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American Journal of  Environmental
Economics (AJEE)

 Role of  Public Awareness and Healthcare in Preventing Substance Abuse: A Policy 
Analysis in Bangladesh

Md Mehedi Hasan1*

Volume 4 Issue 1, Year 2025
ISSN: 2833-7905 (Online)

DOI: https://doi.org/10.54536/ajee.v4i1.5427
https://journals.e-palli.com/home/index.php/ajee

Article Information ABSTRACT

Received: May 28, 2025

Accepted: June 30, 2025

Published: July 24, 2025

Bangladesh is among several developing countries burdened with substance abuse that is 
compounded by misinformation, cultural beliefs, and inadequate healthcare access. Public 
perception and consequent exposure to people with substance use disorders have worsened 
the situation. Public awareness and health policy formulation are crucial in developing 
preventive strategies to address this issue. A study evaluating the impact of  public awareness 
on healthcare in minimizing stigma and maximizing early interventions in Bangladesh will be 
discussed. A quasi-experimental pretest-posttest design was used to study the effectiveness 
of  a national awareness campaign in collaboration with healthcare stakeholders. Baseline 
perceptions of  public attitudes were augmented using a structured survey administered in 
August 2023. Subsequently, an extensive awareness campaign was launched across multiple 
platforms, including community outreach, social media, and healthcare providers. A post-
campaign survey was administered to ascertain any changes in awareness and stigma. The 
community-based seminars and social media-targeted messaging were the most effective 
strategies. A major proportion of  respondents agreed that stigma minimized treatment-
seeking. Furthermore, data analysis reveals significant changes (p < .05) in recovery belief, 
provision of  treatment support, trust in healthcare providers, and stigmatization of  criminal 
behavior. In conclusion, prioritized frameworks incorporating localized strategies with high 
cultural competence, healthcare, and societal leaders should be formulated. Communal 
healthcare communication and outreach interventions for mental illness at the community 
level, reducing stigma in Bangladesh.

Keywords

Bangladesh, Public Awareness, 
Substance Abuse

1 Department of  Narcotics Control, Security Service Division, Ministry of  Home Affairs, Bangladesh
* Corresponding author’s e-mail: mehedihasan1147@ yahoo.com

INTRODUCTION
Drug abuse is becoming a new public health problem 
in Bangladesh. Its prevalence is becoming higher 
among the youth and vulnerable groups (Hasan, 2024). 
Although there is growing attention to this issue at the 
policy level, the country still grapples with social stigma, 
misinformation, and limited access to only some types 
of  care. These issues result in delayed intervention, 
poor treatment-seeking behavior, and weak community 
support networks (Negash et al., 2023). Substance Abuse 
Awareness and Healthcare Awareness of  the public 
and health care are critically important in the prevention 
of  substance use. However, in the majority of  the 
communities in Bangladesh, myths and cultural biases 
about addiction live on and can result in stigmatizing and 
discriminating against individuals with SUD (Inamdar, 
2023). This brings with it the associated stigma, which also 
contributes to poor mental health for those affected and 
prevents families and the wider community from seeking 
professional support. The programs and campaigns 
conducted by government and non-government agencies 
have been implemented to create a background in which 
these social ideas are circulated; however, not much 
research has been done on the effectiveness of  their 
influence on attitudes and stigma reduction (Zavyalova, 
2025). A well-informed and context-specific health 
education campaign, facilitated by community-based 
interventions, can reshape the attitudes of  the public, 
improve community response, and guarantee early access 

to therapy (Ugbor et al., 2024). This paper aims to evaluate 
the efficacy of  combining a media-based public awareness 
strategy with healthcare engagement in various geographic 
settings throughout Bangladesh. The intention of  this 
policy analysis, which assesses shifts in public opinion and 
behavior before and after the PSA campaign, is to inform 
scalable strategies and real-world communication that 
are more effective, contextually relevant, and healthcare-
integrated in preventing drug use.

