
Flipbook
Client booklet and calendar
Content
Harms of ST use and benefits of quitting
Boosting clients’ motivation and self-efficacyTriggers and withdrawal symptoms management
Slide23Participant characteristics
23
Baseline data (100%) and 6-month follow-up (64%)
30/32 participants used ST on daily basis
Quantity used/addiction higher in Pakistan than UK
Most common forms used- Betel Quid and
Gutka
Cotinine levels were higher in Pakistan
UK –saliva
cotinine concentration ng/ml
Baseline
Follow-up
N
1610Min10.1Max577.1609
Mean (SD)237.1 (194.62)174.3 (220.7)Pakistan –urine cotinine dipstick level (cotinine equivalent ng/mL)BaselineFollow-up<3 (1-100)
103
(100-200)00
4 (200-500)0
65 (500-2000)0
16 >2000
156
Missing 0
3
Slide24Site ID
Fidelity index scores
Mean (SD
**
)
N
*
Adherence Index
Quality Index
1
5
23.8 (8.4)
11.6 (5.4)
2511.2 (2.1)1.4 (0.9)3
229.0 (16.9)10.0 (5.7)4414.8 (3.2)6.8 (3.8)51642.6 (1.9)
14 (0)* N is the number of participants with data available **SD is the standard deviation of the mean
Fidelity to deliver BCI
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Slide25Feasibility and acceptability of delivering BCI
25
Triggers management helped build self-efficacy
Negative images found to be motivating
Self-reward and challenging social norms- not effective
Abrupt cessation versus reduction to quit approach
Need family and social support
Slide26Smokeless tobacco cessation App
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App details:
https
://www.york.ac.uk/healthsciences/research/public-health/archive/adapting-behavioural-support-intervention/#
tab-3
http://bit.ly/1rTNPHK
http://amzn.to/26SBXp0
http://apple.co/1SYaYBp
http://bit.ly/1SYb1Nw
Slide27Slide28Slide29Thank you!
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