Attitudes of smokers towards tobacco control policies: findings from the Studying Tobacco users of Pakistan (STOP) survey
http://orcid.org/0000-0003-1529-7778Kamran Siddiqi1,2,
http://orcid.org/0000-0002-2253-3911Faraz Siddiqui1,
Melanie Boeckmann3,
Ziauddin Islam4,
Amina Khan5,
Fiona Dobbie6,
http://orcid.org/0000-0002-1885-8254Zohaib Khan7,
Mona Kanaan1
1 Department of Health Sciences, University of York, UK, York, North Yorkshire, UK
2 Hull York Medical School, York, UK
3 School of Public Health, University of Bielefeld-Germany, Bielefeld, Germany
4 Tobacco Control Cell, Pakistan Ministry of National Health Services Regulations and Coordination, Islamabad, Islamabad, Pakistan
5 The Initiative, Islamabad, Pakistan
6 Usher Institute, University of Edinburgh, University of Stirling, Edinburgh, UK
7 Office of Research Innovation and Commercialisation, Khyber Medical University, Peshawar, Pakistan
Correspondence to Dr Faraz Siddiqui, Department of Health Sciences, University of York, York YO10 5DD, North Yorkshire, UK; faraz.siddiqui{at}york.ac.uk
Background Public attitude is a political driver in successful implementation of tobacco control policies. We assessed support for a range of tobacco control policies among smokers in Pakistan.
Methods We conducted a household survey among adult smokers in 10 cities of Pakistan, using a two-stage random sampling strategy to select households and Kish grid method to select one smoker per household. Attitudes were measured using a five-point ordinal scale on four policy statements: a complete ban on tobacco sale within 10 years; raising the legal age to buy tobacco from 18 to 21; increasing tobacco taxes to fund healthcare and a ban on smoking in cars with minors.
Results 6014 participants were interviewed between September 2019 and March 2020. Most participants demonstrated strong support for all policy statements: a ban on smoking in cars with minors (86.5%); a complete ban on tobacco sale within 10 years (82.1%); raising the legal age to buy tobacco (77.9%) and increasing tobacco taxes (68.1%). Smokers' support for tobacco control policies increased with age but decreased with higher educational attainment and heaviness of smoking.
Conclusions There is strong support among smokers in Pakistan to strengthen tobacco control. Given this, policy-makers should strongly consider strengthening existing national policies on tobacco control.
Twitter @Fsiddiqui532, @zoheb_dr
Contributors KS (principal investigator) along with AK, ZI, ZK and MB (coinvestigators) were involved in designing the original study and provided inputs throughout the project period. KS also wrote the introduction, methods and discussion section. FS analysed the data, drafted results and parts of methods sections and all tables and figures. FD was involved in the interpretation of the results and contributed to the write up. MK supervised the quantitative analysis and contributed to the manuscript. All the above listed authors reviewed and approved the final manuscript draft.
Funding The study was funded by European Union Horizon 2020, grant no 680 995.