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Abdullah SM, Huque R, Siddiqi K, Kanaan M, Huque S, Ullah S, Garg S, Singh MM, Deshmukh C, Borle AL, Iqbal R, Mazhar L, Parascandola M, Mehrotra R, Croucher R, Khan Z. Non-compliant packaging and illicit smokeless tobacco in Bangladesh, India and Pakistan: findings of a pack analysis. Tob Control 2024; 33:333-340. [PMID: 36167826 DOI: 10.1136/tc-2021-057228] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 09/13/2022] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Illicit smokeless tobacco (ST) trade has seldom been documented despite ST use in at least 127 countries across the world. Based on non-compliance with packaging regulations, we report the proportion of illicit ST products from samples on sale in Bangladesh, India and Pakistan where 85% of global ST users reside. METHODS We purchased unique ST products from tobacco sellers in two purposively selected administrative areas (division/district) in each of the three countries. The criteria to determine illicit ST products were based on country-specific legal requirements for ST packaging and labelling. These requirements included: 'market retail price disclosure', 'sale statement disclosure', 'pictorial health warning (PHW) pertinence', 'appropriate textual health warning' and 'using misleading descriptors (MDs)'. Non-compliance with even one of the legal requirements was considered to render the ST product illicit. RESULTS Almost all ST products bought in Bangladesh and India were non-compliant with the local packaging requirements and hence potentially illicit, all products in Pakistan lacked desirable features. The most common feature missing was health warnings: 84% packs in Bangladesh, 93% in India, and 100% in Pakistan either did not have PHW or their sizes were too small. In Bangladesh, 61% packs carried MDs. In India and Pakistan, the proportions of such packs were 32% and 42%, respectively. CONCLUSIONS Weak and poorly enforced ST control policies may be slowing the progress of tobacco control in South Asia. Standardised regulations are required for packaging and labelling ST. Improving compliance and reducing sale of cheap illicit products may require business licensing and market surveillance.
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Affiliation(s)
- S M Abdullah
- Health Sciences, University of York, York, UK
- Department of Economics, University of Dhaka, Dhaka, Dhaka District, Bangladesh
| | - Rumana Huque
- Department of Economics, University of Dhaka, Dhaka, Dhaka District, Bangladesh
- Research and Development, ARK Foundation, Dhaka, Bangladesh
| | | | - Mona Kanaan
- Health Sciences, University of York, York, UK
| | - Samina Huque
- Research and Development, ARK Foundation, Dhaka, Bangladesh
| | - Safat Ullah
- Office of Research Innovation and Commercialization, Khyber Medical University, Pehsawar, Khyber Pakhtunkhwa, Pakistan
| | - Suneela Garg
- Department of Community Medicine, Maulana Azad Medical College and Associated Hospitals, New Delhi, Delhi, India
| | - Mongjam Meghachandra Singh
- Department of Community Medicine, Maulana Azad Medical College and Associated Hospitals, New Delhi, Delhi, India
| | - Chetana Deshmukh
- Department of Community Medicine, Maulana Azad Medical College and Associated Hospitals, New Delhi, Delhi, India
| | - Amod L Borle
- Department of Community Medicine, Maulana Azad Medical College and Associated Hospitals, New Delhi, Delhi, India
| | - Romaina Iqbal
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Laraib Mazhar
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
- Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Mark Parascandola
- National Cancer Institute, Division of Cancer Control and Population Sciences, Bethesda, Maryland, USA
| | - Ravi Mehrotra
- Indian Council of Medical Research (ICMR) - Indian Cancer Research Consortium, New Delhi, Delhi, India
| | | | - Zohaib Khan
- Office of Research Innovation and Commercialization, Khyber Medical University, Pehsawar, Khyber Pakhtunkhwa, Pakistan
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Vegetables and fruits retailers in two urban areas of Bangladesh: Disruption due to COVID- 19 and implications for NCDs. PLoS One 2023; 18:e0280188. [PMID: 36626398 PMCID: PMC9831295 DOI: 10.1371/journal.pone.0280188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 12/22/2022] [Indexed: 01/11/2023] Open
Abstract
Bangladesh is experiencing an increasing prevalence of diet-related non-communicable diseases (NCDs). Considering daily total requirement of 5 servings as minimum recommended amount, 95.7% of people do not consume adequate fruit or vegetables on an average day in the country. Imposition of lockdown during COVID-19 created disturbance in fresh fruits and vegetable production and their retailing. This incident can make these dietary products less affordable by stimulating price and trigger NCDs. However, little is known about the supply chain actors of healthy foods such as vegetables and fruits in urban areas, and how they were affected due to pandemic. Aiming toward the impact of COVID-19 on the business practices and outcomes for the vegetables and fruits retailers in Bangladesh, a survey of 1,319 retailers was conducted in two urban areas, namely Dhaka and Manikganj from September 2021 to October 2021. To comprehend the impact of COVID-19 on the profit margin of the retailers and on the percentage change in sales, a logistic and an Ordinary Least Squares (OLS) regression were estimated. Significant difference in the weekly business days and daily business operations was observed. The average daily sales were estimated to have a 42% reduction in comparison to pre-COVID level. The daily average profit margin on sales was reportedly reduced to 17% from an average level of 21% in the normal period. Nevertheless, this impact is estimated to be disproportionate to the product type and subject to business location. The probability of facing a reduction in profit margin is higher for the fruit sellers than the vegetable sellers. Contemplating the business location, the retailers in Manikganj (a small city) faced an average of 19 percentage points less reduction in their sales than those in Dhaka (a large city). Area-specific and product-specific intervention are required for minimizing the vulnerability of retailers of vegetables and fruits and ensuring smooth supply of fruits and vegetables and increasing their uptake to combat diet related NCD.
