Pakistan: Lack of awareness and high consumption of heated tobacco among adults

A recent study published in BMC Public Health by the Aga Khan University and Jinnah Medical and Dental College assessed the knowledge, attitudes, and use of heated tobacco products among the general population in Pakistan. Conducted on a representative sample of 1,200 adults, the study revealed that more than half of them had heard of heated tobacco, and 13% used it regularly. They are also 27,78% not knowing that these products contain tobacco.

The tobacco epidemic in Pakistan remains significant. According to the World Health Organization (WHO), approximately 19% of Pakistani adults use tobacco products, with a higher prevalence among men (31.8%) compared to women (5.8%). Tobacco use is responsible for more than 160,000 premature deaths annually in the country.

Lack of knowledge about the composition of these products and under-evaluation of the risks

A cross-sectional study was conducted by Aga Khan University and Jinnah Medical and Dental College in Pakistan and published on May 16, 2024. A sample of 1,195 adults over the age of 18 responded to an online questionnaire. The objective of this study was to shed light on the knowledge, attitudes, and use of heated tobacco products in Pakistan.

It reveals that 54.73 % of the participants had heard of heated tobacco products and that nearly 17% have already used them at least once. 13.4% of them report using them regularly.

Nearly half indicated that these products contained both nicotine and tobacco, while 27,78% mentioned that they believed these products contained only nicotine. For the study authors, this high percentage demonstrates the effectiveness of tobacco companies' marketing campaigns for heated tobacco products. Regarding health risks, 31,63% were unaware of the health risks of using these products, such as cancer and stroke. However, a majority of participants (59%) expressed concerns about their use during pregnancy and for people with chronic conditions such as heart disease, blood pressure, and diabetes.

Among the reasons given for consumption, respondents indicated that it was a "pleasant experience", that heated tobacco was a "good alternative" to traditional smoking, that there is less odor than manufactured cigarettes and the availability of flavors.

Pakistan: A market coveted by the tobacco industry

Despite Pakistan's ratification of the WHO Framework Convention on Tobacco Control (FCTC) in 2004 and the country's adoption of various measures, many remain unimplemented. Tax increases remain low, and advertising bans are poorly enforced. The country passed a law to increase the size of pictorial health warnings to 85 % of the cigarette pack surface (SRO 22(KE)/2015). However, this law was never implemented and was continually delayed due to pressure from the tobacco industry. When it was finally implemented, the warning size was only 60 % of the pack surface.[1] This political compromise highlights the power of industry in the country.

Pakistan has a population of 208 million, two-thirds of whom are under 30, a prime target for manufacturers. They deploy aggressive marketing strategies to promote their products as less harmful and "safer" alternatives. About 10 percent of young people aged 13 to 15 regularly use tobacco products.[2]

Need for clarification and awareness on heated tobacco

The study's authors emphasize the need to clarify the status of heated tobacco products, which are tobacco products and must be regulated as such. They call for the public, especially young people, to be informed about the dangers of these new tobacco products.

Indeed, despite tobacco companies' claims about the supposed reduced harm of heated tobacco products, no independent scientific study has validated these products as a healthy alternative to traditional cigarettes. Existing research highlights that these products still contain toxic substances and pose health risks. Manufacturers' claims often rely on their own studies, which lack transparency and are susceptible to bias.

DT

©Generation Without Tobacco

[1] Newspapers, Tracking progress of tobacco control in Pakistan against the MPOWER package of interventions

Challenges and opportunities, published in 2020, accessed July 9, 2024

[2] Tobacco Free Generation, Pakistan: Tobacco industry took advantage of pandemic to promote new products, GST, published June 29, 2021, accessed July 8, 2024