All Theses and Dissertations

Degree

Master of Science in Economics

Faculty / School

School of Economics and Social Sciences (SESS)

Department

Department of Economics

Date of Award

Spring 2021

Advisor

Dr. Khadija Bari

Second Advisor

Dr. Aneel Salman

Committee Member 1

Dr. Khadija Bari, Department of Economics, Institute of Business Administration (IBA), Karachi

Committee Member 2

Dr. Aneel Salman, COMSATS University, Islamabad

Project Type

Thesis

Access Type

Restricted Access

Pages

xvi, 164

Abstract

Smokeless tobacco, propagated as a harm-reduction strategy, is harm-inflicting and a challenge for Pakistan because of its large-scale undocumented cottage industry producing pouches void of statutory warnings neglected even by the country’s tobacco control legislation. Along with deathinducing ailments, it has been found that SLT use can also transmit COVID-19. Hence, it is important to review the socio-econo-tobacco-graphics and awareness about SLT associated products. The NCI and CDCP (2014) defined SLT as tobacco consumption without burning which may be chewed, used as moist snuff, or inhaled. Smokeless tobacco is also a source of environmental pollution in the form of spitting mucosal accumulates and remains of naswar and chalia wherever convenient for the user, be it the ablution area of mosque. Its use and associated pollution has been frequently observed in government based institutions.

Hence, one of the largest government institutions, University of Karachi was chosen to conduct a case study oriented survey to determine socio-demographic variables based prevalence of smokeless tobacco, along with its precursors, smokeless tobacco consumption specific characteristics, trends of quitting in past and future plans to abandon this behavior amongst the non-teaching staff using a semi-structutred questionnaire. The variable that was of prime importance and addressed in the thesis as a pioneer to the best of the knowledge is willingness to pay for quitting smokeless tobacco using contingent valuation method and willingness to participate in environmental cleanliness drive of spitting associated pollution. The survey ended with probing into the policy recommendations to end the SLT pandemic. The present study focused on the chewed and moist form of SLT classified as‘Paan’ and pouch depending upon the product. Pouch-based SLTs include popularly used forms in Pakistan such as Gutka, Mawa, Naswar, Chahlia/Supari, Mainpuri and Patti. After seeking permission from University of Karachi, administration and particular departmental head where required, data was collected from 2-9-2019 to 10-3-2020 by approaching the non-teaching staff from grade 1 to 16 employing convenient sampling by visiting various departments, administration block, transport department and stationed guards.

STATA analysis of 296 responses revealed that daily usage was >40% with male domination, particularly having education up to intermediate, unmarried, and having male family users. Most users consumed ‘Betel Quid’ or ‘Paan’. A significant finding was that the duration of SLT daily usage was approximately 20.6 years. Despite having awareness about the dangers of https://ir.iba.edu.pk/etd/61 Published by iRepository, 2022 xv SLT, average daily expenditure on ‘Betel Quid’and pouch was PKR 72.9 (USD 0.42) and PKR 45.4 (USD 0.26), respectively. In general, participants perceived themselves healthy also evident from rare prevalence of diseases like cardiovascular ailments and cancers. Visiting a dentist was scarcely practiced in routine with females having a greater tendency to seek dental care and had more number of broken teeth as compared to males. Dental expenditure during the past 1 year had large variation having an average of PKR 7906.3 for males and PKR 4821.4 for females. There was seldom existence of any kind of oral diseases. The relative risk of heart attack and angina pain on account of Smokeless tobacco consumption was 0.619 and 2.168 respectively. Though dentist visit was not a daily routine in smokeless tobacco users but less than daily users spent significantly maximal monetary resources during the visit in past year that is an average of PKR 10, 733.3. The odds of consuming smokeless tobacco increased by 2.01 (p<0.05) if there was a family consumer of this form of tobacco and attainment of education till Junior high school and under-graduation also increased the odds of developing SLT habit by 6.85 (p<0.05) and 9.04 (p<0.05) respectively. Married and divorced as compared to single had greater odds of consuming SLT that is 6.26 (p<0.01) and 32.2 (p<0.01) respectively. Participants of age bracket 25 to 44 years were consuming pouch based SLT 9.28 times (p<0.05) more frequently as compared to the older ages. Similarly, those who acquired education till Junior high school, high school and above graduation had used pouch based SLT significantly less frequently with highest odds for those who acquired a degree above graduation. Participants having family income of PKR 80,001-90,000 were consuming pouch based SLT 17.6 times lesser as compared to their counterparts. Paan usage was 4.47 times more frequent in Urdu-speaking (p<0.05) as compared to other ethnic groups.

Quitting history of smokeless tobacco was reported by 81.7% daily users with 49.4% making an attempt within past one year with a high success rate. 36 currently not at all users were thoroughly successful in quitting smokeless tobacco habit forever. Quitting was least attempted by consumers of smokeless tobacco whose habit was recent that is since 1 to 5 years or if the usage span was beyond 26 years. Quitting was practiced even if users reported themselves to be healthy and that healthcare professional’s suggestion to quit this habit motivated 96.8% to abstain from Smokeless Tobacco. Current willingness to quit predominantly existed in 81.7% daily users irrespective of age, education and marital status of users. Perception of hazardous nature of smokeless tobacco and past quit attempts played a role in inculcating willingness to quit in future. Findings from contingent valuation analysis showed that 72.9% of those who were willing to quit were also willing to pay. Real willingness to pay encompassing all benefit dimensions for the treatment was PKR 1070±528.4 for daily users inferior to the monetary value assigned by less than daily users (PKR 1500±707.1). Participants of younger age and those having higher education had greater real willingness to pay for quitting treatment and that the WTP also indicated that treatment was affordable. Individual health was given a significant consideration by those who had attained education above graduation from a holistic point of view and also for pouch based SLT users.

Willingness to participate in cleanliness drive against the SLT associated pollution was favored by a majority such that males were willing to take part physically and females were willing to give monetary contribution. Odds of participation in this voluntary cleanliness were higher for those who were more educated and for Urdu speaking participants. Fine imposition was the most popularly recommended policy to curb this SLT pandemic. Females suggested that on average the fine should range between PKR 718.8 to 1612 whereas males suggested that best suited fine on average would be PKR 396.3-3901.5. The next popular recommendations included verbal communication and complete ban from the government.

Hence, the present study provides the evidence of uprising cost of SLT consumption in the premises of University of Karachi which can burden the individual and also the panel facility. This study recommends the provision of a facilitation center providing behavioral intervention to help those willing to quit and encourage the staff to quit this habit by providing incentives and formulate stringent policies to look into the SLT associated consumption and pollution. Stringent application of WHO’s Framework Convention on Tobacco Control ‘MPOWER approach’ by monitoring and strict policy enforcement against its usage along with encouraging, supporting and reinforcing quitting behaviour can help in reducing and exterminating this preventable cause of disease and death in Pakistan.

JEL Code: D9

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