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Abstract
Background Tobacco products are ubiquitously available in Bangladesh. There are currently no restrictions on who can sell tobacco products and where they are allowed to be sold. The objective of this study was to explore tobacco retailers’ views regarding tobacco retail licensing (TRL) in Bangladesh.
Methods A two-stage cluster sampling procedure was used to collect data from a representative sample of 472 tobacco retailers (97% response rate) in Dhaka city in 2018 through face-to-face interviews using a semistructured questionnaire. Data were analysed using descriptive statistics, X2 tests and logistic regression.
Results The majority (79%) of the retailers reported that they would support TRL, and 68% were interested in applying for TRL if adopted. Support for TRL was higher among those with a university degree (OR 2.1, 95% CI 0.8 to 5.3) and among those with knowledge about existing tobacco control regulations (OR 1.8, 95% CI 1.1 to 2.8). Furthermore, support for TRL was significantly higher among those who believed that it would restrict tobacco retailing locations (AOR 1.9, 95% CI 1.3 to 3.0) and prevent tobacco sales to minors (AOR 3.5, 95% CI 2.2 to 5.5).
Conclusion This sample of tobacco retailers in Bangladesh supported TRL. TRL advocacy efforts could draw on this support.
- advocacy
- prevention
- public policy
- end game
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Introduction
At present, tobacco retailers are not regulated in Bangladesh: any type of outlet is permitted to sell tobacco products. However, access to alcohol in Bangladesh is regulated through a licensing system operated by the government licensing authority. Evidence shows that ‘retail tobacco marketing and tobacco retailer proximity or density increase youth and adult tobacco use, prompt impulse purchases and discourage quit attempts’.1 Higher tobacco outlet density is associated with higher tobacco use prevalence, including greater exposure to tobacco,2 more relapse,3 a more competitive local market4 and higher sales to minors.5
There is a lack of strong tobacco control policies, and weak enforcement of existing regulations in Bangladesh, a country that ranks in the top 10 globally in terms of tobacco use prevalence.6 Tobacco control policy in Bangladesh has been limited to demand-side intervention activities like smoking prevention media campaigns, graphic health warning labels on tobacco packs and restricting all forms of tobacco advertising, promotion and sponsorship (TAPS).7 Studies conducted in 2018 reported that despite the TAPS ban in Bangladesh, 65% of the respondents noticed tobacco promotions in local stores in the char regions of Gaibandha in Northern Bangladesh.8 69.5% of the tobacco outlets had promotional materials inside or outside the outlets, and tobacco products were displayed at the point of sale in 65% of the outlets.9 Lack of regulatory oversight over tobacco retailers and growth in their numbers might cause the condition to deteriorate, with negative public health impacts in a densely populated country like Bangladesh. Therefore, this study aimed to investigate tobacco retailers’ views of mandatory licensing that could reduce tobacco retailer density and tobacco product availability.
Methods
Study design, setting and sampling procedure
This cross-sectional study was conducted between March and November 2018 in Dhaka, Bangladesh. Tobacco retailers were the target population. A two-stage cluster sampling procedure was used. Of the 92 wards in Dhaka City Corporations, eight were randomly selected in the first stage from both City Corporation areas using proportionate allocation. As there is no available list of tobacco retailers in Bangladesh, we sent observers to count all tobacco outlets in the eight wards. They took down the name and address of all tobacco outlets on observer sheets. For clarity of demarcation of the study areas, the observers used both Google maps and Dhaka city corporations’ administrative maps. We prepared a list of 1455 tobacco retail outlets in our selected clusters, excluding mobile vendors. In the second stage, we randomly selected 485 tobacco retail outlets from the list. The sample was evenly distributed across the eight wards.
Study instrument and data collection
A standardised questionnaire was developed based on previous studies.10–13 It covered (1) sociodemographic information; (2) characteristics of tobacco retail outlets; (3) retailers’ tobacco consumption behaviour; (4) knowledge, attitudes and practices about existing tobacco control policies and (5) views about tobacco retail licensing (TRL) and other tobacco control policies. Face-to-face interviews were conducted in the premises of retail outlets by seven trained data collectors who completed the questionnaire. The questionnaire consisted of both open-ended and close-ended items. Data collectors noted down the responses of open-ended questions on the questionnaire, and the research team organised the answers into specific response categories later. Interviews usually took 60–80 min, with occasional pauses when the vendors had to serve customers.
