Most low-income countries including Pakistan continue to face increasing burden of tobacco epidemic with a current cigarette smoking prevalence of 15.2% among adults and 6.3% among youth. Unfortunately, due to the current approach of shunning smokers or labeling a teenager who smokes as a ‘bad person’ alienates them more, risking isolation and further increase in consumption of tobacco in the country.

Teenage is a critical period when the risks associated with tobacco use are particularly high. Smoking behaviour is typically established during adolescence; most smokers had their first cigarette or were already addicted, by the time they turn 18. Compared with adults, young people require fewer cigarettes and less time to establish a nicotine addiction.

The WHO Framework Convention on Tobacco Control asserts the importance of strategies to reduce both tobacco demand and supply, and provides a framework for tobacco control measures to be implemented at the national, regional and international levels. There is good evidence that these measures protect children from smoking initiation and other tobacco-related harm.

Countries need to ensure full implementation of the Framework Convention for Tobacco Control, put special emphasis and employ all resources to curb smoking, undertake research on what works for their populations and develop strategies based on indigenous research results for smoking cessation, especially among youth.

However, until we involve the youth in discussions on what works for them, a top-down approach of interventions designed by public health experts like us will not work and we will see more teens taking up the habit. We need to involve them in discussions, engage with them, let them open up on the pressures they are facing, and then address the root causes. The message here is to stop stigmatizing the youth who smoke and listen to their needs.

In Pakistan, tobacco kills around 160,189 people every year. Almost 15.6 million adults currently smoke tobacco in the country, and around 1,200 Pakistani children between the ages of six and 15 start smoking every day. The economic cost of smoking amounts to Rs 143.2 billion. This includes direct costs related to healthcare expenditure and indirect costs related to lost productivity due to early mortality and morbidity.

The tobacco industry is actively strategist how to counter tobacco control measures and influences government departments that work on tobacco control. During a recent court hearing, health ministry even admitted to being susceptible to the pressures from the tobacco industry lobby groups.

The admission of the ministry to succumbing to the influence of tobacco industry is a clear picture of how easily the tobacco industry lobby can influence law making and implementing bodies in Pakistan.

In such a dismal state of affairs, it becomes extremely necessary to raise awareness among the public about the health hazards of tobacco consumption, which causes cardiovascular and pulmonary diseases and various kinds of cancers. Along with strict control measures that ban the sale of cigarettes to minors, we need to focus on advocating for enhanced graphic health warnings on cigarette packs. Graphic health warnings on cigarette packs are a proven and cost-effective measure to create mass awareness and reduce tobacco consumption.

The significance of these health warnings have been proven through various research studies which show a reduction in consumption rate and intent to quit smoking. Through these graphic health warnings, we can sensitise masses on the health hazards of firsthand and secondhand smoking.

According to a GHW survey conducted by Human Development Foundation in five major cities of Pakistan, 49 per cent shops were selling cigarettes within the 50-meter radius of educational institutions which is banned under the ‘Prohibition of Smoking and Protection of Non-smokers Health Ordinance, 2002. Similarly, some 71 per cent of the visited shops had power walls displaying cigarette brands at the eye level of children. Only plain packaging of cigarettes, as being practiced in the developed countries, can help reduce brand consciousness among the youth.