Behavioural support and nicotine replacement therapy for smokeless tobacco cessation: protocol for a pilot randomised-controlled multi-country trial

on behalf of the ASTRA Global Health Research Group

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Background: Smokeless tobacco (ST) is consumed globally by more than 350 million people, with approximately 85% of all users based in South and Southeast Asia. In this region, ST products are cheap and easily accessible. Evidence-based interventions to people quit ST use are lacking. This study aims to test the feasibility of conducting a future definitive trial of ST cessation, using a culturally adapted behavioural intervention, and/or nicotine replacement therapy (NRT) in three South Asian countries. Methods: We will conduct a factorial design, randomised-controlled pilot trial in Bangladesh, India and Pakistan. Daily ST users will be recruited from primary health care settings in Dhaka, Noida and Karachi. Participants will be individually randomised to receive intervention A (4 or 6 mg NRT chewing gum for 8-weeks), intervention B (BISCA: face-to-face behavioural support for ST cessation), a combination of interventions A and B or usual care (Very Brief Advice - VBA). The participants will provide demographic and ST use related data at baseline, and at 6, 12 and 26 weeks of follow-up. Salivary cotinine samples will be collected at baseline and 26 weeks. The analyses will undertake an assessment of the feasibility of recruitment, randomisation, data collection and participant retention, as well as the feasibility of intervention delivery. We will also identify potential cessation outcomes to inform the main trial, understand the implementation, context and mechanisms of impact through a process evaluation and, thirdly, establish health resource use and impact on the quality of life through health economic data. Discussion: The widespread and continued use of ST products in South Asia is consistent with a high rate of associated diseases and negative impact on the quality of life. The identification of feasible, effective and cost-effective interventions for ST is necessary to inform national and regional efforts to reduce ST use at the population level. The findings of this pilot trial will inform the development of larger trials for ST cessation among South Asian users, with relevance to wider regions and populations having high rates of ST use.

Original languageEnglish
Article number189
Number of pages12
JournalPilot and Feasibility Studies
Issue number1
Publication statusPublished - 22 Aug 2022

Bibliographical note

© The Author(s) 2022.

Funding Information:
The pilot trial is being carried out under ASTRA, a global health research group, and is sponsored by the University of York, UK. ASTRA is funded by the NIHR, using UK aid from the UK government to support global health research (Programme reference 17/63/76/Global Health Research Groups). The funder and the sponsor did not play a role in the design of the pilot trial. The work was also supported by the UK Prevention Research Partnership (UKPRP) an initiative funded by UK Research and Innovation Councils, the Department of Health and Social Care (England) and the UK devolved administrations, and leading health research charities. Linda Bauld’s time is part funded by UKPRP via the SPECTRUM Consortium (Grant ref MR/S037519/1).


  • Asia
  • Nicotine
  • Smokeless
  • Tobacco
  • Tobacco use cessation

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