title: A systematic review of contextual factors relating to smokeless tobacco use among South Asian users in England.
abstract: BACKGROUND
  Certain types of smokeless tobacco (ST) are popular among some people of South Asian origin in England; however, little is known about the contextual factors surrounding use in this population. This systematic review explores the factors associated with ST use among people of South Asian origin in England.
  
  
  METHODS
  An iterative search strategy in targeted databases and grey literature sources was conducted in the summer of 2011. Data extractions and quality assessments were completed and verified by two reviewers, and results were presented as a narrative.
  
  
  RESULTS
  A total of 2,968 references were screened by two reviewers who agreed on the inclusion of 14 studies. ST use is more prevalent among older participants who may have started chewing in India; however, the evidence suggests that some younger English-born South Asians are using ST as well. Reasons for chewing included the use of these products in times of stress, boredom or simply to relax. Traditional health messages and prior held beliefs may lead them to chew these products because of misconceptions about their health benefits, since very few people were aware of the health risks. Many expressed a desire to quit, however found it difficult to go without ST.
  
  
  CONCLUSIONS
  This review examines the complex factors that underpin and influence ST use among South Asians in England with the potential of informing targeted interventions and health policy.
authors.affiliation: University of Sheffield, Section of Public Health, School of Health and Related Research (ScHARR), Sheffield, UK. j.messina@shef.ac.uk
authors.forename: Josie
authors.initials: J
authors.lastname: Messina
authors.forename: Crystal
authors.initials: C
authors.lastname: Freeman
authors.forename: Angie
authors.initials: A
authors.lastname: Rees
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Goyder
authors.forename: Andrew
authors.initials: A
authors.lastname: Hoy
authors.forename: Simon
authors.initials: S
authors.lastname: Ellis
authors.forename: Nicola
authors.initials: N
authors.lastname: Ainsworth
mesh_terms: D001208:Asia / Q000208:ethnology; D004739:England / Q000453:epidemiology; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D012307:Risk Factors; D020340:Tobacco Use Cessation / Q000208:ethnology*; D014029:Tobacco Use Disorder / Q000208:ethnology*; D014030:Tobacco, Smokeless / Q000706:statistics & numerical data*