Smokeless Tobacco Control Policies in South Asia: A Gap Analysis and Recommendations

Khan, Amina; Huque, Rumana; Shah, Sarwat; Kaur, Jagdish; Baral, Sushil; Gupta, Prakash C.; Cherukupalli, Rajeev; Sheikh, Aziz; Selvaraj, Sakthivel; Nargis, Nigar; Cameron, Ian D.; Siddiqi, Kamran

doi:10.1093/ntr/ntu020

Cited by 47 publications

(64 citation statements)

References 8 publications

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“…The production and distribution of packaged forms of smokeless tobacco, including gutka , has recently been banned in all Indian states 5. However, it is unclear how well these bans are being enforced or whether they will curb consumption 6 7…”

Section: Introductionmentioning

confidence: 99%

Perceived effectiveness of text and pictorial health warnings for smokeless tobacco packages in Navi Mumbai, India, and Dhaka, Bangladesh: findings from an experimental study

et al. 2015

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Section: Introductionmentioning

confidence: 99%

Perceived effectiveness of text and pictorial health warnings for smokeless tobacco packages in Navi Mumbai, India, and Dhaka, Bangladesh: findings from an experimental study

et al. 2015

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“…The PubMed search returned 27 articles out of which two were eligible to be included in this review. The first article was the afore-cited review of the SLT control policies in South Asia which had concluded that SLT sale to and by minors is prohibited in Pakistan [16]. The second article was based on a core Non-communicable disease prevention policy document from Pakistan and only addressed the prohibition of sale and consumption of cigarettes to minors, without any mention of SLT use among minors [17].…”

Section: Resultsmentioning

confidence: 99%

“…A 2014 research article explored public policy gaps with regards to SLT control in four Asian countries including Pakistan, by conducting a review of policy documents and interviews with key informants [16], one of the findings of this study was that, “the sale of smokeless tobacco to and by minors is prohibited in Pakistan”. The dichotomy between the alarming prevalence of SLT use among minors in Pakistan and the reported findings of the aforementioned policy review study [16], warranted a review of the Government of Pakistan policies to identify, how the issue of sale to and by, and consumption of SLT by minors has been addressed in these policy documents.…”

Section: Introductionmentioning

confidence: 99%

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A gaping gap (smokeless tobacco control in Pakistan)

Khan¹

2016

Tob. Induced Dis.

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Oral cancer is second most common cancer in Pakistan and one of the major contributing factors to its high incidence is smokeless tobacco (SLT) use. 5.3% of Pakistan’s youth are current SLT users. The World Health Organization requires the signatories of its “Framework Convention on Tobacco Control” to officially ban the sale of tobacco products to minors. We reviewed the Government of Pakistan’s tobacco control, and related supporting policies, to assess how these address the issue of sale of SLT products to minors and found evident gaps in this regard. Legislations need to be in place to ban the sale of SLT products to minors and avoid an SLT epidemic in the future.

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“…Only the studies reporting daily frequencies and total duration of exposure or reporting data to calculate these will be eligible for the exposure-response analysis. Since SLT products in South Asia are often produced unregulated [22], it is difficult to quantify the intensity of exposure and hence intensity will not be used as an inclusion/exclusion criteria for this review. Studies which exposure of interest is areca nut alone or betel quid without added tobacco, although often investigated together along with other SLT products, will not be eligible for this review as these might contribute to increased heterogeneity because of differences in carcinogenic potential among these and SLT products.…”

Section: Eligibility Criteriamentioning

confidence: 99%

Smokeless tobacco and oral potentially malignant disorders in South Asia: a protocol for a systematic review

Khan

Christianson

et al. 2016

Syst Rev

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IntroductionOral potentially malignant disorders (OPMDs) are chronic lesions or conditions characterized by a potential for malignant transformation. Apart from being possible pre-cursors to oral cancer, OPMDs themselves are usually painful and debilitating conditions having an influence on the quality of life, both in terms of pain and social disability. Smokeless tobacco (SLT) use is considered a major risk factor for OPMDs. SLT use is a culturally and socially acceptable habit in South Asia. According to a recent report, 90 % of the SLT burden of the whole world lies in the South Asian countries of Pakistan, India, Sri Lanka, Bangladesh, Bhutan, Nepal, Afghanistan, and Maldives. This review aims to assess the association between the use of various SLT products in South Asia and risk of OPMDs.MethodsThis review will focus on epidemiological studies on the use of SLT and risk modification for OPMDs, which have been carried out in the human population of South Asian countries. Articles reporting estimates of relative risk, e.g., odds ratio (OR) or relative risk (RR) with their 95 % confidence intervals (CI) for SLT users versus non-users. Articles reporting data from which these effect estimates can be computed will be included in the review. We will search MEDLINE, the Science Citation Index (SCI), Scopus, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases for relevant literature using a combination of keywords and MeSH terms, where applicable. Appropriate sources of gray literature will also be included in the search. The electronic searches will be supplemented by a hand search of the bibliographies of the included articles. The included studies will be assessed for their quality using an established quality assessment tool. All relevant data from the included articles will be recorded in an MS Excel spread sheet and then transferred to Rev Man 5.3 to carry out a meta-analysis. Heterogeneity among the estimates will be assessed through the I2 statistic. Sensitivity and subgroup analysis will be carried out to see the effects of individual or group of studies on the pooled effect estimate. Results of the review will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.DiscussionThis review may have a potential limitation with regard to the designs of the studies included as we expect that most of the included studies will be of the observational types. We will however try to address this issue by conducting sensitivity and subgroup analysis of similar quality studies.Systematic review registrationPROSPERO CRD42015029705.Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-016-0320-7) contains supplementary material, which is available to authorized users.

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Smokeless Tobacco Control Policies in South Asia: A Gap Analysis and Recommendations

Abstract: Limited progress has been made so far to address the emerging public health threat posed by SLT consumption in South Asia. International and regional cooperation is required to advocate for effective policy and to address knowledge gaps.

Cited by 47 publications

References 8 publications

Perceived effectiveness of text and pictorial health warnings for smokeless tobacco packages in Navi Mumbai, India, and Dhaka, Bangladesh: findings from an experimental study

Perceived effectiveness of text and pictorial health warnings for smokeless tobacco packages in Navi Mumbai, India, and Dhaka, Bangladesh: findings from an experimental study

A gaping gap (smokeless tobacco control in Pakistan)

Smokeless tobacco and oral potentially malignant disorders in South Asia: a protocol for a systematic review

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