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May 2018, Volume 68, Issue 5


Dual Burden of Tobacco Consumption in Pakistan; Time to Act

Authors: Muhammad Arif Nadeem Saqib  ( Pakistan Medical Research Council Islamabad. )


Detrimental impact of tobacco use on the health and well-being of an individual as well as the society is well established. Consumption of smoked and smokeless tobacco (SLT) products i.e. cigarettes, hookah/shisha and chewing paan, gutka, naswar respectively is common in Pakistan. In the nineties, there were 22-25 million smokers whereas 55% households had at least one smoker.1 Similarly, 15% males and 10% females were using SLT.2 A recent national level survey showed that currently, there are 19.1% adults who were using tobacco. Among them, 12.4% were smokers and 7.7% were using SLT.3 Similarly, 15.4% of the youngsters were using tobacco products including 11.1% smoked and 7.3% smokeless tobacco user.4 These all surveys show the dual burden of tobacco consumption i.e. smoke and smokeless in Pakistan. The government of Pakistan (GoP) has taken different steps and legislative measures to eradicate tobacco use. The crux of these legislations include prohibition of smoking in public and workplaces and public service vehicles and ban on the sale of cigarettes to under-18s and in/near educational institutions. Similarly, import of shisha and related substances, manufacturing, importing and selling of cigarette packs having < 20 cigarette sticks and sale of loose cigarette is also banned. Tobacco advertisements in media have been regulated. There is a ban on possessing, selling or offering cigarettes packs without a health warning.5 Although these measures resulted in an overall reduction of tobacco use6 but a lot of efforts are required to eradicate tobacco use especially the smokeless tobacco. Majority of the steps taken by the government are focusing on smoked tobacco and little attention is given to smokeless tobacco. It was reported that at policy level, there is a clear differential focus with respect to smoked and SLTs.7 The smokeless tobacco products like naswar, paan, and gutka are available at a very cheap rate. Similarly, these products are being sold without any formal packaging and taxation. There are chances that use of smokeless tobacco might increase over the years.7 There is need to formalize the sale of these products and should have health warnings. The government should levy taxes on smokeless products which will ultimately help in increasing its price.


1.  Pakistan Health Education Survey 1991-92. Islamabad: Ministry of Health, Govt. of Pakistan, 1993.
2.  National Health Survey of Pakistan 1990-94. Islamabad, Pakistan: Pakistan Medical Research Council, 1996.
3.  Global Adult Tobacco Survey. Islamabad: Pakistan Health Research Council, 2016.
4. Global Youth Tobacco Survey fact sheets and country reports World Health Organization; [cited 2017 August]. Available from: gtss-youth-survey/gyts-factsheets-reports.html.
5.  Significant Inititatives/Achievements of Tobacco Control Cell Islamabad 2018 [Cited 2018 23 April]. Available from URL:
6.  Saqib MAN, Rafique I, Qureshi H, Munir MA, Bashir R, Arif BW, et al. Burden of Tobacco in Pakistan - Findings from Global Adult Tobacco Survey 2014. Nicotine & tobacco research: official journal of the Society for Research on Nicotine and Tobacco. 2017.
7.  Khan Z. A gaping gap (smokeless tobacco control in Pakistan). Tobacco induced diseases. 2016; 14: 36.

Journal of the Pakistan Medical Association has agreed to receive and publish manuscripts in accordance with the principles of the following committees: