title: Smokeless tobacco control policies in South Asia: a gap analysis and recommendations.
abstract: BACKGROUND
  Almost a fifth of the world's tobacco is consumed in smokeless form. Its consumption is particularly common in South Asia, where an increasing array of smokeless tobacco (SLT) products is widely available. Mindful of the growing public health threat from SLT, a group of international academics and policy makers recently gathered to identify policy and knowledge gaps and proposed strategies to address these.
  
  
  METHODS
  We reviewed key policy documents and interviewed policy makers and representatives of civil society organizations in 4 South Asian countries: Bangladesh, India, Nepal, and Pakistan. We explored if SLT features in existing tobacco control policies and, if so, the extent to which these are implemented and enforced. We also investigated barriers to effective policy formulation and implementation. The findings were presented at an international meeting of experts and were refined in the light of the ensuing discussion in order to inform policy and research recommendations.
  
  
  RESULTS
  We found that the existing SLT control policies in these 4 South Asian countries were either inadequate or poorly implemented. Taxes were low and easily evaded; regulatory mechanisms, such as licensing and trading standards, either did not exist or were inadequately enforced to regulate the composition and sales of such products; and there was little or no cessation support for those who wanted to quit.
  
  
  CONCLUSIONS
  Limited progress has been made so far to address the emerging public health threat posed by SLT consumption in South Asia. International and regional cooperation is required to advocate for effective policy and to address knowledge gaps.
authors.affiliation: Social and Health Inequalities Network, Islamabad, Pakistan;
authors.forename: Amina
authors.initials: A
authors.lastname: Khan
authors.forename: Rumana
authors.initials: R
authors.lastname: Huque
authors.forename: Sarwat K
authors.initials: SK
authors.lastname: Shah
authors.forename: Jagdish
authors.initials: J
authors.lastname: Kaur
authors.forename: Sushil
authors.initials: S
authors.lastname: Baral
authors.forename: Prakash C
authors.initials: PC
authors.lastname: Gupta
authors.forename: Rajeev
authors.initials: R
authors.lastname: Cherukupalli
authors.forename: Aziz
authors.initials: A
authors.lastname: Sheikh
authors.forename: Sakthivel
authors.initials: S
authors.lastname: Selvaraj
authors.forename: Nigar
authors.initials: N
authors.lastname: Nargis
authors.forename: Ian
authors.initials: I
authors.lastname: Cameron
authors.forename: Kamran
authors.initials: K
authors.lastname: Siddiqi
mesh_terms: D001459:Bangladesh; D003132:Commerce / Q000331:legislation & jurisprudence; D006291:Health Policy / Q000331:legislation & jurisprudence*; D007194:India; D009390:Nepal; D010154:Pakistan; D011634:Public Health; D012926:Social Control, Formal; D013660:Taxes / Q000191:economics; D019460:Tobacco Industry / Q000331:legislation & jurisprudence; D014030:Tobacco, Smokeless / Q000191:economics