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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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Chatterjee S, Gawde NC, Gupta PC. Prevalence, Reach of Anti-smokeless Tobacco Messages and Quit Attempts by Product Type: A Secondary Data Analysis from the Global Adult Tobacco Survey (GATS - 2016-17). Asian Pac J Cancer Prev 2024; 25:1277-1283. [PMID: 38679988 PMCID: PMC11162704 DOI: 10.31557/apjcp.2024.25.4.1277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 04/07/2024] [Indexed: 05/01/2024] Open
Abstract
OBJECTIVE India has the highest number of smokeless tobacco (SLT) products available in different forms, consumed in various ways. The current study aimed to understand the pattern of daily SLT use according to different product categories and whether Quit intention and Quit attempts vary by SLT type and exposure to media messages. METHODS Data from Global Adult Tobacco Surveys (GATS), 2016-17, was used to find access to media messages and warning labels by SLT type. Quit attempt and Quit intention were calculated for each of the SLT types. Logistic regression analyses were employed to identify whether access to media messages, warning labels influenced, quit intention and attempts vary by SLT type. RESULTS Khaini or tobacco lime mixture was the most common SLT type consumed by 37% of SLT users, whereas SLT users consuming more than one product accounted for 23% of SLT users. Exposure to media messages and warning labels was high among Gutkha/ paan masala tobacco users (74.7% and 81.2%) and low among oral tobacco (Mishri, Gul, Gudakhu) users (56.1% and 60.0%). Quit attempts and quit intention were high among Gutkha/ paan masala tobacco users (38.3% and 22.3%) and low among oral tobacco (Mishri, Gul, Gudakhu) users (25.3% and 13.6%). Users of Oral tobacco and khaini or tobacco-lime mixture were significantly less likely to attempt quitting (AOR 0.806(95%CI: 0.676-0.962), 0.839(95%CI: 0.736-0.956), and have quit intention (AOR 0.681(95%CI: 0.702-0.976), 0.733(95%CI: 0.627-0.857) compared to Gutkha/ paan masala with tobacco users. CONCLUSION The reach of media messages and warning labels varies by SLT type. Quit intention and attempts vary by SLT type and access to media messages and warning labels. There is a need to re-strategise the tobacco control Information, Education and Communication (IEC) to reach out with effective messaging to the most unreached.
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Affiliation(s)
- Shraddha Chatterjee
- School of Health Systems Studies, Tata Institute of Social Sciences, Deonar, Mumbai, India.
| | - Nilesh C Gawde
- School of Health Systems Studies, Tata Institute of Social Sciences, Deonar, Mumbai, India.
- Research Scholar, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, India.
| | - Prakash C Gupta
- Director, Healis - Sekhsaria Institute of Public Health, Navi Mumbai, India.
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Bhatia M, Sharma N, Saifi S, Parashar S, Nisha N, Srivastava R, Jain M. Evolution of tobacco control in India: a narrative review of the legislative and regulatory approach. REVIEWS ON ENVIRONMENTAL HEALTH 2024; 39:1-12. [PMID: 36103211 DOI: 10.1515/reveh-2022-0160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 08/28/2022] [Indexed: 06/15/2023]
Abstract
Tobacco is the only consumer product that kills half its users yearly. The challenges posed by tobacco control are limitless especially in a country like India where in addition to smoked forms, other smokeless forms of tobacco are also highly prevalent. Apart from being a health hazard tobacco is also a great environmental hazard. Policies for controlling tobacco use also include policy to prevent people from second hand smoke, which is aimed at improvement of air quality. According to the National Non-Communicable Disease Monitoring Survey, 2017-18, daily tobacco use was 32.8% in adults (18-69 years) and 3.1% in adolescents (15-17 years). Overall reduction in tobacco users by 8.1 Million was seen from GATS-1 to GATS-2, and prevalence amongst youth decreased from 18.4 to 12.4%. GYTS-4 (2019) revealed that 8.5% of students, 9.6% of boys and 7.4% of girls-currently used any tobacco products. This makes tobacco control a priority in India. Tobacco control consists of different approaches such as educational, healthcare, legislative, regulatory and fiscal. In the present article we traverse nearly five decades and decode the evolution of legislative, regulatory and fiscal approaches to Tobacco Control in India. A critical evaluation of all these approaches is described in the format of the MPOWER strategy for Tobacco Control which stands for Monitoring Tobacco use, Preventing people from Second Hand Smoke, Offering help to quit, Waring regarding ill effects of tobacco, Enforcing bans and Raising taxes on tobacco products.
