Smokeless tobacco policy in Bangladesh: A stakeholder study of compatibility with the World Health Organization's Framework Convention on Tobacco Control

Abstract

Introduction. Smokeless tobacco (ST) is the predominant form of tobacco used in Bangladesh and is associated with adverse health outcomes. Bangladesh ratified the World Health Organization's Framework Convention on Tobacco Control (FCTC) in 2004. There are concerns that FCTC legislation and implementation of ST control policy is insufficient in Bangladesh. The aim of this study was to investigate the achievements and challenges of ST policy in Bangladesh and its alignment with the FCTC. Methods. We conducted semi-structured key informant interviews with 20 stakeholders from government and non-government offices and international funding agencies, including tobacco control advocates, policy makers and non-governmental organisation workers. We used NVivo software to create key themes and the framework method for thematic analysis. Results. Our findings revealed a lack of national policy in terms of disclosure of harmful contents, illicit trade and standardised packaging of ST. Legislation remains ineffective in relation to graphical health warnings and tax measures. Challenges to ST control identified included inadequate law enforcement; paucity of research, surveillance, and evidence generation; and supply chain control. We identified lack of congruence of ST policies with FCTC due to slow progress in implementation of FCTC measures, lack of a country-specific policy and industry interference. To comply with FCTC, participants recommended strong leadership and political commitment, co-ordination between public and private sectors and proper use of tobacco control resources. Discussion and Conclusions. Bangladesh has adopted several important FCTC measures, but further strengthening of ST policy is needed to enable full implementation of FCTC.

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

“…Despite a high disease burden associated with ST use, cessation services are not available for ST users in routine healthcare at public facilities in Bangladesh1 and integrated policy including cessation support is warranted 22 . Also, as per the participants in the present study, a dearth of research on effective contextual intervention and lack of evidence on supply chain control remain to be addressed in the country, and matches the findings of a recent study 23 . The same study also suggests that the implementation of FCTC has not been in alignment with the requirements of ST control policies and vice versa.…”

Trend over time on knowledge of the health effects of cigarette smoking and smokeless tobacco use in Bangladesh: Findings from the International Tobacco Control Policy Evaluation Bangladesh Surveys

“…The findings of the present study indicated that there may be a gap in delivering messages about the harms of ST use. Recent studies reported poor implementation of graphic health warnings on ST packages in Bangladesh [36,37]. Therefore, by rotation implementation of GHWs including different tobaccorelated harm will motivate people to quit tobacco.…”

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

“…This observation is consistent with a previous study [ 13 ], in that those who believe tobacco use is harmful to health are more likely than others to report that they intend to quit in the future. A recent study found that relevant legislation remains ineffective in relation to graphical health warnings on SLT packets [ 28 ]. Appropriate measures need to be taken without further delay, along with specific programmes targeting SLT use to make people aware of its harmful effects.…”