LITERATURE REVIEW
Substance Abuse is generally considered a 
multidimensional public health problem affecting both 
individuals and their families and communities (Tasfi 
& Mostofa, 2024). Across the world, a wide range of  
responses to this problem has been adopted, from law 
enforcement to harm reduction. Two such well-known 
and effective approaches to combating substance 
abuse today are public education and strengthening 
health systems. One of  the strategies used in the past 
in public health to impact knowledge, attitudes, and 
health practices, including substance use, has been public 
education (Gilham et al., 2024). These campaigns aim to 
counter misinformation, minimize stigma, and promote 
early intervention. Guarded public awareness campaigns 
traditionally utilize mass media; however, community 
engagement, educational programs, and storytelling are also 
employed to humanize the problem and generate empathy 
for individuals with substance use disorders (Young et al., 



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2024). Research from multiple countries indicates that if  the 
message is culturally appropriate and sustained, it increases 
public understanding and reduces stigma, including the 
belief  that people with drug use disorders are personally 
responsible or incapable of  recovery.
A health system is also involved in the prevention and 
treatment of  substance abuse. A robust, well-functioning 
healthcare infrastructure is well-positioned to deliver 
services for screening, early diagnosis, counseling, and 
treatment. Coordination of  mental health and substance 
abuse services with primary healthcare improves access to 
services for populations that may be difficult to reach and 
ensures the provision of  comprehensive care (Isaacs & 
Mitchell, 2024). Additionally, healthcare professionals are 
often considered trusted within their community, enabling 
them to inform patients and direct them to necessary 
recovery services. Capacity development, training, and 
the integration of  addiction education in health care 
curriculums are required to enable this (Newman & 
Swisshelm, 2025). The impact of  lower health literacy 
and stigmatization affects the prevention of  drug abuse 
in Bangladesh and similar developed countries, which is 
constructed by low public awareness and low access to 
healthcare. Some national policies have incorporated the 
relevance of  DR, but it is yet to be enforced enforced 
(Jarre et al., 2024). Community-based interventions that 
combine public education and healthcare-based outreach 
have shown promise at the local level, with strong 
backing from both government and non-governmental 
organizations.
The literature also indicates that not all approaches are 
effective for all populations. There is a prudential need 
to understand and accommodate regional characteristics, 
cultural symbols, and health literacy levels to achieve 
significant results. Therefore, even if  examining and 
adapting successful international prevention strategies 
to Bangladeshi settings and investing in public health 
infrastructure and effective communication strategies, 
the positive effect of  prevention has the possibility 
of  being reinforced in the field of  substance abuse. 
This review reflects the need for public awareness and 
healthcare delivery to address substance abuse. More 
context-specific context-specific studies are necessary for 
Bangladesh to assess the impact of  such interventions 
and to inform future policy formulation.

MATERIALS AND METHODS
Study Design and Sample
This trial utilized a quasi-experimental pretest-posttest 
design to test the effect of  a public service announcement 
and healthcare advocacy for stigma reduction and 
increasing literacy on substance abuse in Bangladesh. 
The pre-intervention survey was conducted in July 
2024 to gather baseline information on public attitudes, 
awareness, and perceptions towards SUDs. Following 
the pretest, a one-month awareness-raising campaign 
commenced in August 2023 in the selected urban 
and semi-urban areas. The campaign involved several 

components targeting a wide range of  communication 
media, including community workshops, mobile health 
services, social media, local radio stations, and printed 
materials (posters, leaflets, and banners), as well as local 
platforms for airing short educational videos. To maintain 
steady exposure, participants were provided with a digital 
awareness toolkit, which included campaign elements 
(e.g., social media images, fact sheets), testimonial 
videos, and FAQs on substance use and the availability 
of  healthcare services. After the campaign, the same 
sample was re-contacted at the beginning of  September 
2024 and requested to complete a posttest questionnaire. 
The posttest reproduced the design of  the pretest to 
ensure comparability but added a section to capture 
respondents’ exposure to the different capacities of  
the campaign and their feedback on content relevance 
and clarity. Participants were enrolled on a voluntary 
response sampling basis (54) through local NGOs, youth 
organizations, healthcare centers, centers, and university 
mailing lists. We recruited adult men and women of  all 
educational and socioeconomic levels. Participation 
was completely optional, and no exclusion criteria were 
applied. Consent was obtained digitally from participants 
prior to their completion of  the survey. A minority of  
subjects were randomly chosen to receive a reward for 
participating (a mobile data package or shopping voucher) 
as a small token of  appreciation for their time. Ethical 
clearance was obtained from an established institutional 
ethics committee in Bangladesh, and participants were 
informed about the principles of  confidentiality and the 
process of  informed consent.

