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Smokeless Tobacco cOntrol in Khyber Pakhtunkhwa, Pakistan
STOP: Evaluation der Rahmenübereinkommen der WHO zur Eindämmung des Tabakgebrauchs (WHO Framework Convention on Tobacco Control, WHO FCTC)
In 2005, Pakistan signed the World Health Organization’s “Framework Convention on Tobacco Control (FCTC). While Pakistan has made considerable progress in curbing the smoking epidemic in the country, the same cannot be said for the control of smokeless tobacco (SLT), which is a socially acceptable habit in Pakistan. Recent evidence suggests that approximately 13% of the population in Pakistan use some form of SLT. SLT products are carcinogenic as they are associated with an increased risk of pre-malignant and malignant conditions of the upper aero digestive tract. Gaps in Pakistan’s SLT policy has been identified, particularly those related to the lack of regulation and taxation of the SLT products and the sale of these products to minors. Moreover, evidence gathered from the actors involved in the supply chain of SLT products suggests that most of the components of the FCTC applicable to the control of SLT are either absent or poorly implemented in Pakistan. Therefore, the study aims to formulate recommendations about effective SLT policy for Khyber Pakhtunkhwa, Pakistan. Barriers and facilitators to the formulation and implementation of an SLT control policy in Khyber Pakhtunkhwa will be analyzed and the knowledge, attitudes, practices, and beliefs of the smokeless tobacco (Naswar) supply chain actors regarding SLT regulation will be explored. To reach this aim, based on an existing partnership of German and Pakistani institutions, young Pakistani scientists will be specialized and trained in Public Health research. With the help of research exchanges with German partners, knowledge transfer covering research and project management skills (like training in questionnaire development and interview methods, mixed methods research, stakeholder analyses, content analyses, policy formulation, and project management) will be fostered. The trained skills are used to apply a methods combination of focus groups interviews with supply chain stakeholder (for questionnaire development), questionnaire survey with supply chain stakeholders, and semi structured interviews with policymakers about barriers and facilitators of a SLT policy within the project. Results of the surveys will be analyzed with NVivo. Information about public policy structures, facilitators and barriers for SLT control are needed for useful recommendations for an effective SLT control policy. An effectively implemented and enforced SLT control may ultimately lead to a decrease in the burden of head and neck cancers associated with SLT use in the country, the second most prevalent cancers in Pakistan, and contribute to the economic and social development of Pakistan in a sustainable manner.