Bangladesh needs strict action against cigarettes and smokeless tobacco

In some Bangladeshi schools, 4 out of 10 children smoke and most have never been refused from buying cigarettes due to their age, shows an icddr,b study.

Nine in 10 children who smoke never receive help to stop smoking. Photo: GMB Akash / icddr,b

“Adolescents are motivated to smoke by their peers, smoker parents or siblings and tobacco advertisements,” says Dr Shariful Islam, a senior research investigator at icddr,b and principle author of the study published in South Asian Journal of Cancer.

Around 40% of these underage school children buy cigarettes directly from stores and 9 out of  10  current smokers had never received any help to stop smoking, finds the study.

The World No Tobacco Day 2017 campaign from the World Health Organization (WHO) observes that tobacco is a threat to development and calls on countries to prioritise and accelerate tobacco control efforts as part of their responses to the 2030 Agenda for Sustainable Development.

The Bangladesh government has recently made public its plans to raise tobacco tax to curb its consumption, following an escalation of price and supplementary duties for cigarettes. The national tobacco control law was amended in 2013, which the WHO Framework Convention on Tobacco Control considered a major step forward.

“The government must now speedily enforce the tobacco control act as an urgent public health priority in Bangladesh in line with global priorities”, urges Dr Islam.


The dangers of smokeless tobacco

The widespread use of smokeless tobacco (SLT) such as dried and processed tobacco leaves (sadapatha and zarda) also remains beyond tobacco regulations in the country, highlights another icddr,b study published in BMJ Open.

Smokeless tobacco (dried and processed tobacco leaves) are widespread. Photo: Yogesh Rao / CC BY-NC-ND 2.0

Older people, the illiterate and day labourers who belong to socioeconomically disadvantaged groups are most likely to use SLT and are involved in the local tobacco production process, found the study conducted in Chakaria, Chittagong. Around 3400 acres of agricultural land grow tobacco in Chakaria.

“Smoking tobacco is challenged by the existing regulatory framework. However, people do not have access to information about SLTs like sadapatha and zarda, which is consumed by a large number of people, especially women and the poor” says Dr Abbas Bhuiya, former deputy executive director of icddr,b and senior author of the study.

Dr Abbas explains that sadapatha is not industrially produced to have packaging with traditional warning labels like cigarettes. Similarly, small amounts of zarda is used with betel leaf (paan) by street-level retailers and the consumers do not see the warning on the packages.

A woman smokes while selling vegetable. Photo: Hasib Wahab / CC BY-NC-ND 2.0

“Smokeless tobacco is way cheaper than cigarettes and its use is culturally more acceptable for women who often cannot afford cigarettes” says Mr Mohammad Nahid Mia, research officer at icddr,b and principal author of the study.

Our study shows that around one in four people use SLT in the study area, he adds.

“The findings call for immediate policy attention to bring SLT under regulatory framework,” says Dr Bhuiya.


Other risks emanating from tobacco smoking

It is well known that the ill-effects of smoking is not limited to the smokers but that it also harms  passive smokers.

What is more, another study with icddr,b has found that smoking inside the home and sharing lavatories with other adjacent households might increase the risk of secondary influenza-like illness (ILI) among household members.

Neighbours could face health complications due to smoking in the household. Photo: Shumon Ahmed / icddr,b

Published in Tropical Medicine and International Health, the study explored whether living in congested areas, hand hygiene or exposure to tobacco smoking or smoke from cooking is connected with ILI.

“Our study found that the risk of developing secondary ILI was 91 percent greater in those who lived in a household in which smoking ever occurred, compared with households without smoking,” says Dr Kaniz Khatun -e- Jannat, a research investigator at icddr,b and the second author of the study conducted with collaborating researchers from US universities and the CDC.

Such findings are clear indications of how closely living neighbours could face health complications due to smoking in the household.

These recent icddr,b studies demonstrate the threat posed by tobacco in any form to public health including underage children. The findings once again call for stringent action to curb the widespread use of tobacco in Bangladesh.

Muhamamd Zahir Hassan Nabil