Global impact of tobacco control policies on smokeless tobacco use: A systematic review protocol

Monika Arora, Aastha Chugh, Neha Jain, Masuma Mishu, Melanie Boeckmann*, Suranji Dahanayake, Jappe Eckhardt, Sarah Forberger, Rumana Huque, Mona Kanaan, Zohaib Khan, Ravi Mehrotra, Muhammad Aziz Rahman, Anne Readshaw, Aziz Sheikh, Kamran Siddiqi, Aishwarya Vidyasagaran, Omara Dogar

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Introduction Smokeless tobacco (ST) was consumed by 356 million people globally in 2017. Recent evidence shows that ST consumption is responsible for an estimated 652 494 all-cause deaths across the globe annually. The WHO Framework Convention on Tobacco Control (FCTC) was negotiated in 2003 and ratified in 2005 to implement effective tobacco control measures. While the policy measures enacted through various tobacco control laws have been effective in reducing the incidence and prevalence of smoking, the impact of ST-related policies (within WHO FCTC and beyond) on ST use is under-researched and not collated. Methods and analysis A systematic review will be conducted to collate all available ST-related policies implemented across various countries and assess their impact on ST use. The following databases will be searched: Medline, EMBASE, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Scopus, EconLit, ISI Web of Science, Cochrane Library (CENTRAL), African Index Medicus, LILACS, Scientific Electronic Library Online, Index Medicus for the Eastern Mediterranean Region, Index Medicus for South-East Asia Region, Western Pacific Region Index Medicus and WHO Library Database, as well as Google search engine and country-specific government websites. All ST-related policy documents (FCTC and non-FCTC) will be included. Results will be limited to literature published since 2005 in English and regional languages (Bengali, Hindi and Urdu). Two reviewers will independently employ two-stage screening to determine inclusion. The Effective Public Health Practice Project's 'Quality Assessment Tool for Quantitative Studies' will be used to record ratings of quality and risk of bias among studies selected for inclusion. Data will be extracted using a standardised form. Meta-analysis and narrative synthesis will be used. Ethics and dissemination Permission for ethics exemption of the review was obtained from the Centre for Chronic Disease Control's Institutional Ethics Committee, India (CCDC-IEC-06-2020; dated 16 April 2020). The results will be disseminated through publications in a peer-reviewed journal and will be presented in national and international conferences. PROSPERO registration number CRD42020191946.

Original languageEnglish
Article numbere042860
Number of pages7
JournalBMJ Open
Issue number12
Publication statusPublished - 24 Dec 2020

Bibliographical note

Funding Information:
Funding This work is funded by the UK’s National Institute for Health Research (NIHR) (ASTRA (Grant Reference Number 17/63/76)).

© Author(s) (or their employer(s)) 2020


  • health policy
  • international health services
  • protocols & guidelines
  • public health

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