GATS 2024 falls short of clarity on Pakistan's tobacco crisis

The Global Adult Tobacco Survey (GATS) 2024 for Pakistan has left more questions than answers. Considered as the most authoritative national survey on tobacco use, it provides nationally representative data on tobacco use, cessation, secondhand smoke exposure, and public attitudes. Conducted by the National Institute of Population Studies Training and Research (NIPS&TR), and the Ministry of National Health Services, with the support of WHO, the household survey used a multi-stage clustered sample design, covering a total of 11,167 adults across Pakistan.

According to the GATS 2024, Pakistan reduced tobacco consumption by 15.7% between 2014 and 2024 thanks to measures implemented to fulfill its international obligations under the WHO’s Framework Convention on Tobacco Control (FCTC). However, it adds that despite progress, tobacco products are still consumed by 16.1% of the Pakistani population aged 15 and above – in other words 22.7 million use tobacco, including 14 million smokers.

GATS 2024 also reported a significant decline in exposure to secondhand smoke. The exposure to secondhand tobacco smoke decreased in all locations measured in the two surveys: homes (48.3% to 28.8%), workplaces (69.1% to 35.9%), government buildings (64.6% to 40.7%), private buildings (77.3% to 54.8%), healthcare facilities (37.6% to 24.5%), restaurants (86.0% to 55.2%), marriage halls (65.7% to 50.3%), public transportation (76.2% to 45.4%), universities (44.2% to 33.3%), and schools (25.1% to 11.5%).

Despite decline, a source of worry identified by GATS 2024 is that female consumption of tobacco increased slightly by 1.7% – with 5.9% of women aged 15 and above smoking. More worryingly, there was also no improvement in quit attempts made by adult smokers in the past 12 months (from 24.7% to 24.1%).

These findings make a case of hope and assurance and the need to continue the work on tobacco control. However, they do not provide the complete picture.

Unlike the GATS 2014 report, there has still been no report accompanying GATS 2024. The GATS 2014 report provided insights into a number of aspects of tobacco use, which are up till now missing in the current findings. The findings of GATS 2024 did not disclose the average number of cigarettes a smoker smokes in a day, and critically what was the age when the current adult smokers initiated smoking.

Ten years ago, 29% of ever daily smokers 20–34 years old started smoking daily before the age of 17 years. It will be interesting and critical to know if there has been any change in the age of initiating smoking. Similarly, the survey a decade ago informed that 8.4% of those who have ever smoked on a daily basis have quit smoking. There seems to be a lack of clarity on the reduction in tobacco use as highlighted by GATS 2024. Is it because of the increase in the population or has the number of smokers quitting successfully increased? In 2014, one of the critical findings was 8.4% of those who ever smoked daily quit smoking. Currently, there is no information regarding the adult smokers who have successfully given up this habit.

The most crucial missing part is the demographic characteristics of the selected population for the GATS 2024. The demographic characteristics help understand various aspects of tobacco use and smoking. The initiation of smoking before the age of 18 years was a concern in 2014, as initiation of daily smoking before the age 17 years was seen in 32.7% adults living in rural areas and 18.8% in urban areas. Currently, there is a lack of such information.

The surest way to bring down the smoking prevalence is keeping the young people away from initiating smoking or use of another tobacco product, including the alternative tobacco products. However, this can only be achieved when there is credible information about the number of underage and young smokers, and their socio-economic background, and where they live.

The GATS 2014 report provided numbers for the smoking prevalence among the 15-24 years age bracket in terms of any smoked tobacco product, any cigarette, manufactured, hand-rolled, waterpipe and other smoked tobacco. Given the fact that in the last decade Pakistan has seen the introduction of alternative tobacco products, this information about the 15-24 years age bracket becomes even more pertinent.

Young people today face an expanded array of tobacco products, with their choices—and risks—growing wider than ever before. In this scenario, it is absolutely essential that their socio-economic background and use of tobacco products, along with other factors, is known. This will help in coming with plans and strategies to keep them away from their use.

Unfortunately, the public release of GATS 2024 seems designed more to downplay than to clarify the extent of smoking and tobacco use. It would have been much better if a comprehensive report regarding the tobacco use over the last years was released, containing indicators used, along with information about sample, the complete questionnaire, and of course, the recommendations.

There is a need to release a comprehensive report on GATS 2024 covering methodology, tobacco use, cessation and methods used for cessation, secondhand smoke exposure, economics of tobacco use, media, tobacco marketing, knowledge, attitude and perceptions of smokers and non-smokers, and of course, the recommendations. Ideally, this should have been done with the release of the findings. Additionally, the data should be made available publicly.

The writer is based in Islamabad and works for Ending Combustible Smoking