Outcome measures
As there is no TRL scheme in Bangladesh, participants were asked to consider a scenario where a licence is required for tobacco retailers. To check whether they understood the concept, they were asked a series of questions (online supplementary file) about their perception of the meaning of the policy, their feelings about it, and their opinions regarding its likely impact on their business. They were also asked whether they would support TRL, and how likely they would be to apply for a licence if doing so incurred a fee.
Supplemental material
Data analysis
X2 tests were used for testing associations between general variables and outcome variables, with a significance level set at p<0.05. Binary logistic regression analysis was performed to identify associations between support for TRL and other study variables. In unadjusted estimates (model 1), we ran each predictor variable presented in table 1 separately to see the effect of the individual predictor on the outcome variable (support for TRL). For adjusted estimates, we presented two models (models 2 and 3). Model 2 is adjusted for educational attainment; we ran each predictor variable with ‘educational attainment’ to get the combined effect of the predictors on the outcome variable. In model 3, we adjusted three predictor variables (knowledge of existing tobacco control regulations, retailers’ view that TRL will restrict tobacco retail locations, and retailers’ view that TRL will prevent tobacco sales to minors) which were significant in model 2 to find the effects on the outcome variable. OR, adjusted ORs (AOR) and their 95% CIs were calculated using SPSS software, V.22.0.
Factors associated with support for TRL, (n=472), Dhaka, Bangladesh, 2018
Results
Out of 485, 472 retailers participated in the study (response rate 97%). Almost all (98.9%) the retailers were male. The mean age of the participants was 36.4 (±12.9) years. Most of the participants (70.6%) were the owners of the tobacco retail outlets.
Participants’ views of TRL in Bangladesh
Most participants (78.8%) supported TRL (table 2). When asked why, nearly half of the participants (44.7%) stated that they would support TRL because they thought that laws should be obeyed, while more than a quarter (26.9%) stated that they would support TRL because doing so would obviate any financial or other penalties associated with non-compliance. While only 4.4% of the retailers thought that a TRL scheme would decrease the density of tobacco retailers, 63.1% thought that TRL would prevent tobacco sales to minors. More than two-thirds (68.2%) of the participants stated that they would apply for a licence if the government adopted TRL, versus 20.1% who reported that they would not apply and would instead stop selling tobacco products. The average licence fee proposed by participants was Tk1091.18 (US$13.15).
Retailers views about TRL in Bangladesh, by role in the tobacco retail outlet (n=472), Dhaka, Bangladesh, 2018
The association between support of TRL with the study variables is presented in table 1. Model 1 represents the unadjusted OR. The participants with some schooling had 1.7 times (95% CI 0.9 to 3.3) the odds of supporting TRL compared with those with no formal education. The OR of TRL support and retailer educational qualifications remains high when adjusted with other variables related to their views of TRL (model 3). In model 1, those who believed that TRL would restrict tobacco retailing locations had twice (95% CI 1.3 to 3.1) the odds of supporting TRL than those who did not believe so, whereas the OR decreased slightly when adjusted with education (AOR 1.9, 95% CI 1.3 to 3.0) in model 2. Retailers believing that TRL would prevent tobacco selling to minors had significantly higher odds in both unadjusted and adjusted models (AOR 3.5, 95% CI 2.2 to 5.5 in model 2) of supporting TRL than those who did not believe so.
Discussion
Retailers’ views and opinions might exert a significant influence on the formulation and introduction of a tobacco licensing policy in any context.10 14 Hence, it is imperative to understand and assess retailers’ perspectives on TRL before it is introduced. Our study reported differing views among tobacco retailers regarding TRL.
Most retailers in our study supported TRL, and stated that they would apply for a licence if TRL were adopted. Their support was primarily based on a respect for the law and desire to avoid any penalties associated with non-compliance. These findings suggest that not only are retailers willing to accept a new TRL scheme imposed by the government, but, more importantly, they would be highly likely to comply with it, thus helping to ensure that the licensing scheme would meet its tobacco control objectives. While most retailers did not think that TRL would reduce retailer numbers or density, our results suggest that the opposite might be true. A significant minority (one-fifth) of participants stated that they would abandon the tobacco business if TRL were adopted, which is consistent with previous research15 in California showing a 30.6% reduction in tobacco outlets after TRL was introduced in one county. Given the associations between retailer proximity and density on smoking uptake, use, and cessation, a 20% reduction in the number of tobacco outlets in Bangladesh could have a significant impact on smoking prevalence.
