ITC Bangladesh Project

Geoffrey T. Fong, Ph.D.Department of Psychology

University of Waterloo

ITC-TTURC Project Annual MeetingPortland, Oregon—March 1, 2008

Bangladesh—Background Information

Population = 141,822,000 Income Group = LOW (Pov=36%)

Tobacco Prevalence (2005):

Cigarettes: Males 41.0%; Females 1.8%

Total Prev: Males 48.6%; Females 25.4%

FCTC Status: Signed Jun 16, 2003; Ratified Jun 14, 2004

FCTC Policies:

– Warning Labels: FCTC minimum (30% text)

– Smoke Free: health care + schools, but Enforcement = 0/10

– Ad/Promo: broad (media, sponsorship): Enforcement = 5/10

– Price: $1.38/pack; 7%; Taxes = 50% of retail price

Why Bangladesh?

• First country to ratify the FCTC• Low-income country, but with good research infrastructure• Identified by the Bloomberg Initiative as one of the 15 high-

burden countries• Highly influential WHO Study on economic impact of tobacco

in Bangladesh was conducted in 2003-04.• Since that time, the National Tobacco Control Act was

passed (15 March 2005) and implemented• There has been no evaluation and no WHO Study followup • Strong linkages to Bangladesh (Nigar Nargis, Post-Doc at

Waterloo, is Economics Professor at Univ of Dhaka). Nigar was a co-investigator on the WHO Study and is the out-of-country PI on the ITC Bangladesh Project

• Very strong links between Univ of Dhaka and Govt.

Why Bangladesh?

• Bangladesh Government is establishing a Tobacco Control Cell and plans mass media campaigns. Already, the Health Promotion Program of the Government is operating in 20 primary health care districts with video and education programs. Also integrated are cancer and heart disease control programs. NRT is available (but obviously inadequate for the population).

• Economic changes in Bangladesh: how will this affect tobacco use?

– Current high prevalence of bidis, kreteks, and smokeless (particularly among women)

– Microcredit financing in Bangladesh: implications for tobacco use (and for women?)

ITC Bangladesh Survey

• Household survey of 2,500 households• Multistage cluster sampling design: 64 districts of the

country• Planned 30-40 minute face-to-face interview• Oversampling of urban households (80% is rural)• Full enumeration of households—>prevalence estimates

• 3 annual survey waves

ITC Bangladesh Survey—Research Team

• University of Dhaka, Bureau of Economic Research, Department of Economics

• Professor SM Ashiquzzaman: Coordination of surveys and collaboration with ITC team for research and technical assistance.

• Project Manager already in place• Nigar Nargis: Co-PI/Consultant• Abu Abdullah: Consultant

ITC Bangladesh Survey—Funding

• Proposal submitted to IDRC/RITC in October 2007

• Very favorably reviewed at high levels

• Feedback and request for revisions sent back Feb 2008

• In process of revisions for resubmission mid-March 2008

• Senior staff at IDRC are optimistic that the ITC Bangladesh Project will be funded beginning in April

ITC Bangladesh Survey—Challenges

• Capacity issues, although we will receive funding for staff from the IDRC grant.

• Fieldwork challenges: training, quality control; but lot of experienced field workers (including economics students at Univ of Dhaka)

Bangladesh: Demographics

Population (1000s) 141,822Adults (>15 years) 64.5%Urban 25.0%Growth rate 2.0%

Income Group LowIncome per capita (Intl $) $2,090Extreme Poverty Rate 36.0%Literacy Rate 42.6%

Bangladesh: Prevalence

Males 5.9 Females 4.7 Overall 5.8

Youth Prevalence (2004 GYTS in Dhaka 13-15 years)

Males 41.0 (48.6) Females 1.8 (25.4) Overall 20.9 (36.8)

Adult Prevalence (2004)

Bangladesh: Tobacco Industry

Cigarette Production (Ms)Unknown, but 5th largest number of workers: 32,829

Cigarette Imports (Ms) 400Cigarette Exports (Ms) —

Tobacco Industry

Bangladesh: FCTC Status

Signed 16 Jun 2003 Ratified 14 Jun 2004

FCTC Status

Bangladesh: FCTC—Price and Taxation

In National Currency 18.00 BOT In International $ $1.38Affordability of most popular

brand: % of annual per capita income required to

buy 100 packs

7%

Taxes50% of retail

price

Cigarette Price of most popular brand

Bangladesh: FCTC—Non-Price Measures

Advertising/Promotion Bans Partial

National TV and radioLocal print mediaBillboards/outdoor advFree distributionBrand extension productsSponsorship

Enforcement Rating 5 / 10

Bangladesh: FCTC—Non-Price Measures

Smoke-Free PartialHealth careSchools

Enforcement =0/10

Warning Labels FCTC min30% text-based and rotating labels