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Original research
Awareness, perceptions of and compliance with tobacco control policies among naswar vendors in Khyber Pakhtunkhwa Pakistan
  1. Fayaz Ahmad1,2,
  2. Zohaib Khan2,
  3. Kamran Siddiqi3,
  4. Muhammad Naseem Khan1,
  5. Zeeshan Kibria1,2,
  6. Sarah Forberger4,
  7. Linda Bauld5,
  8. Mona Kanaan6,
  9. Hajo Zeeb7
  1. 1 Institute of Public Health and Social Sciences, Khyber Medical University, Peshawar, Pakistan
  2. 2 Office of Research, Innovation and Commercialization, Khyber Medical University, Peshawar, Pakistan
  3. 3 Institute of Health Sciences, University of York, UK, York, UK
  4. 4 Leibniz Institute for Prevention Research and Epidemiology, Bremen, Germany
  5. 5 Usher Institute and UK Centre for Tobacco and Alcohol Studies, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
  6. 6 Health Sciences, University of York, York, UK
  7. 7 Prevention and Evaluation, Leibniz-Institute for Prevention Research and Epidemiology, Bremen, Germany
  1. Correspondence to Dr Fayaz Ahmad, Institute of Public Health & Social Sciences, Khyber Medical University, Peshawar, Pakistan; drfayaz1980{at}gmail.com

Abstract

Introduction Regulatory compliance in the retail environment is integral to the success of tobacco control. We assessed compliance among naswar (smokeless tobacco product widely used in South Asia) vendors with tobacco control laws. We also assessed their awareness of tobacco-related harms and policies and perceived effect of policies on their sales.

Methods We surveyed 286 naswar vendors in three districts of the Khyber Pakhtunkhwa province of Pakistan. We recruited general and specialty vendors from urban and rural areas through multistage cluster sampling. Compliance was measured for promotion, sale to/by minors and tax paid on naswar. We used logistic regression analyses for assessing the association between the outcome variables (awareness of tobacco harms and laws, perceptions about the effect of policies on business and compliance with laws) and their predictors.

Results Most vendors (70%) were aware of tobacco-related harms of naswar. Although educated vendors were more aware of tobacco control policies, the greatest awareness was for a ban on sales to/by minors (21% overall). The majority of vendors (76%) violated this policy (measured by self-report), and violations were more common among rural than urban vendors (OR 2.27, 95% CI 1.05 to 4.96). Most vendors (71%) violated a ban on promotion of naswar. Vendors perceived tax increases and sales ban to/by minors as most detrimental for business.

Conclusions There was poor awareness and compliance among naswar vendors in Pakistan with tobacco control laws. This study finds potential areas for policy interventions that can reduce urban/rural disparities in implementation of and compliance with tobacco control laws.

  • priority/special populations
  • taxation
  • non-cigarette tobacco products
  • advertising and promotion
  • public policy

Data availability statement

Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. The raw data for this study can be provided upon reasonable request and on merit to research students of Masters/PhD or any policy-making body.

https://doi.org/10.1136/tobaccocontrol-2020-056377

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    Data availability statement

    Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. The raw data for this study can be provided upon reasonable request and on merit to research students of Masters/PhD or any policy-making body.

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    Footnotes

    • Twitter @zoheb_dr

    • Contributors FA, ZKh, MNK and ZKi contributed to the conduct of the study and data collection. FA, KS, SF, ZKh, MNK, ZKi and MK worked on the analysis of data and the first draft of the manuscript. HZ, LB, SF, KS and MNK provided technical input throughout the study. All authors contributed to the planning of the study and contributed to all versions of the manuscript, including the final version.

    • Funding The research was funded by the German Academic Exchange Service DAAD (project numbers 574 030 10 and 575 236 44). FA and ZKh are also funded by ASTRA Global Health Research Group, which is funded by the National Institute for Health Research, using UK aid from the UK government to support global health research (programme reference 17/63/76/Global Health Research Groups).

    • Competing interests None declared.

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

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.