BACKGROUND: The rise of new tobacco and nicotine products (NTNPs) like vapes, e-cigarettes, and heated tobacco products poses a growing public health risk, particularly among youth in Pakistan. While marketed as safer alternatives, there is growing evidence about their harmful health consequences. Despite their growing use, there is little primary evidence on their market landscape and use in Pakistan
METHODS: This study employed a mixed methods approach to assess the regulatory gaps and challenges posed by NTNPs in Pakistan. The methodology comprised of three parts; a market survey across 28 cities to assess availability and regulatory compliance; a user survey administered to 500 respondents from over 50 locations to explore usage patterns and motivations and perceptions of harms; and. a documentary review comparing national and international NTNP regulatory frameworks to identify gaps and potential opportunities
RESULTS: NTNPs are widely available near educational institutions, with 64% and 55% of stores selling NTNPs being located within 500m or 100m of an educational institution respectively, while 50% of NTNP vendors admit to not verifying the age of buyers. NTNPs mostly evade restrictions applicable to conventional tobacco products (such as graphic health warnings and point-of-sale advertising), highlighting critical gaps in current tobacco control laws. The users survey found 55% of vape users and 53% of nicotine pouch users initiated use before the age of 25. 91% of vape users reported having initiated use with flavored vapes. Around 51% of vape users and 55% of nicotine pouch users also reported smoking cigarettes.
CONCLUSIONS: Comprehensive reforms are necessary to address the rapidly growing availability and use of NTNPs in Pakistan. Adopting effective regulatory practices from countries like India and Australia is recommended. Enhanced research and surveillance are essential to inform evidence-based policymaking.