Institute of Public Health and Social Sciences, Khyber Medical University, Peshawar, Pakistan.
Office of Research Innovation and Commercialization (ORIC), Khyber Medical University, Peshawar, Pakistan.
Nicotine Tob Res. 2020 Dec 12;22(12):2224-2230. doi: 10.1093/ntr/ntaa144.
Smokeless tobacco (SLT) is a significant contributor to tobacco-related harm in Pakistan but its control has lags behind that of combustible tobacco. We assessed the compliance of Naswar's (a widely used SLT product in the Southeast Asia) packaging and sales practices with the national legislations and relevant articles of the WHO framework convention on tobacco control (FCTC).
A cross-sectional observational audit was conducted in three districts of Pakistan. We recruited 286 general point of sale (GPOS) and exclusive Naswar sellers (ENS) through a multistage cluster sampling strategy. Data were gathered on packaging and labeling practices of Naswar and advertisement and promotion practices inside and outside the shops. Statistical tests for association between the dependent variable-advertisement practices, and independent variables-area and vendor types were conducted.
We analyzed 133 and 49 unique Naswar products sold in 229 GPOS and by 57 ENS, respectively. None of the local products had any written or pictorial health warning. More than half of retailers used one or two methods of advertising Naswar inside the shops while only 9% advertised outside the shops. ENS were more likely to be noncompliant with tobacco advertisement and promotion compared with GPOS.
The study presents first insights on the compliance of Naswar packaging and sale practices with local regulations and WHO FCTC provisions in Pakistan. Almost all products were on display in the shops and none of the local products had any health warning or contents disclosure on the packages.
Naswar is a form of SLT used extensively in Pakistan, Central Asia, and Pashtun populations across the globe. This study provides an important insight into the Naswar retail environment in a geographical setting where the use of Naswar is endemic. The study brings to fore previously unreported issues like an urban-rural disparity, and differences between exclusive and nonENS, with regards to Naswar advertisement and promotion. These findings have potential implication on the implementation of tobacco control retail policies. The lack of health warnings and free display of Naswar brands call for alignment of tobacco control efforts with the FCTC.
无烟烟草（SLT）是巴基斯坦与烟草相关危害的重要因素，但对其的控制落后于可燃烟草。我们评估了纳萨尔（一种在东南亚广泛使用的 SLT 产品）的包装和销售实践是否符合国家立法和世界卫生组织烟草控制框架公约（FCTC）的相关条款。
在巴基斯坦的三个地区进行了横断面观察性审计。我们通过多阶段聚类抽样策略招募了 286 个普通销售点（GPOS）和独家纳萨尔销售商（ENS）。收集了纳萨尔的包装和标签实践以及商店内外的广告和促销实践的数据。对依赖变量-广告实践与独立变量-区域和供应商类型之间的关系进行了统计检验。
我们分别分析了在 229 个 GPOS 销售的 133 种和在 57 个 ENS 销售的 49 种独特的纳萨尔产品。没有任何当地产品有任何书面或图片健康警告。超过一半的零售商在店内使用一种或两种方法宣传纳萨尔，而只有 9%的零售商在店外宣传。ENS 比 GPOS 更有可能违反烟草广告和促销规定。
本研究首次提供了关于纳萨尔包装和销售实践在巴基斯坦遵守当地法规和世界卫生组织 FCTC 规定的见解。几乎所有产品都在商店展示，没有任何当地产品在包装上有任何健康警告或内容披露。
纳萨尔是一种在巴基斯坦、中亚和全球普什图人群中广泛使用的 SLT 形式。这项研究提供了一个重要的视角，了解在纳萨尔使用流行的地理背景下的纳萨尔零售环境。该研究突出了以前未报告的问题，如城乡差异，以及独家和非 ENS 之间在纳萨尔广告和促销方面的差异。这些发现对实施烟草控制零售政策具有潜在意义。缺乏健康警告和纳萨尔品牌的免费展示需要将烟草控制工作与 FCTC 保持一致。
