A survey of South Asian males, resident in the UK, with regard to oral cancer risk

Key Points

• The Asian community living in the UK is diverse and should not be considered as being a culturally homogeneous group.

• Significant differences exist between the various community groups with respect to alcohol drinking, tobacco smoking and paan chewing.

• Alcohol use is generally high among the Sikh population who tend not to use tobacco and paan. In contrast, Muslims may smoke and use paan widely but refrain from drinking alcohol.

• Habits may frequently be combined, especially among Hindu males; with the synergy between alcohol, tobacco and paan use being a considerable risk factor in the aetiology of oral cancer.

Abstract

Objectives To determine use of alcohol, tobacco and paan among males from the various Asian communities in Leicester; and assess their knowledge and attitudes towards oral cancer risk factors and prevention. Also, to determine any differences regarding habits and attitudes between first and second generation Asians.

Design Volunteers completed a confidential, bilingual questionnaire regarding alcohol, tobacco and paan use and also knowledge about oral cancer risk factors and preventive measures.

Setting Participants were recruited from sources that included GPs' surgeries, sixth form colleges and places of worship.

Subjects Asian males, i.e. those of Indian, Pakistani, Bangladeshi or Sri Lankan origin; over the age of 16 years and resident in Leicester.

Main outcome measures Quantitative figures were obtained from the questionnaires as to the frequency of alcohol, tobacco and paan use and responses regarding oral cancer knowledge, risk factors and preventive measures.

Results The principal Asian community groups in Leicester were Hindu, Sikh, Muslim and Jain. Significant differences were found in males from these groups with regards to habits and oral cancer awareness. Muslim males use tobacco and paan more than the other groups but avoid alcohol. Sikh males drink more alcohol (especially spirits) than the other groups but their use of tobacco and paan is low. Habits of Hindu and Jain males are variable. However, approximately 10% of both 1st and 2nd generation Hindu males combine all three habits of alcohol, tobacco and paan; and are thus considered to be at high risk of developing oral cancer. Seven percent of 1st generation Hindu males were found to chew paans containing tobacco which are strongly associated with oral cancer. More 2nd generation Jains drank alcohol than the 1st generation, and a greater proportion of Hindu, Sikh and Jain 2nd generation males drink spirits than their older counterparts. Knowledge of oral cancer risk factors and preventive measures were variable, the lowest level of knowledge being among the 1st generation Sikh group. Few volunteers realised the risk of alcohol drinking in the aetiology of oral cancer.

Conclusion The 'Asian' community in Leicester is not homogeneous, but consists of distinct community groups; each with their own cultural beliefs, habits and attitudes. Knowledge of these differences can be used to provide appropriate health education programmes suitably targeted to reduce the use of the known risk factors for oral cancer.

Main

Alcohol, tobacco and paan use and understanding of oral cancer risk among Asian Males in Leicester Vora A. R., Yeoman C. M., and Hayter J. P. Br Dent J 2000; 188: 444–451

Comment

Cancer prevention and care along with smoking cessation programmes have been a significant component of the government's public health strategy. In oral cancer terms this has rightly focused upon early diagnosis and prevention targeted at alcohol and tobacco use.

The South Asian Community (SA) represents almost 3% of the total UK population, and is one of the fastest growing minority ethnic groups. Alcohol and tobacco use (both smoking and chewing) have been reported for this group but little in-depth research has been undertaken with regard to this community's understanding of the oral cancer risk.

This paper presents use, knowledge and attitude of alcohol, tobacco and paan use in a group of South Asian men (Indian, Pakistani, Bangladeshi or Sri Lankan) resident in Leicester. Differences in use and attitude towards oral cancer risk were explored according to the individual's place of birth and religious background.

Volunteers from medical practices, sixth form colleges, places of worship and shopping centres were recruited to complete a self-administered questionnaire. Alcohol consumption varied between those who considered themselves as first rather than second generation South Asians, with the highest levels consumed being in the Sikh community. Although relatively few of the Muslim community used alcohol their levels of tobacco use were high, with 44% of Muslim males regularly using tobacco. It was notable that second generation Muslim males were less likely to smoke compared with their elders.

Knowledge regarding oral cancer risk factors and preventive measures was found to be variable, with the lowest levels among first generation Sikhs. Alarmingly, few respondents in the study realized the risk of alcohol drinking in the aetiology of oral cancer. A more in-depth analysis of the data may help in our understanding of the interactions between ethnicity, age, religious background and place of birth.

The importance of this study is primarily in highlighting the variability in the South Asian community with regard to their knowledge, use and attitude towards the classical oral cancer risk factors. These variations would not have been self-evident simply using the ethnic groupings adopted in the 1991 census. However, using additional variables such as religious background and place of birth have allowed a better understanding of the priority areas for oral cancer health promotion. It is therefore encouraging that the inclusion of religious background is being planned for the 2001 national census.