The price of a tobacco retail licence could also deter retailers from continuing to sell tobacco. In South Australia, 2 years after the licensing fee increased from $A12 (approximately US$10) to $A200 (US$150), there was a 24% reduction in the number of tobacco retail licences.16 Although most participants in our study declined to suggest an appropriate licence fee, among those that did, the average fee proposed (US$13.15) was very close to the initial fee (approximately US$10) in South Australia. If Bangladeshi policy-makers were to follow the later South Australian example and impose a higher licensing fee, some tobacco retailers might decide that the price was too high to justify continued tobacco sales.
Support for TRL was influenced by retailers’ education level, knowledge of existing tobacco control regulations and belief that TRL would restrict the number of tobacco outlets and prevent tobacco sales to minors. This suggests that any effort to promote a TRL scheme among retailers in Bangladesh will have to consider how best to enhance and capitalise on retailers’ knowledge of and attitudes towards tobacco control regulations in general and TRL in particular. Evidence from other jurisdictions regarding the link between the establishment of TRL schemes and reductions in tobacco retailer density, tobacco retailers located near schools and illegal tobacco sales to minors15 17–21 could be a key component of any advocacy effort.
This study is not without limitations. It relied on a sample of retailers drawn from a limited geographical area in Bangladesh. The population of tobacco retailers on which it drew was likely to be incomplete, as we did not have a complete list of tobacco retail outlets in Dhaka, and we excluded mobile vendors. Our questions focused on retailers’ views of proposed, rather than actual, policies. Thus, it is unclear how retailers might respond if a TRL scheme were to be implemented. However, to the best of our knowledge, this is the first study reporting on the views of tobacco retailers in Bangladesh. This study followed a strong methodological process. The random selection of the study areas and retailers within the areas, and the in-depth nature of the interviews made this study rigorous and scientifically sound.
Conclusion
Adopting TRL in Bangladesh could help reduce youth access to tobacco, ensure compliance with other tobacco-related laws, and limit the negative public health effects associated with tobacco use. TRL can also pave the way for other tobacco policy innovations in the retail sector, like restrictions on the sale of certain tobacco products. Additionally, the income generated from licensing can be used to fund administration and enforcement activities, including retailer education, training and compliance checks.22 While further research is needed, our initial findings suggest that Bangladeshi policy-makers could likely count on the support of tobacco retailers—an important stakeholder group—in moving forward with TRL.
What this paper addds
What is already known on this subject
Tobacco retail licensing has been found to be a potential tool for tobacco control, facilitating monitoring of the retailer landscape and implementation and enforcement of other retail policies and reducing tobacco retailer density.
What important gaps in knowledge exist on this topic
There is no provision regarding tobacco retail licensing in Bangladesh’s (2015) Smoking and Tobacco Products Usage (Control) Rule. Tobacco products, especially cigarettes, bidi, zarda, gul and tobacco leaf are widely available everywhere in Bangladesh, and any type of outlet is permitted to sell tobacco products. To date, no study has explored tobacco retailers’ views on tobacco retail licensing for the regulation of tobacco retail outlets in Bangladesh.
What this paper adds
This is the first study to investigate the views of tobacco retailers regarding tobacco retail licensing in Bangladesh.
Our study found strong support for tobacco retail licensing among tobacco retailers, although support was higher among those with higher educational attainment.
The support of retailers for tobacco retail licensing gives policy-makers a mandate to introduce tobacco retail licensing in Bangladesh.
Ethics statements
Patient consent for publication
Ethics approval
This study was conducted conforming to the ethical standards to the highest possible extent. Ethical clearance certificate (Ref No: BBEC, JU/M 2018(6)1) was obtained from the institutional review board (IRB), ‘Biosafety, Biosecurity & Ethical Committee’ of the Jahangirnagar University, Savar, Dhaka. International ethical guidelines for biomedical research involving human subjects were followed throughout the study. Furthermore, individual informed consent was taken from all participants who read/understood the purpose and procedure of the study before data collection. Participation in the study was voluntary and no financial benefit was provided to the participants.
Acknowledgments
Joanna Cohen edited and provided feedback on the manuscript.
References
Footnotes
Twitter @sahadathossain.phi.ju@gmail.com
Contributors SH was responsible for study concept, implementation, statistical analysis and drafted the manuscript. AA, MEU, FR, HMM, MKA and MSI were responsible for the implementation of the study. MEU also edited the manuscript.
Funding This study was supported by the Johns Hopkins Bloomberg School of Public Health Institute for Global Tobacco Control with funds from the Bloomberg Initiative to Reduce Tobacco Use.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.