Smoking initiation among marginalized communities in Pakistan

Tobacco is a major cause of more than 8 million deaths every year worldwide. Direct tobacco use is responsible for approximately 7 million deaths while 1.2 million deaths are caused by exposure to second-hand smoke. Many diseases including lung, liver, oral, and throat cancers, Chronic Obstructive Pulmonary Disease (COPD), heart disease, and stroke are linked to tobacco use. Cigarette smoking increases the burden of disease and the probability of death. In Pakistan, there are more than 25 million tobacco users, and smoking is a major cause of cardiovascular disease, lung cancer, emphysema, and chronic bronchitis.

Although Pakistan has taken several initiatives, including increasing prices and taxation, enforcing warning laws, and banning public smoking and advertising, smoking cessation remains a significant challenge. The success rate of smoking cessation is less than 3%, and most smokers in Pakistan want to quit smoking but are unable to do so.

Research studies revealed a disturbing trend of increasing cigarette consumption in marginalized areas. The evidence suggests that socioeconomic factors such as poverty, lack of education, and limited access to healthcare have contributed to this trend. These factors have made individuals living in these areas more vulnerable to the harmful effects of tobacco.

The Alternative Research Initiative (ARI) team conducted research on the “Barriers to Cigarette Smoking Cessation in Pakistan: Evidence from Qualitative Analysis”. According to the research, a lack of awareness about the health risks associated with smoking has also contributed to the rising trend of cigarette consumption. This has resulted in a higher prevalence of smoking-related diseases such as lung cancer, respiratory problems, and heart disease among individuals living in these areas.

To address this issue, there is a need for comprehensive anti-smoking campaigns that target marginalized communities. These campaigns should focus on increasing awareness about the health risks associated with smoking and provide access to resources and support to help individuals quit smoking. Additionally, there is a need for stricter regulations on tobacco advertising and sales to prevent the tobacco industry from targeting vulnerable communities.

This study focuses on understanding the barriers to smoking cessation in marginalized, low-income communities in Pakistan. The study assesses adult smokers’ knowledge and understanding of the health hazards of smoking and why attempts to quit smoking remain unsuccessful. It also examines the dichotomy between easy and cheap access to combustible tobacco and the lack of cessation services for marginalized communities. The study highlights the fact that the most ignored smokers in marginalized communities have the most access to unregistered, illicit, and cheapest cigarette brands in marginalized areas. Understanding the barriers to smoking cessation in marginalized communities can help develop effective and accessible interventions.

Smoking initiation often begins before the age of 18, due to a variety of factors such as the presence of older smokers at home, lack of parental guidance or monitoring, poor enforcement of tobacco legislation, and lack of knowledge about the legal age to start smoking. The study also revealed that those with lower levels of education and in poverty or social deprivation are more likely to smoke and find it harder to quit.

The social environment plays a major role in the initiation and continuation of smoking in marginalized communities. The study found that the company and friendship of smokers within and outside the household, and at the workplace, leads to young people initiating smoking. The curiosity of trying out smoking just for the fun of it is also a major reason for teens becoming smokers. Exposure to second-hand smoke (SHS) is also a serious health concern in Pakistan, with over half of non-smoking adults and one-third of youth exposed to SHS in public places.

Marginalized communities in Pakistan lack access to health facilities and knowledge about smoking cessation clinics. Lack of knowledge about the health hazards of smoking seems to be the major reason for not seeking medical assistance for quitting smoking. Respondents did not consider smoking a health issue and therefore did not feel the need to consult a doctor in this regard. While many smokers in Pakistan have made attempts to quit, most of these attempts have been made without any medical help. The success rate of quitting smoking in Pakistan is only 2.6%, with a lack of clinical and healthcare delivery systems, effective treatments, practical counseling, and social support being major reasons behind the high failure rate.

The study also found that current knowledge about tobacco harm reduction such as e-cigarettes in marginalized communities is vague. Those who used e-cigarettes did so more out of curiosity than for smoking cessation, and there was no evidence of any respondent opting for prolonged use of e-cigarettes with the intent of harm reduction or cessation. The high cost of e-cigarettes in Pakistan also deters respondents from buying them.

The study highlights the urgent need for effective smoking cessation programs, policies, and health care delivery systems in marginalized communities in Pakistan to address the high prevalence of smoking and improve health outcomes.