Intervention
The Campaign in August 2024, a multi-media public 
awareness campaign was rolled out to combat the general 
stigma and erroneous beliefs about drugs amongst 
the Bangladeshi. Substance Abuse is Preventable and 
Treatable. The campaign’s focus was on generating 
awareness, empathy, and early intervention by supporting 
the core message. This message was also uniformly 
included in all outreach copy and communication 
channels to build public awareness and establish trust. A 
media- and health-oriented approach was applied in the 
campaign to encourage wide community participation. 
Posters, banners, and billboards placed in prominent 
areas, such as community clinics, were used as a medium 
to distribute awareness materials. A series of  brief  videos 
featuring testimonies from people in recovery and their 
relatives were disseminated through social networks, 
television broadcasts, and YouTube. The videos sought 
to put a human face on recovery and debunk myths and 
stigma around addiction. Educational videos, including 
animated explainer videos and infographics, were also 
produced to focus on the use of  non-stigmatizing 
language in addressing substance use. Medical 
professionals and community leaders were mobilized to 
promote awareness, treatment, and mental health support 
through the use of  social media and community radio. 



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A tailored methodic toolkit was produced for various 
publics and purposes. For instance, the toolkit for local 
religious leaders included spiritual teaching resources 
and culturally sensitive terms for discussing addiction-
related issues with empathy. Prevention, peer support, 
and the dangers of  early substance use were the main 
topics for schools. Training was provided to community 
health workers and volunteers on how to use this toolkit 
through hands-on sessions, workshops, and outreach 

visits. The campaign also collaborated with providers 
in local medical institutions to incorporate screening, 
counseling, and referrals into their services during the 
intervention period. Mobile health vehicles were deployed 
to remote and underserved areas to enhance access to 
information and prompt assistance. On the whole, the 
intervention was designed to mitigate stigma as well as 
bolster community support networks, and prompt timely 
healthcare-seeking for substance use disorders.

Table 1: Public Awareness and Healthcare-Based Campaign Interventions in Bangladesh
Media/
Platform

Description Estimated Cost 
(3 Months)

Billboards • Installed in key locations across Dhaka, Chattogram, and regional towns with 
the core message “Substance Abuse is Preventable and Treatable.” 
• Each billboard included a QR code and web link to access awareness 
materials and hotline numbers.

BDT 850,000 for 
six billboards

Public 
Transport 
Signage

• Interior posters and exterior visuals on local buses and CNG-run auto-
rickshaws. 
• Repeated messaging from billboards and promotion of  local rehabilitation 
centers.

BDT 300,000 for 
20 interior/exterior 
placements

Digital and 
Social Media 
Campaign

• Targeted outreach through Facebook, YouTube, and popular local news portals. 
• Shared testimonial videos, myth-busting infographics, and mental 
health messages. 
• Directed users to a dedicated website and helpline.

BDT 2,000,000 for 
digital outreach

Radio 
Broadcasting

• Aired 30-second messages in Bengali across FM and community radio 
channels covering urban and rural areas. 
• Focused on stigma reduction and healthcare access. 
• Included localized messages and endorsements from health professionals.

BDT 600,000 for 
10 stations

Earned Media 
and Influencer 
Engagement

• Collaborated with television hosts, social workers, and local celebrities. 
• Conducted interviews, storytelling sessions, and panel discussions. 
• Shared stories of  recovery, resilience, and family involvement in healing.

In-kind 
collaboration and 
outreach

Data Collection
Digital engagement measures and pre- and post-
intervention survey responses were used to assess the 
effectiveness of  the public awareness and healthcare 
campaign. Digital outreach was measured through 
platform-specific analytics, including those from social 
media tools, email campaign software, and web traffic 
monitoring systems. These metrics assessed the reaction 
of  the target group to campaign materials (informational 
posts, banner ads, email newsletters, video content, and 
social marketing). The effectiveness of  email marketing 
was evaluated by open rates (the percentage of  recipients 
who opened the campaign emails) and click-through rates 
(the proportion who clicked on embedded links leading 
to health education resources or support services). Users 
were assessed as unique across different platforms based 
on their impressions of  banner ads and social media 
posts. When it came to engagement, passive interactions, 
such as scrolling, hovering, or video autoplay, on both 
mobile apps and digital display networks were also 
included in the analysis. A pre-post intervention online 
survey, administered via email invitations to the project’s 
list of  partners’ networks in urban and semi-urban areas, 
was used to collect data. The questionnaire assessed 

demographic variables (gender, age, education, income, 
and occupation), attitudes toward drug use, and media 
consumption patterns (i.e., print, television, radio, and 
social media). Respondents answered a five-point Likert 
scale (strongly agree to disagree strongly) about their 
attitudes to drug taking and drug addicts.
Stigma was measured using 19 items (questions) built 
into the survey, which were used to assess attitudes 
and biases toward people with substance use problems. 
The scale structure was held identically. However, the 
scale items’ titles were re-phrased to accommodate the 
diversity of  substances used in Bangladesh, including 
alcohol, cannabis, over-the-counter (OTC) drugs, 
injectable drugs, and synthetic drugs. The term substance 
use problem was explicitly defined as a pattern of  use 
that results in considerable damage, health complaints, 
or social or psychological interference. This two-pronged 
quantitative analysis of  digital platforms and self-
reported perceptions provided a more complete picture 
of  how general awareness and health messaging have 
affected perceptions of  drug abuse in Bangladesh.

Data Analysis
An analysis in two parts was performed for evaluating the 



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effects and effectiveness of  public awareness and healthcare 
campaign on drug abuse prevention in Bangladesh. 
Performance on digital engagement the performance in 
digital engagement was assessed by comparing the key 
outreach indicators against established benchmarks of  
the media and public health communication Working 
at the communication factory, we made a plan. Table 2 
All your outputs belong to us203sector (Table 2). These 
were analytics like email open rates, click-through rates, 
ad impressions, social media engagement and user views 
of  educational videos and website content. Secondly, data 
for survey measurements before and after the campaign 
were analyzed with a matched sample approach. Seven 
hundred forty-four respondents took part in the baseline 
(pretest) survey. Nevertheless, because of  discrepancies 
in participants’ ID and issues (e.g., logging in to the 
experiment multiple times with different email addresses 
and errors in entering the codes), much of  the posttest 
data were unmatchable to the pretest data. Accordingly, 
the last examination took into consideration 69 matched 
valid responses. This shortcoming was documented for 
future rounds of  research to address.
Summary statistics were analyzed to quantify length of  
exposure to participants, since exposure duration differed 
according to how much participants interacted with 
campaign materials. Survey answers were considered in 

terms of  six primary axes: demographic data, perceived 
social stigma, contact with campaign contents (either face-
to-face or through digital means), personal acquaintance 
with cases of  substance abuse, exposure to media and 
radio station contents, as well as stigma-related attitudes. 
Subjects were categorized into two groups according to 
the type of  exposure to the campaign. Participants who 
had experienced awareness materials in public spaces 
(e.g. billboards, radio or transport advertisements) were 
classified as “previously exposed” (n = 25). Participants 
who only interacted with digital content (videos, emails, 
and social media) preceding the posttest were classified 
as “Not Previously Exposed,” (n = 44).
To evaluate shifts in stigmatizing attitudes and social 
prejudice, pretest and posttest responses within each 
group were compared using a paired sample t-test. 
The scale was a 19-item attitude shot that indexed 
stigmatization, wherein lower scores signified more 
positive and supportive attitudes toward those with 
substance use disorders. Data were analyzed using 
a one-tailed significance test at p-value ≤ 0.05. This 
analytical design enabled the study to examine the 
extent of  attitudinal changes regarding various outreach 
strategies and levels of  exposure, which added to policy 
level insight for effective awareness mechanisms in 
Bangladesh.

Table 2: Results of  the Public Awareness Campaign in Bangladesh
Media Strategy Industry Average Benchmarks Campaign Results
Email Marketing
Email open rate 12% – 25% 17%
Email click-through rate 2% – 5% 2%
Email click-to-open rate 10% – 22% 9%
Mobile In-App Advertising & Social Media Engagement
Engagement rate based on display network views 0.31% 0.20%
Pre-roll video engagement — 0.14%

RESULTS AND DISCUSSIONS
The quantitative digital advertising aspects of  this public 
campaign in Bangladesh were, in fact, in line with typical 
industry benchmarks. Digital outreach in the form of  
email marketing and social media was highly effective in 
getting to the end user. Radio was another platform that 
showed significant reach with an average of  132 listeners 
tuning in to each ad. This meant that radio was the 
second performing media platform for audience reach, 
following social media networks. The overall exposure to 

the campaign on various media is presented in Table 3.

Exposure Time
In participants for whom we still had data (n = 69,) 
the median time spent living in a community where the 
public awareness campaign existed before participating 
virtually was around 24 days. The length of  exposure 
across participants spanned 8-38 days, with exposure 
commencing as early as mid-August 2020 and ending in 
late September 2020.

