Barriers to accessing stop smoking services in Bangladeshi men

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Barriers to accessing stop smoking services in
Bangladeshi men

• Ray Croucher
• Professor of Community Oral Health
• Barts The London

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Asian communities in London
(Office for National Statistics April 2001
Census)
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Smoking Prevalence in England by Minority Ethnic
Group
(Health Survey for England, 1999)
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Study aims

• To identify barriers to accessing current tobacco
  cessation services
• To contribute to the development of approaches to
  tobacco cessation which Bangladeshi men perceive
  to be culturally appropriate

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Study methods

• A qualitative investigation using focus groups

Participants recruited to reflect Place of
birth Age Tobacco use status

• Bi-lingual male group moderator

Discussion guide access (Penchansky Thomas,
1981), self-efficacy, quit intentions
experiences

• Community validation

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The participants

• 81 focus group participants
• Elders, restaurant workers, unemployed

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Key themes (Tobacco White Paper, 2005)

• Public policy
• Supportive environments
• Tobacco smuggling
• Nicotine replacement therapy
• Stop Smoking Services

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Different jobs
English jobs or other jobs you cant smoke and
work See the white men, they go tie and suit,
blue collar joband everything, they will have no
smoking environment
Our people they work in restaurants and
factories, its like a little club in there innit,
you go in to smoke .. I think I managed to give
up .. Then I came back to it, cause I was working
in Bengali working environment
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Introducing supportive environments
If there was some sort of message for example
for factory workers, restaurant workers .. If
it was a non-smoking environment then they will
definitely have to give up

• When I was at the bus garage the drivers
• when they come into the garage for their
• 15 minute break, the first thing they do is
• spark up .. The TG came in and said to the
• driver off you go to the snooker room ..
• So instead of sitting in my bus having a fag, I
  go
• to the snooker room .. They did not charge for
  that

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Roll up for duty free

• So everyone is smoking roll ups .. The price of
  cigarettes .. It is too much

• I cannot afford them,
• cigarettes anymore,
• nowadays you can
• buy duty free cigarettes,
• they are cheap in the
• market, oh 2.50

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Traditional tobaccos

• As a result of giving up smoking I took up
  chewing. I would chew large amounts of processed
  tobacco

• In order for me to give up smoking I had to chew
  paan .. Once the urge to smoke went away I also
  stopped chewing paan .. Chewing was also very
  difficult to give up

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Nicotine Levels in Smoked and Traditional Tobacco
Products

• Smoked tobacco
• Cigarette (Benson Hedges, Gold Leaf)
  1.19-1.22 mg nicotine per cigarette.

• Traditional tobacco
• Bidi 2.25 mg nicotine
• Pan Parag gutkha 4.1 mg/g nicotine
• Baba zarda 26.5 mg/g nicotine
• Finely chopped whole leaf 33.8 mg/g nicotine
• Tooth cleaning powder 39.4 mg/g nicotine

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Images of nicotine replacement therapy

• They charge too much and they are aiming at
  totally different target group .. They are aiming
  at white, middle-class people.. These are the
  kind of people you see on adverts

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Challenges for nicotine replacement therapy

• Well, we have never heard of this medicine,
• never seen, do not know what it does

• I do not think it (NRT) will work for me .. Its
  in my mind not in that patch

• I would not spend money on something which
• does not guarantee me success

• My friend told me he does not want to buy
  patches,
• it is same as buying the cigarettes its
  nicotine

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Smoking cessation services

• People around me are
• smokers and I did not
• know where to turn

• If I was aware of
• services I would have
• visited it

• If they have someone
• English, whats the worth
• them going?

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BMEG tobacco prevention resources (Crosier
McNeill, 2003)

• Projects are short term a strategic approach to
  share good practice
• Few previously identified projects still existed
• Little needs assessment at local level
• Regional advocates
• Upstream activity

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Factors for success
Staffing
Accessible outreach work
Recognition of need

• A sustainable
• service

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Acknowledgement
This work was undertaken by Ray Croucher and
Shamsour Choudhury who received funding from the
Department of Health. The views expressed are
those of the author and not necessarily those of
the Department of Health.
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Thanks for listening!
r.e.croucher_at_qmul.ac.uk www.btcp.globalink.org