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Affiliation(s)
- Muskan Bhatia
- Manav Rachna Dental College and Hospital, Faridabad, India
| | - Nikita Sharma
- Manav Rachna Dental College and Hospital, Faridabad, India
| | | | - Swati Parashar
- Manav Rachna Dental College and Hospital, Faridabad, India
| | - Nisha Nisha
- Manav Rachna Dental College and Hospital, Faridabad, India
| | - Roomani Srivastava
- Faculty of Dental Sciences, Manav Rachna Dental College and Hospital, MRIIRS, Faridabad, India
| | - Meena Jain
- Department of Public Health Dentistry, Faculty of Dental Sciences, Manav Rachna Dental College, MRIIRS, Faridabad, India
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Naik BN, Nirala SK, Patil S, Rao R, Yankannavar BS. Determinants of awareness on pictorial health warnings on tobacco products in an Eastern state of India. J Family Med Prim Care 2023; 12:3266-3270. [PMID: 38361852 PMCID: PMC10866222 DOI: 10.4103/jfmpc.jfmpc_822_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/03/2023] [Accepted: 07/31/2023] [Indexed: 02/17/2024] Open
Abstract
Background Pictorial health warnings (PHW) are an effective strategy to deter or reduce tobacco use. This study was conducted to determine the level of awareness of PHWs on tobacco products and their correlates among adults attending the outpatient department (OPD) of a tertiary care facility in Eastern India. Materials and Methods This cross-sectional study was conducted over a period of 3 months among 307 patients aged 18 years to 65 years. A pre-tested semi-structured questionnaire was used for the collection of data and inferential statistics were performed using JAMOVI version 2.3.21. Results About 84% (95% CI, 78.9-87.2) of the participants were aware of PHW on tobacco products, 82.4% (95% CI, 77.8-86.3) for smoked forms and 51.8% (95% CI, 46.2-57.3) for smokeless forms. More than half of the participants felt that the current PHW were ineffective. Male [AOR, 3.13; 95% CI, 1.33-7.37], being educated [AOR, 3.37; 95% CI, 1.29-8.76], employment [AOR, 5.65; 95% CI, 1.21-26.30] and ever-tobacco use [AOR, 3.23; 95% CI, 1.43-7.2] were found to be independent correlates of PHW awareness for smoked tobacco products, whereas as being male [AOR, 2.01; 95% CI, 1.02-3.95] and being young (18-30 years) [AOR, 2.51; 95% CI, 1.08-5.84] were found to be the independent predictors of PHW awareness for smokeless tobacco products (SLT). Conclusion Four out of every five individuals were aware of pictorial health warnings (PHW) on tobacco products; however, it was much less for SLT compared to smoked tobacco products. Male, being educated, employment and ever-tobacco use were independent correlates of awareness for the smoked form of tobacco products, whereas being young (18-30 years) was an independent predictor of awareness for SLT.
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Affiliation(s)
- Bijaya N. Naik
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Santosh K. Nirala
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Shreyas Patil
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Rajath Rao
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Basavaraj S. Yankannavar
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Patna, Bihar, India
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Ravi P, Agarwal D, Purohit BM, Bhadauria US, Priya H. Qualitative Analysis of Opinions and Beliefs Associated with the Use of Tobacco Dentifrice among Individuals Attending a Tobacco Counselling Session. Asian Pac J Cancer Prev 2023; 24:4293-4300. [PMID: 38156866 PMCID: PMC10909080 DOI: 10.31557/apjcp.2023.24.12.4293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 12/17/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND Smokeless tobacco (SLT) use is positively associated with oral, oesophageal, and pancreatic cancers. The tobacco dentifrice is a type of SLT which is applied to the teeth and gums. It is available in different forms which include mishri, gul/gulmanjan, gudhaku, snuff, red tooth powder, and creamy snuff. This qualitative study aims to explore the opinions and beliefs associated with the harmful effects of tobacco dentifrice use. METHODOLOGY Thirty in-depth interviews were conducted among tobacco dentifrice users visiting a dental hospital. The data were coded and analysed using thematic analysis in ATLAS.ti software 8. RESULTS A total of 11 codes and six categories were generated which comprised of the reason for the initiation, awareness of health effects, perception of oral tobacco application, perception of quitting, the reason for continued use, and use in society. Family, peers, access to the product, curiosity were important factors to initiate the tobacco dentifrice use. Participants believed in the myth that tobacco dentifrice was beneficial for the teeth, gums, and bowel movements. The participants considered tobacco dentifrice to be less harmful than other forms of tobacco. However, some participants were aware of its adverse effects on health and have tried to quit in the past. None of the participants had taken any professional help for quitting. CONCLUSION There were strong beliefs and myths among the participants that tobacco dentifrice was beneficial for oral and general health. There is a need to create awareness and improve the standard of the health warning of such products.
