How Pakistan’s youngest generation is being drawn into nicotine, and what it will take to pull them back
Pakistan has over 18 million smokers and loses approximately 164,000 lives to tobacco-related illness every year. Those numbers took decades to build. What is happening now, quietly, one scroll at a time, could build the next set faster.
Walk through any mixed-age gathering in Pakistan, a school gate in the afternoon, a chai stall on a busy street, a college common room, and something has quietly shifted. The kids using tobacco are not hiding behind the building anymore. Some of them are not hiding at all. The question worth asking is: how did we get here, and how much further are we prepared to let this go?
The WHO Global Youth Tobacco Survey in 2014 found that roughly one in ten Pakistani adolescents between thirteen and fifteen was already a current tobacco user, a figure recorded when vaping was still a foreign novelty and nicotine pouches did not yet exist on local shelves. What that survey found was troubling enough on its own. What the decade since has produced is something else entirely. A 2023 multi-city Pakistan study by Tobacco Tactics, University of Bath, reported that nearly half of participants were already using e-cigarettes, with the average initiation age around seventeen years. A scoping review of ten studies across Pakistan, published in the Journal of the Dow University of Health Sciences in 2024, recorded adolescent smoking prevalence ranging from nine percent in some settings to above sixty percent in others. The numbers disagreed with each other on scale. They agreed completely on direction.
It is worrisome why young people are so much more at risk, because this is not simply about poor choices or peer pressure, though both play their roles. Nicotine, at a biological level, is particularly devastating for a brain that has not finished forming yet. The human brain continues developing into the mid-twenties. During that window, it is far more susceptible to addiction than an adult brain — more plastic, more responsive to chemical reward signals, more likely to wire itself permanently around a substance. A teenager who picks up a nicotine product is not just forming a habit in the way an adult might. They are, in a very real sense, reshaping the organ they think with. A PMC adolescent smoking study from Karachi, referencing longitudinal data on age of initiation, found that the overwhelming majority of daily adult smokers had taken their first cigarette before the age of eighteen. The addiction is almost never an adult decision. It is planted young, and it harvests for a lifetime.
What makes the current moment different is not the product; it is the packaging. Flavoured vapes and nicotine pouches are marketed not as tobacco but as personality, appearing in the
same frame as travel aesthetics, good music, confidence, and youth. Celebrities and social media influencers carry these products into the feeds of millions, many of them teenagers, with no health warnings, no age restrictions, and no accountability. The appeal is deliberate: the flavours mask harshness, the branding masks addiction, and the platforms mask the age of the audience watching. This is not how harm reduction works. It is how a new generation of consumers gets built.
There is something worth naming directly. When a public figure promotes a nicotine product to an audience that includes teenagers, they are making a choice. The law may not yet require more from them, but the trust their audience placed in them was not built to be spent this way.
There is also a class dimension that rarely surfaces in these conversations. These products are currently premium-priced, making the problem feel contained and urban. That will not last. As cheaper versions enter the market, they always do. The communities that have already carried the heaviest burden of tobacco illness in this country will be targeted next. Pakistan cannot afford to wait until that point to start paying attention.
Tobacco has killed hundreds of thousands of Pakistanis in the last decade and is quietly adding the next generation of customers, using platforms the law does not cover, through faces the public trusts, with products designed to taste like something a child would enjoy. And the response, so far, has been the same as it has always been: too slow, too cautious, too willing to treat the lives of ordinary people as an acceptable cost of doing business.
But this story has not ended. Regulating the unregulated products and tax increases, that should have happened years ago, can still happen. Digital advertising regulations that are long overdue, can still be written. A generation of young Pakistanis who are currently being targeted, can still be saved with honest information, with counter-narratives built for the health and safe spaces where they actually live, with the simple message that what is being sold to them as freedom or style is neither of these, rather brings addiction.
The question is not whether Pakistan knows what to do. The question is whether and when the people in positions of power will decide to act. The policy makers, health ministry, provincial governments, and regulators cannot remain spectators while an unregulated market shapes the habits and the health of an entire generation. Silence from those who have the power to act, is not neutrality. It is a decision. And every year that passes without updated regulation, without a tax increase, without a serious public health campaign, is a year in which the problem compounds quietly, another scroll, another , another teenager drawn into addiction before the harm is fully understood.
Sources
WHO EMRO, May 2025 — tobacco mortality and smoker population, Pakistan WHO Global Youth Tobacco Survey (GYTS), Pakistan Country Report, 2014
Tobacco Tactics, University of Bath — Pakistan country profile, multi-city e-cigarette study, 2023 Journal of the Dow University of Health Sciences — scoping review of adolescent smoking studies, 2024
PMC — adolescent smoking study, Karachi; referencing longitudinal data on age of initiation among daily adult smokers
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