School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia.
Centre for Medicine Use and Safety, Monash University, Melbourne, Australia.
Drug Alcohol Rev. 2021 Jul;40(5):856-863. doi: 10.1111/dar.13243. Epub 2021 Jan 20.
Smokeless tobacco (ST) is the predominant form of tobacco used in Bangladesh and is associated with adverse health outcomes. Bangladesh ratified the World Health Organization's Framework Convention on Tobacco Control (FCTC) in 2004. There are concerns that FCTC legislation and implementation of ST control policy is insufficient in Bangladesh. The aim of this study was to investigate the achievements and challenges of ST policy in Bangladesh and its alignment with the FCTC.
We conducted semi-structured key informant interviews with 20 stakeholders from government and non-government offices and international funding agencies, including tobacco control advocates, policy makers and non-governmental organisation workers. We used NVivo software to create key themes and the framework method for thematic analysis.
Our findings revealed a lack of national policy in terms of disclosure of harmful contents, illicit trade and standardised packaging of ST. Legislation remains ineffective in relation to graphical health warnings and tax measures. Challenges to ST control identified included inadequate law enforcement; paucity of research, surveillance, and evidence generation; and supply chain control. We identified lack of congruence of ST policies with FCTC due to slow progress in implementation of FCTC measures, lack of a country-specific policy and industry interference. To comply with FCTC, participants recommended strong leadership and political commitment, co-ordination between public and private sectors and proper use of tobacco control resources.
Bangladesh has adopted several important FCTC measures, but further strengthening of ST policy is needed to enable full implementation of FCTC.
无烟烟草（ST）是孟加拉国主要使用的烟草形式，与不良健康后果有关。孟加拉国于 2004 年批准了世界卫生组织《烟草控制框架公约》（FCTC）。人们担心孟加拉国的 FCTC 立法和 ST 控制政策的执行不足。本研究旨在调查孟加拉国 ST 政策的成就和挑战及其与 FCTC 的一致性。
我们对来自政府和非政府办公室以及国际资助机构的 20 名利益相关者进行了半结构化的关键知情人访谈，包括烟草控制倡导者、政策制定者和非政府组织工作人员。我们使用 NVivo 软件创建关键主题和主题分析框架方法。
我们的研究结果表明，在披露有害成分、非法贸易和 ST 标准化包装方面缺乏国家政策。立法在图形健康警示和税收措施方面仍然无效。确定的 ST 控制挑战包括执法不力；缺乏研究、监测和证据生成；以及供应链控制。我们发现，由于 FCTC 措施的实施进展缓慢、缺乏国家特定政策和行业干扰，ST 政策与 FCTC 不一致。为了遵守 FCTC，参与者建议加强领导和政治承诺、公共和私营部门之间的协调以及合理利用烟草控制资源。
孟加拉国已经采取了一些重要的 FCTC 措施，但需要进一步加强 ST 政策，以实现 FCTC 的全面实施。
