Policy priorities for strengthening smokeless tobacco control in Bangladesh: A mixed-methods analysis

Abstract

INTRODUCTION Smokeless tobacco (ST) remains poorly regulated in Bangladesh. This study describes the prevalence and trends of ST use in Bangladesh, presents ST-related disease burden, identifies relevant policy gaps, and highlights key implications for future policy and practice for effective ST control in Bangladesh. METHODS We analyzed secondary data from the two rounds (2009 and 2017) of The Global Adult Tobacco Survey, estimated ST-related disease burden, and conducted a review to assess differences in combustible tobacco and ST policies. In addition, we gathered views in a workshop with key stakeholders in the country on gaps in existing tobacco control policies for ST control in Bangladesh and identified policy priorities using an online survey. RESULTS Smokeless tobacco use, constituting more than half of all tobacco use in Bangladesh, declined from 27.2% (25.9 million) in 2009 to 20.6% (22 million) in 2017. However, in 2017, at least 16947 lives and 403460 Disability-Adjusted Life Years (DALYs) were lost across Bangladesh due to ST use compared to 12511 deaths and 324020 DALYs lost in 2010. Policy priorities identified for ST control have included: introducing specific taxes and increasing the present ad valorem tax level, increasing the health development surcharge, designing and implementing a tax tracking and tracing system, standardizing ST packaging, integrating ST cessation within existing health systems, comprehensive media campaigns, and licensing of ST manufactures. CONCLUSIONS Our analysis shows that compared to combustible tobacco, there remain gaps in implementing and compliance with ST control policies in Bangladesh. Thus, contrary to the decline in ST use and the usual time lag between tobacco exposure and the development of cancers, the ST-related disease burden is still on the rise in Bangladesh. Strengthening ST control at this stage can accelerate this decline and reduce ST related morbidity and mortality.

Perceptions and reasons for quitting and transitioning between smoking and smokeless tobacco products: Findings from four waves of the ITC Bangladesh survey

“…Furthermore, tobacco control measures such as price/tax, ban on Tobacco Advertisement Promotion & Sponsorship (TAPS) in entertainment media, and health education programs for awareness of the harmful effects, have an essential influence on the reported reasons for consumers to switch to, co-use or discontinue using different tobacco products. a key opportunity against the culturally engrained acceptance of tobacco and SLT use 25 . Therefore, educational campaigns should focus on the social aspect of smoking behaviors.…”

“…Despite the high disease burden associated with SLT use in Bangladesh, access to doctors' advice and cessation services are not yet widely available for SLT users in routine healthcare in Bangladesh 11,25 . To combat the high prevalence of SLT use and the frequent transition between smoking and smokeless products, authorities should place a greater emphasis on integrating SLT cessation services on treating nicotine dependence 25 and provide support for high-risk populations (e.g. rural female SLT users or older male SLT users transitioning to cigarette use).…”

How does Indian news media report smokeless tobacco control? A content analysis of the gutka ban enforcement

“…Combating the use of SLT is slowly but surely becoming a policy priority in Southeast Asia, with countries such as Nepal, Bhutan, and Bangladesh amending existing tobacco control laws to prohibit SLT in public places, ban manufacturing and supply, and advertising. Simultaneously, multi-pronged strategies such as cessation services, pictorial warnings, taxation, education and awareness, vendor licensing, and litigation measures are being implemented [ 31 , 51 , 52 ]. Our study adds significant value and can assist policymakers, researchers, and practitioners better understand the gutka ban policy measure in India.…”

Comparison between Smokers and Smokeless Tobacco Users in Their Past Attempts and Intentions to Quit: Analysis of Two Rounds of a National Survey

“…Most tobacco control measures in Bangladesh aim to prevent tobacco initiation and/or exposure to tobacco smoke in the environment. However, its achievement in reducing the overall prevalence of tobacco users through those control measures may be decelerated due to scarce cessation services and limited counselling facilities [ 31 , 32 ]. The treatment services that are available in Bangladesh focus mainly on smoking and rarely on SLT [ 33 ].…”