{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,15]],"date-time":"2025-08-15T02:58:47Z","timestamp":1755226727552,"version":"3.43.0"},"reference-count":19,"publisher":"BMJ","issue":"4","license":[{"start":{"date-parts":[[2025,4,2]],"date-time":"2025-04-02T00:00:00Z","timestamp":1743552000000},"content-version":"unspecified","delay-in-days":1,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100015283","name":"Bloomberg Philanthropies","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100015283","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,3,17]]},"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:sec>\n<jats:title>Objective<\/jats:title>\n<jats:p>To qualitatively explore Bangladeshi adult males\u2019 perceptions of existing<jats:italic>bidi<\/jats:italic>(tobacco-leaf cigarettes hand-rolled in tendu leaf) packs, which are currently sold in various shapes and sizes, often without the required graphic health warning label (HWL) covering 50% of the top of the pack, versus a proposed standard bidi pack, which was designed by advocates and is a cardboard, rectangular box shape with the required 50% HWL coverage.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Design<\/jats:title>\n<jats:p>Focus group study<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Setting<\/jats:title>\n<jats:p>Male participants were recruited from predetermined low-income urban and rural areas in three geographic divisions (Dhaka, Khulna, Sylhet) of Bangladesh.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Participants<\/jats:title>\n<jats:p>98 males participated in 14 focus group discussions (FGDs). An equal number of groups were conducted with males who currently used bidis (n=7 groups) and males who never used tobacco (n=7 groups). Each group had 6\u20138 participants. For FGDs with males who used bidis, participants were eligible if they were at least 18 years old and reported smoking bidis on at least one of the past 30 days. For FGDs with males who never used tobacco, participants were eligible if they were between 18 and 35 years old to capture those at most risk of initiating tobacco and reported never using any tobacco.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Intervention<\/jats:title>\n<jats:p>Participants were shown four existing bidi packs sold in Bangladesh and one standard bidi pack. The groups were asked to first rank and discuss the existing bidi packs in terms of<jats:italic>perceived attractiveness<\/jats:italic>,<jats:italic>HWL noticeability<\/jats:italic>and<jats:italic>perceived harmfulness<\/jats:italic>. Next, the groups discussed how the standard bidi pack compared with the existing bidi packs in terms of the same three outcomes.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>All groups, regardless of bidi use status, discussed the limited noticeability of HWLs on existing bidi packs, which reduced perceived product harm. In contrast, most groups discussed how the standard pack HWL was clearly printed, easy to see and increased perceived harm. Overall, most groups across bidi use status found that the standard pack was as attractive or more attractive than the existing bidi packs, particularly noting that the standard pack shape, colour and cardboard material were attractive.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Standardising the size and shape of bidi packs has the potential to improve HWL compliance and increase harm perceptions. Complementing a standard bidi pack policy with a plain packaging policy (eg, packs only sold in a single drab olive colour), as well as efforts to enhance HWL compliance at the point of manufacturer, could further reduce product appeal and enhance harm perceptions.<\/jats:p>\n<\/jats:sec>","DOI":"10.1136\/bmjopen-2024-094166","type":"journal-article","created":{"date-parts":[[2025,4,3]],"date-time":"2025-04-03T06:20:03Z","timestamp":1743661203000},"page":"e094166","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["How do focus groups of adult males in Bangladesh perceive a standard bidi pack versus existing bidi packs"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7496-0990","authenticated-orcid":false,"given":"Lauren","family":"Czaplicki","sequence":"first","affiliation":[{"name":"Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raniyan","family":"Zaman","sequence":"additional","affiliation":[{"name":"Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sanjana","family":"Balagere","sequence":"additional","affiliation":[{"name":"Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A B M","family":"Rasheduzzaman","sequence":"additional","affiliation":[{"name":"Bangladesh Center for Communication Programs, Dhaka, Bangladesh"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sejal","family":"Saraf","sequence":"additional","affiliation":[{"name":"Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M Shamimul","family":"Islam","sequence":"additional","affiliation":[{"name":"Bangladesh Center for Communication Programs, Dhaka, Bangladesh"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3869-3637","authenticated-orcid":false,"given":"Joanna E","family":"Cohen","sequence":"additional","affiliation":[{"name":"Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,4,2]]},"reference":[{"key":"2025070104211769000_15.4.e094166.1","unstructured":"WHO . National Tobacco Control Cell, 2019. 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An Act for the Amendment of Smoking and Tobacco Products Usage (Control) Act, 2005. Available: https:\/\/assets.tobaccocontrollaws.org\/uploads\/legislation\/Bangladesh\/Bangladesh-TC-Amdt.-Act-2013.pdf"},{"key":"2025070104211769000_15.4.e094166.6","doi-asserted-by":"publisher","DOI":"10.1136\/tc.2010.037630"},{"key":"2025070104211769000_15.4.e094166.7","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-021-10810-z","article-title":"The effectiveness of graphic health warnings on tobacco products: a systematic review on perceived harm and quit intentions","volume":"21","author":"Pang","year":"2021","journal-title":"BMC Public Health"},{"key":"2025070104211769000_15.4.e094166.8","doi-asserted-by":"crossref","DOI":"10.18332\/tid\/108614","article-title":"Impact of tobacco-pack pictorial warnings on youth and young adults: A systematic review of experimental studies","volume":"17","author":"Francis","year":"2019","journal-title":"Tob Induc Dis"},{"key":"2025070104211769000_15.4.e094166.9","doi-asserted-by":"publisher","DOI":"10.1136\/tobaccocontrol-2018-054249"},{"key":"2025070104211769000_15.4.e094166.10","doi-asserted-by":"publisher","DOI":"10.1136\/tobaccocontrol-2011-050078"},{"key":"2025070104211769000_15.4.e094166.11","doi-asserted-by":"publisher","DOI":"10.1111\/add.12183"},{"key":"2025070104211769000_15.4.e094166.12","doi-asserted-by":"publisher","DOI":"10.1136\/tobaccocontrol-2017-053993"},{"key":"2025070104211769000_15.4.e094166.13","doi-asserted-by":"crossref","first-page":"I73","DOI":"10.1136\/tc.11.suppl_1.i73","article-title":"The cigarette pack as image: new evidence from tobacco industry documents","volume":"11 Suppl 1","author":"Wakefield","year":"2002","journal-title":"Tob Control"},{"key":"2025070104211769000_15.4.e094166.14","doi-asserted-by":"publisher","DOI":"10.3109\/16066359.2011.632700"},{"key":"2025070104211769000_15.4.e094166.15","unstructured":"Tobacco Control Research Cell, Dhaka International University . Introduce standard packaging for smokeless tobacco and bidi for effective implementation of pictorial warnings in Bangladesh, Available: https:\/\/api.diu.ac\/\/images\/diu_tcrc\/researchAndPublications\/1642069728_TDk7K3KJ5J.pdf"},{"key":"2025070104211769000_15.4.e094166.16","doi-asserted-by":"publisher","DOI":"10.1136\/tc-2022-057597"},{"key":"2025070104211769000_15.4.e094166.17","unstructured":"Islam MS . Re: recruiter and moderator and notetaker training (Email Correspondence on existing bidi packs to purchase from public retail outlets). Dhaka, Bangladesh: Microsoft Outlook, 2021."},{"key":"2025070104211769000_15.4.e094166.18","unstructured":"Bangladesh Gazette of Bangladesh National Parliment . Act no.16 Of 2013 - An Act for the Amendment of Smoking And Tobacco Products Usage (Control), 2005. 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