Table 3: Reach of  Public Awareness Campaign in Bangladesh
Media Strategy Type Reach Details
Targeted Digital Advertising

E
m

ai
l 

M
ar

ke
tin

g

- 8,352 impressions- 17% open rate (out of  50,000 emails sent)- 2% click-
through rate- 9% click-to-open rate

Mobile In-App Advertising - 186,920 impressions- 373 clicks- 20% click-through rate
Social media - 303,900 impressions- 595 link clicks- 20% click-through rate



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Pre-Roll Video - 250,560 impressions- 359 clicks- 14% click-through rate- 68.63% viewed 
entire video

Radio Advertisements - 2,232 radio spots aired- Net reach of  approximately 295,100 people 
(impressions)

Table 4: Demographic Characteristics of  Study Participants
Demographic Category Characteristic Count Percentage (%)
Gender Female 52 75.4

Male 17 24.6
Ethnicity Bengali 64 92.8

Other Ethnic Minorities 5 7.2
Education Level Secondary School Graduate 4 5.8

Some College/Intermediate 8 11.6
Diploma/Associate Degree 7 10.1
Bachelor’s Degree 15 21.7
Professional Degree 26 37.7
Postgraduate/Doctorate 9 13.0

Age Group (years) 18–24 5 7.2
25–34 18 26.1
35–44 19 27.5
45–54 15 21.7
55–64 9 13.0
65+ 3 4.3

Income Level (BDT) 0 – 200,000 6 8.7
200,001 – 400,000 21 30.4
400,001 – 600,000 12 17.4
600,001 – 800,000 7 10.1
800,001 – 1,000,000 11 15.9
Above 1,000,000 12 17.4

Employment Affiliation Academic (student, teacher) 24 34.8
Business sector (owner, manager) 5 7.2
Religious community (leader, volunteer) 2 2.9
Healthcare professional 31 44.9
Other 6 8.7
Recovery community member 1 1.4

Participant Characteristics
Summary of  a demographic profile of  the respondents 
is presented in Table 4. Most participants were women 
(75.4%) and Bengali (92.8%). The most common highest 
educational attainment was professional degree (37.7%) 
or 4-year cohort university degree (21.7%). The age 
distribution concentrated between 25 and 54 years, and 
the majority were 35-44 years (27.5% of  the sample). 
In terms of  income, the majority of  the participants 
had monthly incomes of  between BD 20,000-40,000 4 
Taka (30.4%), and more than half  (56.5%) earned less 
than 60,000 Taka. Regarding occupation, the highest 
proportion was among the healthcare professionals, at 
44.9%, followed by academic personnel, at 34.8%.
The perceived SUD related stigma and exposure to SUD

Participants answered 3 questions measuring stigmatized 
attitudes and self-reported SUD exposure. The responses 
were measured on a 0–10 scale. All participants were of  
the opinion that people with a substance use problem are 
spoken about in very negative terms, and they recognized 
substance use as an important social problem. This belief  
also significantly rose after the first visit to the follow-
up. In addition, the respondents perceived fewer negative 
norms or stereotypes related to drug addiction in their 
local area after the awareness intervention. Similarly, 
reported exposure to public materials on substance 
use disorders dropped sharply after the campaign. 
Statistically significant effects were predominantly found 
for participants who had been unexposed to stigma-
reducing campaigns prior to propagation. This indicates 



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that public awareness and healthcare outreach led to an 
increased recognition of  the severity of  stigma related to 
SUD and to a lower perception of  negative attitudes in 
the community.

Assessment of  Stigma and Bias Reduction
Perceptions of  stigma and bias toward substance 
use before and after the public awareness campaign 
were compared. In general, stigma scores decreased 
and the biggest decrease was in people with previous 
awareness educational exposure.
However, a difference in the total stigma and bias scores 
between the pre-campaign (Mean = 32.9, SD = 20.8) 
and post-campaign (Mean = 31.8, SD = 20.3) periods 
among all participants was not observed to be significant, 
suggesting that the campaign did not successfully reduce 
stigma for the entire sample. A closer analysis of  certain 
attitude statements showed meaningful changes:

1. Among those who had previously been exposed to 
awareness-raising efforts there was a significant decline 

in the proportion that believed that “there is little hope 
that people with a substance use problem could recover.”

2. There was a significant reduction in endorsement 
among all participants for the statement “people with 
substance use problems cannot be trusted” indicating 
increased trust in affected individuals.

3. The belief  that “people with drug problems who 
use treatments such as methadone are really substituting 
one drug for another” also fell sharply, especially among 
those newly exposed to the campaign.

