KARACHI: A study published in an international journal highlighted the use of heated tobacco products (HTP) amongst Pakistani youth, underscoring the need for addressing gaps in knowledge about these new potentially harmful products.

The study titled ‘Heated Tobacco Products — Well Known or Well Understood? A National Cross-Sectional Study on Knowledge, Attitudes and Usage in Pakistan’ is published in the BMC Public Health journal.

It is conducted by Aga Khan University’s section of pulmonary and critical care in collaboration with Jinnah Medical and Dental College.

A HTP is a tobacco product that heats the tobacco at a lower temperature than conventional cigarettes.

About their impact on human health, the Centres for Disease Control and Prevention-US says that while more research is needed to understand their short- and long- term health effects, the use of any type of tobacco product—including heated tobacco products—is harmful.

“They are especially harmful for youth, young adults, and pregnant women, as well as adults who do not currently use tobacco products. HTPs have not been scientifically shown to help smokers quit,” it says.

The AKU study refers to the Tobacco Products Scientific Advisory Committee of the Food and Drug Administration (FDA) which voted against endorsing HTPs as carrying reduced harm compared to conventional cigarettes in 2018.

“Similarly, the WHO contends that even if exposure to harmful chemicals in HTPs is diminished, it does not confer harmlessness nor does it translate to a reduction in health risks,” the study says. There are no clear laws on HTPs in Pakistan, it says.

“The tobacco industry is closing down its cigarette manufacturing in many countries of the world. This will also happen in Pakistan, and industry focus is now on new tobacco products like heated tobacco products, vaping, and nicotine pouches,” said Dr Javaid Ahmed Khan, senior professor and consultant pulmonologist at the Aga Khan University Hospital, also the principal investigator of the study.

We must prepare our younger generations on the potential harm of new tobacco products, he emphasized.

Low level of knowledge

More than 1,000 adults including women participated in the web-based, nationwide study on heated tobacco products.

A majority of participants, 54.73 per cent, reported having heard of HTPs prior to the survey. When asked about the contents of these products, 49.96pc believed they contained both nicotine and tobacco, while 27.78pc thought they contained only nicotine.

Notably, 40.25pc thought these products were not prohibited by law and 38.24pc were unsure if these products were prohibited by law.

Regarding health risks, 68.37pc agreed that these products can cause serious illnesses like cancer and stroke. Additionally, 70.38pc believed these products had added chemicals.

Lastly, a significant portion, 58.83pc, strongly disagreed that these products are safe to use during pregnancy, and 58.91pc strongly disagreed that they are safe for individuals with underlying medical conditions such as heart disease, blood pressure, and diabetes.

Pertinent factors in encouraging the use of HTPs in respondents included the appeal of various flavours, stress relief properties, and their perceived role as an alternative to traditional cigarettes.

“Despite the multitude of encouraging factors, there exists a low prevalence of current users in our population. A potential barrier could be the cost of the product, with a device and pack of 100 heat sticks selling for approximately Rs25,000 or more.

“However, among both past and current users, frequency of use was reported on a weekly to monthly basis, similar to other studies which reported weekly HTP use. This could be due to the less addictive nature of HTPs compared to cigarettes, but further studies are needed to confirm their addictive potential,” the study says.

Published in Dawn, July 7th, 2024