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Affiliation(s)
| | | | | | | | - Harsh Priya
- Department of Public Health Dentistry, Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India.
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Gupta B, Kumar N, Mahajan A. Awareness about Tobacco Causing Head and Neck Cancers via Mass Media: A Case-Control Study from India. Asian Pac J Cancer Prev 2023; 24:2593-2600. [PMID: 37642044 PMCID: PMC10685227 DOI: 10.31557/apjcp.2023.24.8.2593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 08/19/2023] [Indexed: 08/31/2023] Open
Abstract
OBJECTIVE This study aimed to assess the awareness of people about the adverse effects of tobacco (smoking and chewing) consumption causing head and neck cancers (HNCs) via mass media channels like television, cinema, radio and newspapers or magazines, wall painting or billboards / hoardings, public transportation and packets of chewing tobacco, bidis or cigarettes. METHODS Hospital-based case-control was conducted in Pune, Maharashtra, India. Face to face interviews were conducted for the purpose of data collection on 225 cases and 240 controls. The relationship between two categorical variables were estimated using chi-square test with a 2-tailed P value of <.05. SPSS software was used for data analysis. RESULTS Controls as compared to cases had good awareness scores for chewing (59.9%) and smoking tobacco (63.7%), P<0.001. The most common form of mass media was television where the cases (60.4%) and controls (77.9%) had heard messages about tobacco in chewing and smoking form causing HNCs. Level of awareness of tobacco causing HNCs amongst tobacco users, stratified by their status (cases versus controls) showed that cases were 1.68 times less likely than controls to have heard or seen messages about the association between chewing tobacco and HNCs via radio. Males (61.3% and 61.0%) had significantly (P<0.001) more awareness as compared to females (46.9% and 43.5%) about chewing and smoking tobacco as a causal factor for HNCs. CONCLUSION Mass media needs to create a social environment which discourages tobacco consumption and promotes oral health at the population level. Additionally, there should be easy access to the availability of support services like Quitline and other community support services.
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Affiliation(s)
- Bhawna Gupta
- Department of Public health Torrens University Melbourne, Australia.
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Ahmad F, Khan Z, Siddiqi K, Khan MN, Kibria Z, Forberger S, Bauld L, Kanaan M, Zeeb H. Awareness, perceptions of and compliance with tobacco control policies among naswar vendors in Khyber Pakhtunkhwa Pakistan. Tob Control 2022; 31:e111-e117. [PMID: 34226260 DOI: 10.1136/tobaccocontrol-2020-056377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 05/03/2021] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Regulatory compliance in the retail environment is integral to the success of tobacco control. We assessed compliance among naswar (smokeless tobacco product widely used in South Asia) vendors with tobacco control laws. We also assessed their awareness of tobacco-related harms and policies and perceived effect of policies on their sales. METHODS We surveyed 286 naswar vendors in three districts of the Khyber Pakhtunkhwa province of Pakistan. We recruited general and specialty vendors from urban and rural areas through multistage cluster sampling. Compliance was measured for promotion, sale to/by minors and tax paid on naswar. We used logistic regression analyses for assessing the association between the outcome variables (awareness of tobacco harms and laws, perceptions about the effect of policies on business and compliance with laws) and their predictors. RESULTS Most vendors (70%) were aware of tobacco-related harms of naswar. Although educated vendors were more aware of tobacco control policies, the greatest awareness was for a ban on sales to/by minors (21% overall). The majority of vendors (76%) violated this policy (measured by self-report), and violations were more common among rural than urban vendors (OR 2.27, 95% CI 1.05 to 4.96). Most vendors (71%) violated a ban on promotion of naswar. Vendors perceived tax increases and sales ban to/by minors as most detrimental for business. CONCLUSIONS There was poor awareness and compliance among naswar vendors in Pakistan with tobacco control laws. This study finds potential areas for policy interventions that can reduce urban/rural disparities in implementation of and compliance with tobacco control laws.