4. The attitude that “people with substance use problems 
don’t care about anything other than getting their next fix” 
also had a large reduction post-campaign exposure.
These findings imply that stigma-reduction beliefs 
about drug abuse can be reduced effectively by targeted 
public awareness and healthcare communications in 
Bangladesh, especially if  people have had prior or direct 
contact with these communication campaigns. But, some 
more long-term efforts may require to bring more general 
attitudinal changes in the society (Islam et al., 2025).

Table 5: Changes in Public Perception and Exposure Related to Substance Abuse
Question Mean 

Pre-Test
SD Pre-
Test

Mean 
Post-Test

SD Post-
Test

Statistically 
Significant (p < .05)

B1: Awareness of  negative discussion 
about substance abuse and recognition of  
its seriousness

7.55 0.29 8.10 0.26 Yes (0.02)

B2: Frequency of  encountering negative 
attitudes toward substance abuse

7.26 0.28 7.07 0.30 No (0.24)

B3: Exposure to substance abuse materials 
in public

6.42 0.33 5.72 0.32 Yes (0.03)

Table 6: Changes in Attitudes Toward Substance Abuse Stigma Following Public Awareness Efforts
Performance Change Total (n = 69) Previously Exposed (n = 25) Not Previously Exposed (n = 44)
Decrease in Stigma 37 (53.6%) 15 (60.0%) 22 (50.0%)
Increase in Stigma 30 (43.5%) 8 (32.0%) 22 (50.0%)
No Change 2 (2.9%) 2 (8.0%) 0 (0.0%)

There was a significant increase in the awareness of  the 
seriousness of  substance abuse problem after campaign 
as evidence of  public attention. There was also a notable 
decline in the reported exposure to substance abuse 
materials in public areas (B3), indicating the possibility that 
awareness initiatives could reduce visible stigma content. 
But the number of  times that they had seen negative 
attitude towards substance abuse (B2) was still the same 
according to the participants, that is, stigma on personal 

level may be existed though the level of  consciousness is 
so much higher (Mallik & Rahman, 2024). These findings 
emphasize the urgent need for a comprehensive public 
awareness campaign and health-related intervention to 
enhance recognition of  substance abuse problems and 
their repercussions on the people in Bangladesh. Efforts 
are still needed to further destigmatize social attitudes 
and behavior.

Overall, there was a decrease in stigma-related attitudes 
toward substance abuse by more than half  of  the 
participants (53.6%) after the campaign. The greater 
reduction in stigma was observed among the previously 
exposed to community awareness (60.0%) than those 
newly exposed (50.0%). But a significant portion in 
particular in naïve group still increased their stigma 
attitude (50.0%). These findings indicate the possibility 

of  de-stigmatizing substance abuse in Bangladesh at a 
public health and advocacy level that could be facilitated 
by public awareness and healthcare interventions, 
and may be enhanced through continued community 
exposure. However, the continued high level of  stigma 
in some respondents finds support to the view that over 
time, sustained efforts might be required aimed at altering 
the societal attitudes (Mallik & Rahman, 2024).



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Table 7: Analysis of  Changes in Stigma-Related Attitudes Following Public Awareness and Healthcare Initiatives
Question Pre-Test Mean Pre-Test SD Post-Test Mean Post-Test SD Statistically 

Significant (p < .05)
E1 1.51 0.15 1.38 0.14 .17
E2 1.45 0.16 1.45 0.17 .50
E3 2.09 0.18 1.83 0.18 .06
E4 1.33 0.15 1.43 0.16 .21
E5 2.20 0.20 2.26 0.21 .37
E6 2.39 0.23 2.58 0.21 .15
E7 1.38 0.17 1.43 0.17 .35
E8 2.46 0.19 2.12 0.17 * .01
E9 2.10 0.20 1.81 0.18 * .03
E10 1.52 0.17 1.48 0.17 .39
E11 1.91 0.19 1.54 0.15 * .02
E12 1.62 0.16 1.58 0.17 .40
E13 1.71 0.19 1.46 0.16 .06
E14 1.59 0.18 1.67 0.17 .30
E15 1.25 0.16 1.19 0.15 .34
E16 1.03 0.13 1.10 0.14 .31
E17 2.43 0.20 2.54 0.18 .30
E18 1.29 0.17 1.42 0.17 .21
E19 1.59 0.20 1.58 0.19 .47
Overall 32.87 2.50 31.84 2.44 .24

The overall findings indicate a modest decrease in 
stigma-related attitudes following the public awareness 
and healthcare campaign; however, this change was not 
statistically significant. However, substantial reductions 
in stigmatizing beliefs were observed in specific areas, 
notably regarding the trustworthiness of  people with 
substance use problems, beliefs about drug replacement 
therapies, and assumptions about drug-seeking behavior. 
These results highlight the critical role of  targeted public 
awareness and healthcare interventions in addressing 
negative perceptions surrounding substance abuse in 
Bangladesh. While overall stigma remains a challenge, 
focused efforts can shift particular attitudes and support 
prevention strategies.