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Forberger S, Khan Z, Ahmad F, Ahmed F, Frense J, Kampfmann T, Ullah S, Dogar O, Siddiqi K, Zeeb H. Scoping Review of Existing Evaluations of Smokeless Tobacco Control Policies: What Is Known About Countries Covered, Level of Jurisdictions, Target Groups Studied, and Instruments Evaluated? Nicotine Tob Res 2022; 24:1344-1354. [PMID: 35428887 DOI: 10.1093/ntr/ntac102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 03/17/2022] [Accepted: 04/12/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The implementation of smokeless tobacco control policies lags behind those for smoking. This scoping review summarizes the studies that evaluated public policies on smokeless tobacco regulation (SLT) and provides an overview of the jurisdictional level, target groups, and policy instruments. METHODS Seven databases were systematically searched for studies reporting on public policies regulating SLT. Two reviewers independently screened all studies. Data extraction was performed using a predefined extraction form. Extraction was replicated for 10% of the identified studies for quality assurance. A narrative synthesis of the included studies was used to analyze and interpret the data. The protocol was published beforehand with the Open Science Foundation (OSF). RESULTS Fourty articles comprising 41 studies were included. Most of the studies reported in the articles were conducted in the United States (n = 17) or India (n = 14). Most studies reported outcomes for students (n = 8), retailers/sellers (n = 8), and users/former users (n = 5). The impact of public policies on smokeless tobacco use, in general, was most frequently assessed (n = 9), followed by the impact of taxes (n = 7), product bans (n = 6), sales/advertising bans near educational institutions (n = 4), and health warnings (n = 3) on consumer behavior. CONCLUSIONS There are significant gaps in the evaluation of smokeless tobacco regulation studies that need to be filled by further research to understand the observed outcomes. WHO reporting on Framework Convention on Tobacco Control (FCTC) implementation should be linked to studies evaluating smokeless tobacco control measures at all levels of jurisdictions and in countries not members of the WHO FCTC or do not provide data. IMPLICATION Large gaps in the evaluation of SLT control policies exist. For some countries, WHO FCTC evaluations are available for different levels of jurisdictions. In countries with a strong federal structure, there is a lack of data beyond the national level to provide a more detailed look at compliance, indirect effects, or implementation gaps. More research is needed at all levels of jurisdictions, which add to the work of the WHO to understand what works for which target group, how the different levels of jurisdiction interact, how the real-world context can be incorporated, and what indirect effects may occur.
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Affiliation(s)
- Sarah Forberger
- Department Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstrasse 30, 28359 Bremen, Germany
| | - Z Khan
- Office of Research, Innovation, and Commercialization (ORIC), Khyber Medical University, Phase 5 Hayatabad, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - F Ahmad
- Faculty Institute of Public Health & Social Sciences, Khyber Medical University, F1 Phase-6 Rd, Phase 5 Hayatabad, Peshawar, Khyber Pakhtunkhwa 25100, Pakistan
| | - F Ahmed
- Department Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstrasse 30, 28359 Bremen, Germany
| | - J Frense
- Department Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstrasse 30, 28359 Bremen, Germany
| | - T Kampfmann
- Institute for Ethics and Transdisciplinary Sustainability Research, Leuphana University Universitätsallee 1, 21335 Lüneburg, Germany
| | - S Ullah
- Office of Research Innovation and Commercialization, Khyber Medical University Peshawar; Phase 5 Hayatabad, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - O Dogar
- Department of Health Sciences, University of York, Heslington, York YO10 5DD, UK
- Usher Institute, The University of Edinburgh, Old College, South Bridge, Edinburgh EH8 9YLUK
| | - K Siddiqi
- Department of Health Sciences, University of York, Heslington, York YO10 5DD, UK
- Hull York Medical School, John Hughlings Jackson Building, University Rd, Heslington, York YO10 5DD, UK
| | - H Zeeb
- Department Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstrasse 30, 28359 Bremen, Germany
- Health Sciences Bremen, University of Bremen, 28359 Bremen, Germany
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