A new research has called for employing a two-pronged strategy comprising the provision of effective cessation services and making tobacco harm reduction part of the national efforts to control combustible smoking in Pakistan.

The cross-sectional study, assessing the Knowledge, Attitude, and Practices of Cigarette Smokers and Use of Alternative Nicotine Delivery Systems in Pakistan, has been published by the UK journal Advances in Public Health. Using cross-sectional survey data, the study ascertained the knowledge, attitude, and practice of smokers in 13 districts of Pakistan, and the use of alternative nicotine delivery systems. The study has been conducted in Pakistan by Alternative Research Initiative.

According to the study, most of the smokers in Pakistan are keen to quit smoking, know that combustible cigarette smoking is carcinogenic, and even recognize that secondhand smoke is harmful for the health of people around them, and their families. However, smokers lack access to effective cessation services. “The lack of smoking cessation services, which are available to only a few hundred out of the 25 million tobacco users in the country, is a key impediment,” the study maintained. It further recommended stringent enforcement of law on banning smoking at public and private places.

Although Pakistan included NRTs in the Essential Drugs List in 2017, they are expensive and not easily available. It is clear from the study that the intent to quit combustible smoking is present, but the policy and infrastructure necessary for successful quitting is missing in Pakistan.

The study said over the last five years, Pakistan has witnessed a steady increase in the number of people using tobacco harm reduction (THR) products, mainly e-cigarettes. Expensive and limited to upscale localities, THR products are being used in a regulatory vacuum. Being legally imported, individuals use them without any medical consultation or advice. Therefore, the shift to THR products from combustible smoking remains an individual decision.

Most of the smokers do not know about the availability of THR products. Their main sources of information about these products are friends, and they largely use them out of curiosity.

The high prices of THR products are a major barrier for combustible smokers interested in switching over. This study has found that only 10.9% of the respondents were ready to spend more than Rs. 4000 per month on a THR product. In Pakistan, the price of a vaping kit starts from $24 and goes up to $162, primarily because vaping products are imported.

The study maintains Pakistan should look at the use and regulation of safer nicotine products in the UK. Instead of rejecting them, “the country should carefully weigh the options of ensuring how to incorporate the use of THR in its tobacco control efforts. A sensible approach to regulating safer nicotine delivery systems should be adopted.”