ASTRA began in 2018, and since then we have achieved a lot!
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What we have achieved:
● Collaboration: We have brought together a group of 50+ researchers across 15+ institutions in Bangladesh, India, Pakistan and the UK to design and conduct applied health research to address smokeless tobacco and disseminate our findings.
● Equitable partnerships: ASTRA promoted equitable partnerships as four of the five themes were led by researchers from LMICs; three led by women.
● Capacity: We have built capacity in conducting systematic reviews, policy analysis, longitudinal studies, natural experiments, randomised controlled trials and process and economic evaluations among our partners and our 20+ post-doctoral and PhD students and 3 SPARC awardees (NIHR Academy).
● Training: Using digital platforms, ASTRA has trained additional researchers in research methods, practitioners in smokeless tobacco cessation and wider audiences in smokeless tobacco control.
● Awareness: We have raised awareness among the general public and stakeholders, through public engagement events, public awareness videos, lay publications and through social media.
● Linkages and Co-creation: We have created sustainable linkages between the researchers and key stakeholders within each country through policy forums and engagement platforms. This allowed them to identify key policy priorities in ASTRA’s partner countries.
● Expansion and Leverage: Through its Affiliate Membership, networks (e.g. GHRN, TCCP) and impact acceleration awards, the ASTRA group has extended beyond our original partners. This allowed us to seek expertise within other institutions in Australia, Canada, Germany, the UK, and the US and extended our influence in other South and Central Asian countries.
● Sustainability: ASTRA generated momentum to apply for additional research grant income, and was successful in securing over 1.6 million GBP of NIHR, MRC and Wellcome Trust funding.
● High-quality Research: We developed new knowledge (outputs) in the following areas and so far published 30 manuscripts. We:
○ Published four papers expanding on ASTRA’s ambitions and plans, its networks, and its advocacy efforts.
○ Published updated global disease burden estimates attributable to smokeless tobacco use.
○ Reviewed literature on the levels of nicotine and carcinogens, and the health effect of additives like sugar and humectant, within smokeless tobacco products.
○ Updated systematic reviews and meta-analysis on the health risks associated with smokeless tobacco use for cardiovascular diseases, and cancers.
○ Published an overview on betel quid and areca nut practice and control in selected Asian and southeast Asian countries.
○ Identified gaps in the implementation of FCTC (an international treaty to address tobacco control) with respect to smokeless tobacco, and generated international consensus on key priorities.
○ Highlighted national policy gaps in Bangladesh, India and Pakistan and secured stakeholders’ agreement on the short, medium and long-term priorities for addressing smokeless tobacco.
○ Identified key factors that attract and deter young people from smokeless tobacco uptake in South Asia.
○ Highlighting the disease burden of dual tobacco use in adults in India,18 and the social factors that determine this dual tobacco use.
○ Published the findings of a multi-methods study to inform policy on smokeless tobacco products, supply chain and retailers in the UK.
○ Published three study protocols for: (a) a systematic review on the global impact of tobacco control policies on smokeless tobacco use; (b) a feasibility study for conducting a longitudinal study to assess the impact of tobacco control policies on smokeless tobacco uptake among adolescents in South Asia; and (c) assessing the compliance of smokeless tobacco supply chain actors and products with tobacco control laws in Bangladesh, India and Pakistan.
○ Evaluated three different tobacco dependence measures in south Asian smokeless tobacco users.
○ Published the STOP survey findings on the perceptions of tobacco users on key tobacco control policies in Pakistan.
○ Assessed compliance of Naswar packaging and sales practices with the tobacco control laws in Pakistan.
○ Published a qualitative study among Naswar supply chain actors to explore barriers and facilitators to implementing smokeless tobacco control policy in Pakistan.
○ Published an industry watch piece on Pakistan commenting on industry’s pre-budget tantrums.
○ Published three papers relating to COVID-19, highlighting: (a) the public health perspectives of smokeless tobacco and areca nut use in the COVID-19 era; (b) links between tobacco use and COVID-19 manifestations, and (c) the effect of the pandemic on tobacco use behaviour in general.