Exposure, access, susceptibility to and use of nicotine and tobacco products among 10-16 year-olds: National cross-sectional survey of 14,232 in-school and out-of-school children in Pakistan

Citation

Farzeen M, Ansari S, Khan A, Moodie C, Sheikh A, Hewitt C, Khan SA, Khan Z, Ross H, Bauld L & Siddiqi K (2025) Exposure, access, susceptibility to and use of nicotine and tobacco products among 10-16 year-olds: National cross-sectional survey of 14,232 in-school and out-of-school children in Pakistan. Nicotine and Tobacco Research. https://doi.org/10.1093/ntr/ntaf171

Abstract
Introduction: Tobacco and newer nicotine products pose significant risks to children. Data is needed on tobacco and nicotine use among children in Pakistan, given the evolving market and lack of regular surveillance. Methods: We conducted a cross-sectional survey of 10-16-year-olds in Pakistan. Using a multistage stratified random sampling strategy, we planned to recruit 9,000 school children from 180 schools and 4,320 out-of-school children from 72 enumeration blocks. We gathered data on their tobacco/nicotine use, exposure, access, and susceptibility. Descriptive analyses were performed to estimate frequencies and usage patterns. Results: Between December 2023 and May 2024, 14,232 children were surveyed; one-third were out-of-school, with one-third girls. Overall, 9.1% (95%CI:8.5-9.6) of boys and 7.1% (95%CI:6.3-7.7) of girls reported using nicotine and/or tobacco products. Their use did not differ between school-going (8.3%; 95%CI:7.7-8.9) and out-of-school (8.5%; 95%CI:7.7-9.2) children. Reported use of e-cigarettes (boys=4.3%; girls=3.2%) and nicotine pouches (boys=3.4%; girls=2.7%) appeared higher than smoking (boys=2.1%; girls=0.7%) and smokeless tobacco use (boys=2.7%; girls=2.0%), though no statistical comparisons were conducted. More children stated that they would accept cigarettes (27%) and nicotine pouches (23.4%) than smokeless tobacco (18.5%) and electronic cigarettes (16.7%) when offered by a friend. A significant proportion could access tobacco shops near their schools (55.4%) and homes (43.1%); and 33.3% indicated they could buy these easily. Conclusions: In Pakistan, more children reported using e-cigarettes and nicotine pouches than smoking cigarettes, although these differences were not tested for statistical significance. Nonetheless, the observed prevalence underscores the need to regulate these products.

Journal
Nicotine and Tobacco Research