KARACHI: A study recently published in an international journal shows how the youth is being lured into nicotine addiction across the country in the absence of any government regulation to check unethical marketing practices.

Titled ‘Knowledge, attitudes, practices, and prevalence of nicotine pouches in Pakistan: Where do we stand?’, the study is published in the International Journal of Community Medicine and Public Health.

It’s jointly conducted by the Aga Khan University’s Medical College and Multan Medical and Dental College.

A total of 1,749 individuals participated in the study, and their mean age was 20.6 years.

According to the study, nicotine pouches are a relatively new type of oral smokeless tobacco-free nicotine product which is considered an alternative nicotine delivery system to ‘help quit smoking’.

Study calls for urgent country-wide interventions to prevent nicotine pouches from becoming a lethal addiction

They are small receptacles that contain white nicotine powder, which a user places in between the upper lip and gum, leaving it there for nicotine to be released.

These pouches, the study says, are potentially appealing to the youth due to availability in wide range of flavours and their ability to be used discreetly.

More than seven per cent of the respondents reported a diagnosis of hypertension while 6.6pc reported having asthma.

Almost 40pc of the participants reported a previously diagnosed psychiatric illness while 53.2pc believed themselves to be currently under stress.

Most of the respondents knew about nicotine pouches through the internet or friends. Most of them knew that they cause addiction and potentially have long-term health consequences. However, majority (68pc) was not aware of the ingredients of these products.

“Majority of the participants think that either psychological factors (37.5pc) or the urge to quit smoking (38.4pc) makes people start using nicotine pouches and 57.2pc people believe these products might be slightly effective in assisting cessation of smoking.

“In contrast to this, 34pc of the respondents believe they are equally addictive and 26.5pc think they are equally harmful to health when compared to cigarettes.

“For practices regarding nicotine pouches, 300 (17.2pc) participants reported using nicotine products at least once in their life and the mean age at which they tried was 20.3 years.

“Among the users, 164 (54.7pc) were current users and 41.4pc of these users were daily users. Most of these users started using nicotine pouches either to quit conventional cigarette smoking or out of curiosity,” the study says.

It also refers to studies conducted in other parts of the world which show a rising trend in the consumption of smokeless tobacco and nicotine products.

A survey conducted among 121 countries in 2015 reported that there were 352 million users in 121 countries and nearly 95pc of these lived in developing countries, especially in South-East Asia region.

Furthermore, studies conducted in Pakistan also show that nicotine products are becoming a mainstream trend as alternates for the conventional cigarette smoking. However, the studies conducted in Pakistan are very few, and limited to small population sizes with a paucity of nationwide studies.

“Many factors have been seen to influence the use of smokeless tobacco and nicotine products and result in the increased global, regional, and local prevalence rates,” Dr Javaid Ahmed Khan, the study’s principal investigator and senior consultant pulmonologist and professor at Aga Khan University Hospital’s department of medicine, said.

According to him, nicotine pouches actively being promoted through social media platforms have recently been launched in the Pakistani market and there is a sudden upsurge in the advertisements and free of cost distribution of nicotine pouches in various cities across Pakistan.

“This trend is similar to the one that was once observed in the early 1900s when cigarettes were being advertised extensively in an attempt to make them socially acceptable. There is little information available about the safety and contents of nicotine pouches, and yet they are being endorsed by various influential institutions and social media platforms.

“The lack of anti-narcotic campaigns has led to a delusional perception among the general population that these products are safe to use and help in smoking cessation, though there is no scientific evidence to support this.”

According to him, while studies are needed on these specific products, ample evidence already exists on the harmful effects of nicotine, a dangerous and highly addictive chemical that can cause serious health problems, including gum diseases, cavities, stunted growth, kidney disease, cancers of the oral cavity, and a higher risk of heart disease and stroke. It might lead to other addictions as well.

Data from the study, he said, showed a 10pc prevalence of current nicotine pouch consumption among youth with below adequate knowledge regarding their ingredients.

“There is an urgent need for country-wide interventions to prevent this trend from becoming an addiction through education and regulated distribution.

“A study conducted by the Institute for Global Tobacco Control showed that 22pc of tobacco vendors across eight cities of Pakistan had these products displayed at their stores and 13pc of tobacco vendors had advertisements for these products posted at their point-of-sale.”

Explaining the tobacco industry’s interest in new addictive products, Dr Khan said the industry had been forced to stop manufacturing cigarettes in many countries over heightened concern on the harms of active and second-hand smoking.

“In order to continue their business, their focus now is on new tobacco products, such as nicotine pouches, electronic cigarettes and heated tobacco products. Our youth must be warned about these new highly addictive products.”

Published in Dawn, May 29th, 2023