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Affiliation(s)
- Fayaz Ahmad
- Institute of Public Health and Social Sciences, Khyber Medical University, Peshawar, Pakistan
- Office of Research, Innovation and Commercialization, Khyber Medical University, Peshawar, Pakistan
| | - Zohaib Khan
- Office of Research, Innovation and Commercialization, Khyber Medical University, Peshawar, Pakistan
| | - Kamran Siddiqi
- Institute of Health Sciences, University of York, UK, York, UK
| | - Muhammad Naseem Khan
- Institute of Public Health and Social Sciences, Khyber Medical University, Peshawar, Pakistan
| | - Zeeshan Kibria
- Institute of Public Health and Social Sciences, Khyber Medical University, Peshawar, Pakistan
- Office of Research, Innovation and Commercialization, Khyber Medical University, Peshawar, Pakistan
| | - Sarah Forberger
- Leibniz Institute for Prevention Research and Epidemiology, Bremen, Germany
| | - Linda Bauld
- Usher Institute and UK Centre for Tobacco and Alcohol Studies, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Mona Kanaan
- Health Sciences, University of York, York, UK
| | - Hajo Zeeb
- Prevention and Evaluation, Leibniz-Institute for Prevention Research and Epidemiology, Bremen, Germany
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Goyal LD, Verma M, Garg P, Bhatt G. Variations in the patterns of tobacco usage among indian females - findings from the global adult tobacco survey India. BMC Womens Health 2022; 22:442. [DOI: 10.1186/s12905-022-02014-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 10/18/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Males dominate in tobacco usage, as well as in tobacco research, knowing that women face more severe health consequences. There is a specific lack of information on epidemiological statistics, risks, and the level of knowledge among women regarding tobacco. This study examines the Global Adult Tobacco Survey (GATS)-India dataset to estimate female tobacco usage and assess socio-economic variations in tobacco consumption, awareness regarding the adverse effects of tobacco, noticing pack health warnings (PHW), and intention to quit tobacco use well as factors influencing these domains.
Methods
Using a geographically clustered multistage sampling method, the nationally representative GATS II (2016–17) interviewed 40,265 female respondents aged 15 years and above from all Indian states and union territories. Standard operational definitions were used to estimate the primary independent variables (community, individual, and household categories) and dependent variables like awareness regarding the adverse effects of tobacco, noticing pack health warning (PHW), and intention to quit tobacco. Sampling weights were adjusted while performing the analysis. Bivariate and multivariable analysis were used to generate the estimates.
Results
Of the total female respondents, 84.2% were never-users, 13.3% ever consumed Smokeless Tobacco (SLT) products, 1.8% ever smoked tobacco, and 0.8% were dual users once in their lives. Around 16% of the women had exposure to Second Hand Smoke (SHS) either at their homes, workplaces or in public places. Overall, maximum awareness was seen among non-smoker females (64.7%) and dual users (64.7%), followed by women exposed to SHS, SLT users, and smokers. PHW was noticed more by the bidi smokers, followed by SLT users and cigarette smokers. Factors that positively affected intention to quit smoking included younger age, secondary school education, self-employed status, the habit of buying packed cigarettes/bidi, believing that smoking causes serious illness, and attempted quitting in the last 12 months.
Conclusion
A high proportion of women consume tobacco which is significantly influenced by socio-demographic factors. Tobacco regulators should be especially concerned about women as the tobacco marketing experts target them. Mobilizing self-help groups and organizations working for women and children could assist broader campaigns to generate awareness and motivate quitting attempts.
