Awareness, perceptions of and compliance with tobacco control policies among naswar vendors in Khyber Pakhtunkhwa Pakistan

Abstract

IntroductionRegulatory 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.MethodsWe 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.ResultsMost 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.ConclusionsThere 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.

Awareness of tobacco control policies and anti-tobacco attitudes and behaviors among school personnel

“…In fact, some studies supported the view that the involvement of school personnel in tobacco control campaign on campus can be effective. Increased awareness has been reported to increase compliance with policies and as a result reduce smoking 27 . This could be explained by the KABP model 20 that is well known in behavioral studies.…”

“…Therefore, first they may hold a positive attitude towards tobacco control, thinking students’ smoking as an unhealthy behavior and likely to step in to help 11 . Second, many policies include detailed action plan so school personnel will be equipped with necessary knowledge and skills to take more effective actions for students 27 - 29 . Finally, many policies and regulations already include the requirements or suggestions for school personnel in the plan so they will be motivated during the process 30 .…”

Retail-focused tobacco control: equity and endgame implications

“…Evaluating compliance with policies and effects on tobacco use is a major focus of this e-issue, with 9 of 17 studies examining minimum legal sales age (MLSA), [22][23][24][25] price and flavour restrictions, [26][27][28] or tobacco sales bans. 29 30…”

“…31 Retailer interviews in Pakistan reveal low awareness of the MLSA and marketing regulations on naswar, a smokeless tobacco product widely used in South Asia. 22 More than 70% of retailers engage in selling and…”

“…According to the WHO, 90% of countries require a MLSA for tobacco, but only 42% of countries that permit sales of ENDS have adopted such regulations 31. Retailer interviews in Pakistan reveal low awareness of the MLSA and marketing regulations on naswar, a smokeless tobacco product widely used in South Asia 22. More than 70% of retailers engage in selling and marketing the product to minors, and lower awareness among rural than urban retailers raises concern about exacerbating use disparities among youth.…”