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Implementing smokeless tobacco control policy in Pakistan: a qualitative study among Naswar supply chain actors.

Authors
  • Ahmad, Fayaz1, 2
  • Boeckmann, Melanie2
  • Khan, Zohaib3
  • Zeeb, Hajo4
  • Khan, Muhammad Naseem5
  • Ullah, Safat3
  • Dreger, Steffen4
  • Haq, Zia Ul3
  • Forberger, Sarah6
  • 1 Institute of Public Health and Social Sciences, Khyber Medical University, Peshawar, Khyber Pakhtunkhwa, Pakistan [email protected] , (Pakistan)
  • 2 School of Public Health, University of Bielefeld, Bielefeld, Germany. , (Germany)
  • 3 Khyber Medical University, Peshawar, Khyber Pakhtunkhwa, Pakistan. , (Pakistan)
  • 4 Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology, Bremen, Germany. , (Germany)
  • 5 Institute of Public Health and Social Sciences, Khyber Medical University, Peshawar, Khyber Pakhtunkhwa, Pakistan. , (Pakistan)
  • 6 Leibniz Institute for Prevention Research and Epidemiology, Bremen, Germany. , (Germany)
Type
Published Article
Journal
Tobacco control
Publication Date
Sep 01, 2021
Volume
30
Issue
5
Pages
548–552
Identifiers
DOI: 10.1136/tobaccocontrol-2020-055748
PMID: 32817262
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

To obtain insights into the perceptions of barriers and facilitators to implementation of the WHO Framework Convention on Tobacco Control (FCTC) among smokeless tobacco (SLT) supply chain actors in the Khyber Pakhtunkhwa province of Pakistan. We conducted a qualitative study to investigate the perceptions about SLT control policy formulation and implementation among exclusive Naswar sellers and point of sale vendors. We conducted five focus group discussions in three districts of Khyber Pakhtunkhwa using combined deductive-inductive thematic analyses. We identified three central themes that potentially impact policy formulation, its implementation and application. The first theme examines the role of children in the Naswar business: as potential customers, and as potential heirs to a Naswar-selling business. A second theme targets the 'business of Naswar', which includes a specific identity of Naswar sellers, its potential to generate profits and the special case of Naswar regulation as a socially accepted and culturally rooted product. The third theme addresses the unusual ingredients of Naswar and its production process, making Naswar a health risk for consumers and producers. We also report conflicting views regarding SLT control among the supply chain actors. This study provides insights into the perceptions of important SLT supply-side stakeholders regarding various SLT control policy options based on the FCTC. While there is some opposition to policy approaches like taxation and switching of business, implementing a ban on selling SLT to minors may be a viable option for policymakers in the short term. © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

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