New study to explore Pakistan’s smokeless tobacco blind spot

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New study to explore Pakistan’s smokeless tobacco blind spot

Smokeless tobacco products are unregulated and untaxed despite being a leading cause of mouth, head and neck cancer in Pakistan

Researchers from Aga Khan University have launched a comprehensive study aimed at understanding and addressing the public health risks posed by smokeless tobacco products, which have largely been ignored by policymakers. Unlike cigarettes, smokeless or chewing tobacco products such as paan (betel leaf), niswaar (powdered tobacco snuff) and gutka (a mix of tobacco and areca nut), carry no health warnings on packaging resulting in many individuals failing to appreciate the life-threatening consequences of consuming these addictive products.

“You can buy four packets of chewing tobacco for under a rupee from any cabin on the street and most people think that these products are a harmless high,” says Prof. Javaid Khan from Aga Khan University who is leading the Pakistan component of a regional study, Astra, into smokeless tobacco. “Everyone is focused on cigarettes even though 85 per cent of the world’s 300 million users of chewing tobacco live in countries in South Asia such as Pakistan, India and Bangladesh.”

According to Dr. Khan, the use of smokeless tobacco products is a major factor behind oral cancer being the second most common form of cancer in Pakistan. He adds that recent research has shown that smokeless tobac co can now be linked to cardiovascular diseases: the leading cause of death around the world. Astra will see researchers from 12 universities collaborate on this interdisciplinary project that spans Pakistan, Bangladesh and India. The wide scope of activities under the study range from qualitative studies into the personal and socio-economic reasons that drive smokeless tobacco use, right through to the development of cost-effective interventions that work best for each country’s policy environment.

“We first want to establish a baseline scenario of the drivers of smokeless tobacco consumption, especially among the youth,” says Dr Khan. “This would not only cover the motivations of consumers but would also explore the lobbies and business interests that are preventing legislation.”  Insights from this phase of the study will lead to the development of cessation interventions. This phase will see researchers test whether economic incentives, behavioural change measures, or the use of medicine-based therapies, can help users quit smokeless tobacco products.  Astra’s next phase involves research into the policy environment and the development of cost-effective proposals that can be implemented by governments.

“The idea is to get a comprehensive picture of the scale of the problem before we develop feasible cost-effective policy proposals,” said Dr. Romaina Iqbal, an associate professor at Aga Khan University and co-investigator of the study.  “In the long-term, our goal is to build the capacity of researchers in this crucial area of public health which will help Pakistan to implement tobacco control measures specifically focusing on smokeless tobacco products.”

The project Addressing Smokeless Tobacco and Building Research Capacity in South Asia (ASTRA) is funded by the UK’s National Institute for Health Research. The study will be led by Dr Kamran Siddiqui at the University of York in the UK and will be conducted in partnership with Aga Khan University and Khyber Medical University in Pakistan; Maulana Azad Medical College in India, and the University of Dhaka in Bangladesh.