Identification of policy priorities to address the burden of smokeless tobacco in Pakistan: a multimethod analysis

Kamran Siddiqi, Ziauddin Islam, Zohaib Khan, Faraz Siddiqui, Masuma Mishu, Omara Dogar, Vandana Shah, Javaid Khan, Subhash Pokhrel, Romaina Iqbal, Linda Bauld, Aziz Sheikh, Jean Grugel

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction
We assessed the magnitude of smokeless tobacco (ST) use in Pakistan and identified policy gaps to help ascertain short-, medium- and long-term priorities. We then elicited stakeholders’ views as to which of these identified priorities are most important.

Methods
In a multi-method study, we: analysed Global Tobacco Surveillance System datasets to estimate ST consumption and disease burden; conducted a documentary review to identify gaps in policies to control ST in comparison with smoking; elicited stakeholders’ views in an interactive workshop, to identify a set of policy options available to address ST burden in Pakistan; and ranked policy priorities using a post-event survey.

Results
Among all tobacco users in Pakistan (n=24million), one-third of men and two-thirds of women consume ST. In 2017, its use led to an estimated 18,711 deaths due to cancer and ischemic heart disease. Compared to smoking, policies to control ST lag behind significantly. Priority areas for ST policies included: banning ST sale to and by minors, advocacy campaigns, introduction of licensing, levying taxes on ST and standardising ST packaging. A clear commitment to close cooperation between state actors and stakeholder groups is needed to create a climate of support and information for effective policy making.

Conclusions
Smokeless tobacco control in Pakistan should focus on four key policy instruments: legislation, education, fiscal policies and quit support. More research into the effectiveness of such policies is also needed.

Implications
A number of opportunities to improve ST regulation in Pakistan were identified. Among these, immediate priorities include banning ST sale to and by minors, mobilising advocacy campaign, introduction of licensing through the 1958 Tobacco Vendors Act, levying taxes on ST and standardising ST packaging.
Original languageEnglish
JournalNicotine and Tobacco Research
Early online date29 Aug 2019
DOIs
Publication statusE-pub ahead of print - 29 Aug 2019

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