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Can visual nudges reduce smoking tobacco expenditure? Evidence from a clustered randomized controlled trial in rural Bangladesh

Published online by Cambridge University Press:  27 July 2020

Adnan M. S. Fakir Open the ORCID record for Adnan M. S. Fakir [Opens in a new window] ,
Afraim Karim Open the ORCID record for Afraim Karim [Opens in a new window] ,
Mutasim Billah Mubde Open the ORCID record for Mutasim Billah Mubde [Opens in a new window] ,
Mustahsin Aziz  and
Azraf Ahmad
Adnan M. S. Fakir*
Affiliation:
University of Western Australia, Business School, 35 Stirling Highway, Crawley, WA, 6009, Australia BRAC University, Economics and Social Sciences (ESS) Department, 66 Mohakhali, Dhaka, 1206, Bangladesh
Afraim Karim
Affiliation:
Innovations for Poverty Action, House 35, Road 7, Dhaka, 1212, Bangladesh
Mutasim Billah Mubde
Affiliation:
Economic Research Group, D6, House 06, Road 33, Gulshan 01, Dhaka, 1212, Bangladesh
Mustahsin Aziz
Affiliation:
The World Bank, Plot E 32, Sher-e-Bangla Nagar, Agargaon, Dhaka, 1207, Bangladesh
Azraf Ahmad
Affiliation:
Simon Fraser University, Department of Economics, 8888 University Dr, Burnaby, BCV5A 1S6, Canada
*
Author for correspondence: Adnan M. S. Fakir, E-mail: adnanfakir@gmail.com
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Abstract

Introduction

A household-level constant visual deterrent advocacy campaign to reduce tobacco intake was conducted in rural Bangladesh.

Aims

To evaluate smoking tobacco expenditure by campaign components.

Methods

We conducted a single-blind clustered randomized controlled trial on 630 adult male household heads from 16 chars (riverine islands) in rural northern Bangladesh, between November 2018 and January 2019. Intervention allotment was randomized at the char level to minimize spillovers, with 8 chars in treatment and control groups each. The intervention provided households in treatment chars (n = 323) with two visual warning posters, detailing the health effects of tobacco on oneself and external actors, to be hung inside the household for 4 weeks. Households in control chars (n = 307) received nothing. Reported daily smoking (log) tobacco expenditure values were the primary outcome of interest.

Results

Final analysis was conducted using 251 and 210 smokers in treatment and control chars respectively. The intervention reduced relative smoking tobacco expenditure by 12.8% (95% CI −31.45 to 5.81) but was not statistically significant (P-value = 0.163). Weak to moderate emotional reactions to the posters was identified as a reason for the statistical insignificance.

Conclusion

For a visual anti-tobacco intervention to have a substantial impact, it must induce strong emotional responses.

Keywords

Bangladeshbehavioral economicsChars Tobacco Assessment Project (CTAP)nudgetobacco control
Type
Original Articles
Information
Journal of Smoking Cessation , Volume 15 , Issue 3 , September 2020 , pp. 163 - 170
Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

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