sms-based mcessation: suggestions for potential ...-+final+project...on zarda and gul. who study...

SMS-Based mCessation: Suggestions for Potential Implementation in Bangladesh

Matthew BabcockAbhinav Gautam

T4ID Final Presentation12/18/15

PROJECT OVERVIEW

• Problem Statement

• Methods: Literature Review & Example Comparisons

SMOKING

• #1 Cause of Preventable Death

• 5+ M deaths/ year

• Nearly 80% of the world's 1B smokers live in low- & middle-income countries

MCESSATION

• Comparison of mCessation programs in developed/high-income countries (US, UK, TK, NZ)

• SMS based programs, like Test2Quit, were effective among adults, but not for youth

• SMS programs more effective than MMS, voice calling, websites, apps

BANGLADESH

• Population: 168+ M (#8 globally)

• Mobile Users: 130+ M (#9 globally) with 80% penetration

• Growing smoking prevalence

SMOKING IN BANGLADESH

• 41.1 M use tobacco, with 20.9 M smoking and numbers still increasing

• 50+% of 25+ old men smoke

• Each year ~57,000 people die of tobacco-related illnesses and 300,000 suffer disabilities

• 50% of smokers use bidis (higher nicotine), which is taxed much less and is having higher usage growth, especially among low-income population

BANGLADESHTimeline of Tobacco Control Policies and ITC Surveys

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Wave 1Jan-May 2009

Tobacco User=3,109Non-User=2,658

Wave 2Mar-Jun 2010


Wave 3Nov 2011-Jun 2012Tobacco User=3,275

Non-User=2,247

Survey Mode: Face-to-Face (F2F)Respondent Types: Cigarette, Bidi, Dual, Mixed, Smokeless, Non-User

June 2004FCTC ratification

2010 • Cigarette price slabs for SD raised. Increase in SD on cigarettes by 1% in four price slabs.• SD on filtered bidi raised from 20% to 25%.• SD on chewing tobacco raised to 20%.• 10% export duty on raw tobacco imposed.• Cigarettes (mainly low brands), bidis, zarda, and gul no longer cottage industry products, required to pay corporate taxes.

2009• Cigarette price slabs for SD raised (taxes unchanged).• SD of 10% imposed on zarda and gul.

WHO Study2004-2005

2007• National Strategic Plan of Action for Tobacco Control adopted.• Cigarette price slabs for SD raised (taxes unchanged).

2011• Cigarette price slabs for SD raised. Increase in SD on cigarettes by 2% at each price slab in the top three tiers and 3% in the bottom tier.• Tobacco Tax Policy Cell formed at National Board of Revenue.• Export duty on raw tobacco decreased from 10% to 5%.

Updated November 2015

2012• Cigarette price slabs for SD raised.• Increase in SD on cigarettes by 1% at each price slab in the top three tiers and 3% in the bottom tier.• SD on chewing tobacco raised to 30%.• Gul, zarda, and khoyni considered tobacco products. • Fine of Tk100,000 for airing tobacco advertisements.

2006• Warning labels covering 30% of both sides of package implemented.• Cigarette price slabs raised, increasing the supplementary duty (SD) in the upper three tiers.

2005Tobacco Control Law 2005• Smoking banned in educational, health care, and public transport facilities.• Ban on advertising of tobacco products, sponsorship, and automatic vending machines.• Text warning labels to be on 30% of the front and back of cigarette packages.

2008• SD on bidiraised to 20% from 17.5%.• Cigarette price slabs for SD raised (taxes unchanged).• 15% VAT on zarda and gul.

2013• Cigarette price slabs for SD raised (taxes unchanged).• Tariff value and price of bidi raised (taxes unchanged).

Wave 4Oct 2014-Apr 2015


March 2015Smoking and Tobacco Products Usage (Control) (Amendment) Act, 2013 came into effect• Total ban on smoking to include all public places. Fine raised from Tk50 to Tk300. Fine of Tk500 for management of public places failing to enforce laws.• Anti-tobacco messages required if tobacco use is shown in a movie.• Ban on point-of-sale advertising.• Ban on use of descriptors.•Ban on sale of tobacco to minors.• Smokeless tobacco is now part of the definition of tobacco.• Restrictions on corporate social responsibility activities.

