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Graphic health warnings on tobacco packets and containers: compliance status in Bangladesh
  1. Syed Mahbubur Rahman1,2,
  2. Md Shariful Alam3,
  3. ABM Zubair2,
  4. Md Hasan Shahriar2,
  5. Monowar Hossein2,
  6. Md Shahedul Alam2,
  7. Marita Hefler4
  1. 1 American International University-Bangladesh (AIUB), Dhaka, Bangladesh
  2. 2 PROGGA: Knowledge for Progress, Dhaka, Bangladesh
  3. 3 Campaign for Tobacco Free Kids (CTFK), Bangladesh Program, Dhaka, Bangladesh
  4. 4 Tobacco Control Research Program, Wellbeing & Preventable Chronic Diseases Division, Menzies School of Health Research, Casuarina, Northern Territory, Australia
  1. Correspondence to Marita Hefler, Menzies School of Health Research, Casuarina, NT 0811, Australia; marita.hefler{at}


Objective This study describes and analyses compliance with tobacco product graphic health warning (GHW) legislation introduced in Bangladesh in March 2016.

Methods A survey based on a structured questionnaire was conducted in April 2016 (immediately following the law coming into force), and 8 months later in November 2016, in eight divisional cities in Bangladesh. Five stores from three categories of retailers of combustible and smokeless tobacco products were surveyed, providing a total of 120 completed questionnaires. The study investigated a range of measures including the image and text of GHW, their ratio and colour use, and prescribed rotation.

Findings Warning labels for 3312 tobacco items were assessed. In April 2016, 75% of tobacco products surveyed did not have GHWs. In November 2016, 19% were still found to not have the prescribed warnings. Even among products which did include GHW, there was significant non-compliance with the full range of requirements, in both survey periods. Compliance was highest for cigarette packets and lowest among smokeless tobacco products. In addition, awareness among tobacco retailers about the range of GHW requirements was low.

Conclusion Effective implementation of GHW labels in low-income and middle-income countries requires awareness-raising among key stakeholders, combined with focused monitoring and compliance strategies. This should take into account different product categories and manufacturers, as well as measures targeted at retailers.

  • low/middle income country
  • non-cigarette tobacco products
  • packaging and labelling
  • surveillance and monitoring

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  • Contributors SMR, MSharA, ABMZ, and MHossein contributed to the study design. SMR, MSharA, MHossein, MShahA contributed to data collection. SMR, MSharA, ABMZ, MHS, MShahA contributed to data analysis. SMR, MSharA, ABMZ, MHS, MShahA and MHefler contributed to interpretation of data. SMR, MSharA, MHS, MH, MdShahA and MHefler contributed to drafting and revising the manuscript. All authors approved the final version and agree to be accountable for the work.

  • Funding This study was funded by PROGGA Knowledge for Progress and Campaign for Tobacco Free Kids (CTFK).

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Correction notice This article has been updated since it was published Online First. The ORCID ID has been updated for the first author.