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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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Singh A, Ross H, Dobbie F, Gallagher A, Kinnunen T, Logo DD, Boateng OA, Gilmore A, Bauld L, Owusu-Dabo E. Extent of illicit cigarette market from single stick sales in Ghana: findings from a cross-sectional survey. BMJ Open 2023; 13:e062476. [PMID: 36948551 PMCID: PMC10040054 DOI: 10.1136/bmjopen-2022-062476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 11/24/2022] [Indexed: 03/24/2023] Open
Abstract
OBJECTIVE This study aims to measure the extent of illicit cigarette consumption from single stick sales, to determine the nature and types of illicit cigarettes present in Ghana, and to identify the factors associated with illicit cigarette consumption in Ghana. DESIGN A cross-sectional study using empty cigarette packs generated by 1 day's single stick cigarette sales collected from cigarette vendors. SETTING Five large cities (Accra, Kumasi, Takoradi, Tamale and Bolgatanga) and three border towns (Aflao, Paga/Hamele and Elubo) in the northern, middle and coastal belt of Ghana. PROCEDURE AND PARTICIPANTS Ten areas were randomly selected in each city/town, and all shops selling cigarettes within 1 km of the central point were surveyed. OUTCOME MEASURES (1) Estimates of the share of illicit cigarette packs in the total cigarette sales from vendors selling single stick cigarettes in Ghana; (2) nature and types of illicit cigarette packs; (3) factors associated with illicit cigarette sales in Ghana. RESULTS Of a total of 4461 packs, about 20% (95% CI 18.3 to 20.7) were found to be illicit. Aflao (Ghana-Togo border) and Tamale (Ghana-Burkina Faso border) had the highest percentage of illicit cigarette sales at 99% and 46%, respectively (p<0.001). Over half of the illicit packs originated from Togo (51%), followed by Nigeria (15%) and then Cote d'Ivoire (10%). Adjusted and unadjusted logistic regression models indicated that convenience stores, border towns, pack price and the northern zone had higher odds of illicit cigarette sales. CONCLUSION To effectively tackle illicit cigarettes, market surveillance and strengthening supply chain control are required, particularly at the border towns and the northern region of the country.
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Affiliation(s)
- Arti Singh
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Hana Ross
- University of Cape Town Research Unit on the Economics of Excisable Products, Rondebosch, Western Cape, South Africa
| | - Fiona Dobbie
- The University of Edinburgh College of Medicine and Veterinary Medicine, Edinburgh, UK
- Usher institute, University of Edinburgh, Edinburgh, UK
| | | | - Tarja Kinnunen
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Divine Darlington Logo
- Research & Development Division-Ghana Health Service, Ghana Health Service, Accra, Greater Accra, Ghana
- Research Division, Ministry of Health/Ghana Health Service, Accra, Ghana
| | - Olivia A Boateng
- Tobacco Control and Substance Abuse, Food and Drug Authority, Accra, Ghana
| | - Anna Gilmore
- Department for Health, University of Bath, Bath, UK
| | - Linda Bauld
- Usher Institute and SPECTRUM Consortium, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Ellis Owusu-Dabo
- Department of Global Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ashanti, Ghana
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Paraje G, Stoklosa M, Blecher E. Illicit trade in tobacco products: recent trends and coming challenges. Tob Control 2022; 31:257-262. [PMID: 35241598 PMCID: PMC8899477 DOI: 10.1136/tobaccocontrol-2021-056557] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 07/26/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Illicit trade in tobacco products is a menace to the goal of eliminating tobacco consumption. Although tax policy is very effective in reducing consumption, illicit trade can reduce (though not eliminate) its effectiveness. METHODS This article discusses the recent evolution of illicit trade and the context in which it occurred; the new methods that have been developed to measure it and, finally, the challenges in the next phase in the control of illicit trade. RESULTS There has been a remarkable stability in the penetration of cigarette illicit trade in the past decade. Such a stability, however, occurred in a world of shrinking tobacco consumption, implying a decreasing absolute illicit trade. Most countries have progressed in increasing tobacco taxes and changing tax structures. Prices of illicit cigarettes follow legal cigarette prices. Concomitantly, many new studies, independent from the tobacco industry, have been conducted allowing for better understanding of the illicit trade and providing inputs to its solution. The entry into force of the WHO FCTC Protocol to Eliminate Illicit Trade in Tobacco Products provides both a global and a national policy framework to further curb illicit trade. Instruments such as track-and-trace systems must be promoted and adopted to maximise reductions in illicit trade. CONCLUSIONS Global efforts to curb the illicit trade in tobacco products are gaining momentum and progress has been made in many parts of the world. The next decade can witness a decisive decrease in tobacco consumption, both licit and illicit, if countries further engage in international collaboration.
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Affiliation(s)
- Guillermo Paraje
- Business School, Universidad Adolfo Ibanez, Santiago de Chile, Chile
| | - Michal Stoklosa
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Evan Blecher
- Fiscal Policies for Health, World Health Organization, Geneva, Switzerland
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Barolia R, Iqbal S, Virani SS, Khan F, Petrucka P. Cigarette smokers' perceptions of smoking cessation and associated factors in Karachi, Pakistan. Public Health Nurs 2021; 39:381-389. [PMID: 34546580 DOI: 10.1111/phn.12971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/30/2021] [Accepted: 08/31/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The study explored the perceptions of adult smokers with cardiovascular and respiratory diseases regarding cigarette smoking cessation. We also explored factors that may hinder or facilitate smoking cessation process. DESIGN Qualitative descriptive exploratory design SAMPLE: Purposive sample of 13 adult smokers with cardiovascular or respiratory diseases visiting outpatient cardiac and respiratory clinics at a private tertiary care hospital MEASUREMENTS: In-depth, face-to-face, and semi-structured interviews were conducted. The interviews were digitally recorded and transcribed verbatim followed by a six steps process of manual thematic analysis of data. RESULTS Meaningful statements were assigned codes and grouped into categories. Categories were clustered under three themes representing individual factors, socio-cultural factors, and institutional factors. CONCLUSIONS Smoking cessation is influenced by personal, cultural, as well as social aspects. Institutionally, there is a need to recognize that smoking is a learned behavior; hence, prohibiting public smoking will potentially contribute to non-smoking behaviors. Although the nature of misconceptions varies, this is imperative to ensure consistency in messaging, programming, and supports led by healthcare professionals.
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Affiliation(s)
- Rubina Barolia
- Clinical Practice, Aga Khan University School of Nursing and Midwifery, Karachi, Pakistan
| | | | - Salim S Virani
- Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine & Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
| | - Faris Khan
- School of Nursing and Midwifery, Aga Khan University, Karachi, Pakistan
| | - Pammla Petrucka
- College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.,Aga Khan University School of Nursing and Midwifery, Karachi, Pakistan
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