9

SMOKING CESSATION IN BANGLADESH• Despite negative view of smoking, 36% of bidi

smokers and 51% of cigarette and dual smokers plans to quit

• Only 5% of bidi smokers and 10% of cigarette and dual smokers plans to quit within the next 6 months

• Natural quit rate is a ~4%

• No national cessation programs, only policies on banning and taxation

FACTORS TO CONSIDER FOR BANGLADESH

• High mobile penetration, yet limited Internet access

• 50+ M youth growing population

MOBILE PENETRATION

EXAMPLE ANALYSES

• What can be learned through studies of the efficacy of mCessation programs?

• What can be learned through the recent example programs in other middle/low income countries?

META-ANALYSIS OF EFFICACY

Spohr, Stephanie A. et al. (2015). Efficacy of SMS Text Message Interventions for Smoking Cessation: A Meta-Analysis. Journal of Substance Abuse Treatment, 56: 1-10.

• 13 STUDIES, 11 OF WHICH WERE HIGH ECONOMIC

• ISSUE OF YOUTH EFFICACY

MCESSATION IN COSTA RICA

COUNTRY COMPARISONMeasure Costa Rica Bangladesh

Population ~5 million ~`156 million

% of Male Adults that Smoke

18.0% 53.3%

% of Male Youth that Smoke

7.5% 9.2%

National Literacy Rate 97.8% 61.5%

$ spent on Government Anti-Smoking Efforts

~$53,000,000 ~$90,000

Does government cover the cost of non-mobile cessation programs?

Yes No

COSTA RICA VS. BANGLADESHCosta Rica

Bangladesh

Legend: the darker the color in each category the better performance, grey represents no action

REFERENCES• Abroms, Lorien (2015) Mobile Phones and Smoking Cessation (Presentation). Found at: https://www.yumpu.com/en/document/view/38583700/kc6rgtw/11

• Ahmed, Tanvir, et al.(2014) "eHealth and mHealth initiatives in Bangladesh: A scoping study." BMC health services research 14.1 : 260.

• AllAfrica.com (2015). Tunisia: Quit-Smoking Mobile App M-Cessation to be launched soon. Website. Found at: http://allafrica.com/stories/201512161058.html

• Health and Development Foundation (2015a) A Day to Quit Smoking and the Results of Our New mCessation program. Website. Found at: http://www.fzr.ru/eng/news/_a_day_to_quit_smoking_and_results_from_our_new_mc.html

• Health and Development Foundation (2015b) MHealth Support for Smoking Cessation. Website. Found at: http://www.fzr.ru/eng/programs/mhealth_support_for_smoking_cessation.html

• IndiaTimes.com (2015). Government to Launch “M Cessation” to help kick tobacco habit. Website. Found at: http://economictimes.indiatimes.com/industry/cons-products/tobacco/government-to-launch-m-cessation-to-help-kick-tobacco-habit/articleshow/49308988.cms

• ITU (2015) Be He@lthy, Be Mobile website: http://www.itu.int/en/ITU-D/ICT-Applications/eHEALTH/Be_healthy/Pages/Be_Healthy.aspx

• Khatun, Fatema, et al. (2014)"Prospects of mHealth Services in Bangladesh: Recent Evidence from Chakaria." e111413.

• Lomotey, Richard K., Shomoyita Jamal, and Ralph Deters. (2012) "SOPHRA: a mobile web services hosting infrastructure in mHealth." Mobile Services (MS), 2012 IEEE First International Conference on. IEEE, 2012.

• Spohr, Stephanie A. et al. (2015). Efficacy of SMS Text Message Interventions for Smoking Cessation: A Meta-Analysis. Journal of Substance Abuse Treatment, 56: 1-10.

• Tinoco, Roxana (2015). mCessation in Costa Rica: country experiences and lessons learnt. Presentation. Found at: http://www.who.int/tb/features_archive/Roxana-Tinoco-ehealth-consultation-feb-2015.pdf

• WHO-ITU Joint Program (2014) Fighting the Global Health Burden through New Technology. Presentation. Found at: https://www.itu.int/en/ITU-D/ICT-Applications/eHEALTH/Be_healthy/Documents/mHealth_for_NCDs_June2013.pdf

• WHO (2015a) Noncommunicable Diseases Fact Sheet. Found at: www.who.int/mediacentre/factsheets/fs355/en/

• WHO (2015b) WHO Report on the Global Tobacco Epidemic 2015: Country Profiles. Found at: http://www.who.int/tobacco/surveillance/policy/country_profile/en/