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Crespi E, Iacobelli M, Welding K, Saraf S, Clegg Smith K, Cohen JE. Industry manipulation of pictorial health warning labels in Pakistan. Tob Control 2021; 31:687-688. [PMID: 33863834 PMCID: PMC9411902 DOI: 10.1136/tobaccocontrol-2020-056433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 03/11/2021] [Accepted: 03/18/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Elizabeth Crespi
- Department of Health, Behavior & Society, Institute for Global Tobacco Control, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Michael Iacobelli
- Department of Health, Behavior & Society, Institute for Global Tobacco Control, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kevin Welding
- Department of Health, Behavior & Society, Institute for Global Tobacco Control, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Sejal Saraf
- Department of Health, Behavior & Society, Institute for Global Tobacco Control, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Katherine Clegg Smith
- Department of Health, Behavior & Society, Institute for Global Tobacco Control, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Joanna E Cohen
- Department of Health, Behavior & Society, Institute for Global Tobacco Control, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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Khan Z, Huque R, Sheikh A, Readshaw A, Eckhardt J, Jackson C, Kanaan M, Iqbal R, Akhter Z, Garg S, Singh MM, Ahmad F, Abdullah SM, Javaid A, A Khan J, Han L, Rahman A, Siddiqi K. Compliance of smokeless tobacco supply chain actors and products with tobacco control laws in Bangladesh, India and Pakistan: protocol for a multicentre sequential mixed-methods study. BMJ Open 2020; 10:e036468. [PMID: 32554728 PMCID: PMC7304837 DOI: 10.1136/bmjopen-2019-036468] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION South Asia is home to more than 300 million smokeless tobacco (ST) users. Bangladesh, India and Pakistan as signatories to the Framework Convention for Tobacco Control (FCTC) have developed policies aimed at curbing the use of tobacco. The objective of this study is to assess the compliance of ST point-of-sale (POS) vendors and the supply chain with the articles of the FCTC and specifically with national tobacco control laws. We also aim to assess disparities in compliance with tobacco control laws between ST and smoked tobacco products. METHODS AND ANALYSIS The study will be carried out at two sites each in Bangladesh, India and Pakistan. We will conduct a sequential mixed-methods study with five components: (1) mapping of ST POS, (2) analyses of ST samples packaging, (3) observation, (4) survey interviews of POS and (5) in-depth interviews with wholesale dealers/suppliers/manufacturers of ST. We aim to conduct at least 300 POS survey interviews and observations, and 6-10 in-depth interviews in each of the three countries. Data collection will be done by trained data collectors. The main statistical analysis will report the frequencies and proportions of shops that comply with the FCTC and local tobacco control policies, and provide a 95% CI of these estimates. The qualitative in-depth interview data will be analysed using the framework approach. The findings will be connected, each component informing the focus and/or design of the next component. ETHICS AND DISSEMINATION Ethical approvals for the study have been received from the Health Sciences Research Governance Committee at the University of York, UK. In-country approvals were taken from the National Bioethics Committee in Pakistan, the Bangladesh Medical Research Council and the Indian Medical Research Council. Our results will be disseminated via scientific conferences, peer-reviewed research publications and press releases.
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Affiliation(s)
- Zohaib Khan
- Office of Research, Innovation, and Commercialization, Khyber Medical University, Peshawar, Pakistan
- Institute of Public Health and Social Sciences, Khyber Medical University, Peshawar, Pakistan
| | - Rumana Huque
- Department of Economics, University of Dhaka, Dhaka, Bangladesh
- Department of Research and Development, ARK Foundation, Dhaka, Bangladesh
| | - Aziz Sheikh
- Division of Community Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Anne Readshaw
- Department of Health Sciences, University of York, York, UK
| | | | - Cath Jackson
- Department of Health Sciences, University of York, York, UK
- Vaild Research Ltd, Wetherby, UK
| | - Mona Kanaan
- Department of Health Sciences, University of York, York, UK
| | - Romaina Iqbal
- Department of Community Health Sciences and Medicine, Aga Khan University, Karachi, Pakistan
| | - Zohaib Akhter
- Department of Community Health Sciences and Medicine, Aga Khan University, Karachi, Pakistan
| | - Suneela Garg
- Department of Community Medicine, Maulana Azad Medical College, New Delhi, Delhi, India
| | | | - Fayaz Ahmad
- Institute of Public Health and Social Sciences, Khyber Medical University, Peshawar, Pakistan
| | - S M Abdullah
- Department of Economics, University of Dhaka, Dhaka, Bangladesh
- Department of Research and Development, ARK Foundation, Dhaka, Bangladesh
| | - Arshad Javaid
- Office of Research, Innovation, and Commercialization, Khyber Medical University, Peshawar, Pakistan
| | - Javaid A Khan
- Department of Pulmonary medicine, Aga Khan University, Karachi, Pakistan
| | - Lu Han
- Department of Health Sciences, University of York, York, UK
| | - Aziz Rahman
- Faculty of Health, Federation University Australia, Ballarat, Victoria, Australia
| | - Kamran Siddiqi
- Department of Health Sciences, University of York, York, UK
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