title: Smokeless Tobacco Supply Chain in South Asia: A Comparative Analysis Using the WHO Framework Convention on Tobacco Control.
abstract: BACKGROUND
  Most South Asian countries are signatories to the WHO Framework Convention for Tobacco Control (FCTC). However, there is little information on the extent to which FCTC standards are effectively implemented for controlling smokeless tobacco (SLT)-used by over 250 million people in the region. We assessed the feasibility of a novel approach based on interviewing the key actors of SLT supply chain and analyzing its findings using standards set by FCTC.
  
  
  METHODS
  Using a snowball-sampling technique, we interviewed point-of-sale vendors, wholesale retailers, manufacturers, raw-tobacco retailers, and farmers involved in the supply chain of SLT in Bangladesh, Nepal, and Pakistan. Using a structured-questionnaire, participants were asked about their customer profiles; product types; marketing practices; suppliers; profit margins, awareness and adherence to legislation.
  
  
  RESULTS
  We recruited 72% (130/180) of all supply chain actors approached. Findings indicate several loopholes in the existing taxation, regulatory, and inspection systems. A significant proportion of smuggled and counterfeit SLT products are available in the market. Most SLT products are sold without recommended warnings, information on their ingredients, and manufacturers' details. There appear to be no restrictions on sale of SLT products to minors. On the other hand, there are also several incentives built-in the supply chain that makes tobacco farming, SLT manufacturing, and its sale a profitable business.
  
  
  CONCLUSIONS
  Our novel approach to study SLT control was successful in identifying and interviewing actors involved in its supply chain. The analysis using FCTC could provide valuable information to policy makers and enable them to effectively regulate SLT products.
authors: Department of Health Sciences, University of York, York, United Kingdom; kamran.siddiqi@york.ac.uk.
authors: Kamran
authors: K
authors: Siddiqi
authors: Health Research and Social Development Forum, Thapathali, Kathmandu, Nepal;
authors: Katy
authors: K
authors: Scammell
authors: Department of Economics, University of Dhaka, Dhaka, Bangladesh;
authors: Rumana
authors: R
authors: Huque
authors: Initiative Trust, Islamabad, Pakistan.
authors: Amina
authors: A
authors: Khan
authors: Health Research and Social Development Forum, Thapathali, Kathmandu, Nepal;
authors: Sushil
authors: S
authors: Baral
authors: Department of Health Sciences, University of York, York, United Kingdom;
authors: Shehzad
authors: S
authors: Ali
authors: Department of Health Sciences, University of York, York, United Kingdom;
authors: Ian
authors: I
authors: Watt
mesh_terms: D001208:Asia / Q000453:epidemiology; D003132:Commerce / Q000191:economics* / Q000331:legislation & jurisprudence; D005260:Female; D006801:Humans; D008297:Male; D040541:Marketing / Q000331:legislation & jurisprudence; D012907:Smoking / Q000191:economics* / Q000453:epidemiology* / Q000331:legislation & jurisprudence; D011795:Surveys and Questionnaires; D013660:Taxes / Q000331:legislation & jurisprudence; D019460:Tobacco Industry / Q000191:economics* / Q000331:legislation & jurisprudence; D014030:Tobacco, Smokeless / Q000191:economics*; D014944:World Health Organization / Q000191:economics*