Discussion
With the exponential increase in internet access, and 
smartphone usage, including the use of  social media 
“adopt by ALL” has been one of  the “how” to in 
public health interventions in Bangladesh (Islam et al., 
2024). This study discovered that social media had the 
highest penetration amongst the population compared 
to conventional mediums of  radio and television. The 
decrease in radio exposure and increase in digital 
streaming services indicates that social media is a more 
feasible medium in future efforts to prevent substance 
abuse on a larger scale.
Nevertheless, reducing stigma toward people who use 
substances (PWUS) continues to be Despite this, reducing 

stigma toward people with SUD does not (El Hayek et al., 
2024). There is still stigma that affects the recovery, self-
esteem and utilization of  healthcare services. Our study 
showed that although broad public awareness campaigns 
may increase public knowledge and self-efficacy on a 
range of  topics, they may not be enough to reduce stigma. 
Participants frequently described encountering negative 
stereotypical attitudes towards individuals with a substance 
use disorder, indicating common societal stereotypes.
This data suggests that people’s language and perceptions 
are a significant component of  the stigma associated with 
addiction; language that focuses on the person instead of  
the addiction could promote more sympathetic attitudes 
(Schachman et al., 2024). The current research also found 
that participants who had experienced substance abuse 
issues, themselves or through others, were more receptive 
to attitude change, highlighting the necessity of  tailoring 
messages for those who are personally or indirectly 
affected. In future public health campaigns in 
Bangladesh, the use of  more focused messages aimed at 
specific target groups such as healthcare providers, law 
enforcement personnel, educators and policy makers 
may increase intervention effectiveness (Mallik, 2024). 
Further, combining media interventions with healthcare 
approaches to foster empathy and recovery could 
enhance prevention and decrease stigma.

Limitations
Concerning limitations, the present policy analysis 



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also had limitations. There was a selection bias in the 
sample, which was not fully representative of  the diverse 
population of  Bangladesh, and was over represented by 
the urban and educated population, which might limit the 
generalizability of  the findings. Loss to follow-up between 
survey waves hindered tracking all attitudinal change for 
each respondent. Moreover, some respondents may have 
elected to pass some stigma questions and this might 
have biased the overall findings. Filling these gaps and 
presenting more generalizable findings are necessary 
to reflect the diverse cultural and socioeconomic settings 
in all over Bangladesh. In addition, the use of  self-
reported data in this study may bias estimates of  stigma 
downward because of  social desirability.

CONCLUSIONS
The present study also shows the potentially significant, 
but ambivalent, influence of  public perceptions, health 
service and health promotion in preventing substance use 
in Bangladesh. Although broad public health campaigns 
raise knowledge, they have less effect on stigma without 
specific tactics. Population-specific campaigns tailored 
messages, and provider engagement also hold promise 
for shifting beliefs related to hope, trust, drug acceptance, 
and misconceptions pertaining to drug-seeking behavior. 
Therefore, optimal public policy should highlight a 
multicomponent approach that includes extensive public 
education and targeted strategies for sentinel populations 
who impact stigma and substance use outcomes. Using 
well-received social media tools and developing the role 
of  health providers in online environments to promote 
drug prevention messages is considered as a way of  
expanding prevention work and modernizing the delivery 
of  prevention interventions. Further work is required 
to develop and test messaging strategies, and measure 
their impact across different Bangladeshi populations, to 
support more informed policy and practice.

REFERENCES
El Hayek, S., Foad, W., de Filippis, R., Ghosh, A., 

Koukach, N., Mahgoub Mohammed Khier, A., ... & 
Shalbafan, M. (2024). Stigma toward substance use 
disorders: a multinational perspective and call for 
action. Frontiers in psychiatry, 15, 1295818.

