ITC Bangladesh Project Geoffrey T. Fong, Ph.D. Department of Psychology University of Waterloo

1. ITC Bangladesh Project Geoffrey T. Fong, Ph.D. Department of Psychology University of Waterloo ITC-TTURC Project Annual Meeting Portland, Oregon—March 1, 2008

2. 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

3. 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.

4. 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?)

5. 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

6. 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

7. 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

8. 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)

9. Bangladesh: Demographics

10. Bangladesh: Prevalence

11. Bangladesh: Tobacco Industry

12. Bangladesh: FCTC Status

13. Bangladesh: FCTC—Price and Taxation

14. Bangladesh: FCTC—Non-Price Measures

15. Bangladesh: FCTC—Non-Price Measures