Gilham, E. L., Pearce-Smith, N., Carter, V., & Ashiru-
Oredope, D. (2024). Assessment of  global 
antimicrobial resistance campaigns conducted to 
improve public awareness and antimicrobial use 
behaviours: a rapid systematic review. BMC Public 
Health, 24(1), 396.

Hasan, M. R. (2024). Mental Health Challenges in 
Bangladesh Based on the Integrated Examination 
of  Illicit Drug Use, Substance Abuse, Tobacco 
Consumption, and Escalating Suicidal Tendencies: A 
Comprehensive Review. Bangladesh Journal of  Infectious 
Diseases, 11(1), 65-70.

Inamdar, S. (2023). Approaching Effective Substance Abuse 
Treatment With South Asian American Populations 

(Doctoral dissertation, The Chicago School of  
Professional Psychology).

Isaacs, A. N., & Mitchell, E. K. (2024). Mental health 
integrated care models in primary care and factors 
that contribute to their effective implementation: a 
scoping review. International Journal of  Mental Health 
Systems, 18(1), 5.

Islam, M. R., Hossain, M. T., Mallik, S. K., & Rahman, 
M. A. (2025). Bangladeshi Garment Industry Welfare 
Policies and Employee Satisfaction: An Empirical 
Study. International Journal of  Research and Innovation in 
Social Science, 9(15), 334-346.

Islam, M. R., Mondol, A. A., Kundu, R., Baroi, J. A., Akter, 
S., Urmi, T. J., ... & Kabir, E. R. (2024). Prevalence, 
associated factors and consequence of  problematic 
smartphone use among adolescents and young adults 
in Bangladesh: A cross-sectional study. Plos one, 19(8), 
e0308621.

Jarre, M., Noussan, M., & Campisi, E. (2024). Avoid–
Shift–Improve: Are Demand Reduction Strategies 
Under-Represented in Current Energy Policies?. 
Energies, 17(19), 4955.

Mallik, S. K. (2024). Financial Institutions in Bangladesh: 
Assessing Performance, Risk, and Sectoral 
Contributions in 2023.

Mallik, S. K., & Rahman, M. A. (2024). An analysis of  
business students learning styles to improve the 
effectiveness of  teaching methods.

Mallik, S. K., & Rahman, M. A. (2024). Smart agriculture 
as a driving technology for sustainability in intensive 
greenhouse production within smart manufacturing 
systems.

Negash, M., Temesgen, B., Kassaw, C., Abebe, L., Moges, 
S., Sime, Y., & Yimer, S. (2023). Delayed treatment 
seeking and its associated factors among people 
with schizophrenia spectrum disorders who are on 
follow-up at Dilla University Referral Hospital in the 
southern region of  Ethiopia, 2022: a cross-sectional 
study. Frontiers in Psychiatry, 14, 1230448.

Newman, L. C., & Swisshelm, A. T. (2025). Teaching 
Knowledge and Empathy in Substance Use Disorder 
Through Enriched Education in the Neurobiology 
of  Addiction: A Narrative Review on Addiction 
Education in Professional Schools. Substance Use & 
Addiction Journal, 29767342251317026.

Schachman, K. A., Martini, K., Kaufman, S., Mitchell, M. 
L., Covyeou, J. A., Galbraith, A., ... & Charbonneau-
Ivey, T. K. (2024). Health professions students’ 
perspectives of  a stigma-reducing simulation including 
simulated patients with lived experience of  addiction 
and recovery. Clinical Simulation in Nursing, 94, 101588.

Tasfi, J. T., & Mostofa, S. M. (2024). Understanding 
complex causes of  suicidal behaviour among 
graduates in Bangladesh. BMC public health, 24(1), 560.

Ugbor, A. C., Ndubueze, G., Adepoju, A. G., Adepoju, 
D. A., & Karbo, S. A. I. (2024). Evaluating the role 
of  health education in sexually transmitted infections 
prevention through the lens of  the health belief  model.



Pa
ge

 
12

6

https://journals.e-palli.com/home/index.php/ajee

Am. J. Environ Econ. 4(1) 118-126, 2025

Young, R., Dongilli, D., Souder, A., & Peek-Asa, C. (2024). 
Stories for Us, or for Others: Digital Storytelling with 
a Harm Reduction Organization as Culture-Centered 
Health Communication. Health communication, 1-14.

Zavyalova, A. (2025). Stigmatization by an authoritarian 
government: Russian NGOs under the 2012 Foreign 
Agents Law. Administrative Science Quarterly, 70(1), 69-
118.


