Abstract
Since the ratification of the WHO Framework Convention on Tobacco Control (FCTC) in 2004, Pakistan has taken various measures of tobacco control. This study examines how these tobacco control measures are associated with change in household-level tobacco consumption patterns in Pakistan over the decade (2005 to 2016) after FCTC ratification. We used multiple waves of the household survey data of Pakistan from 2004–2005 to 2015–2016 for analyzing household-level tobacco use. We find that tobacco consumption remains at a significantly high level (45.5%) in Pakistan despite the recent declining trend in the post-FCTC era. During the preparatory phase of FCTC implementation between 2005 and 2008, the smoking rate was on the rise, and smokeless tobacco use was declining. Over the implementation phase of FCTC policies between 2008 and 2016, the pattern of change in tobacco use reversed—the smoking rate started to decrease while smokeless tobacco use started to rise. However, the decrease in the smoking rate was slower and the increase in smokeless tobacco use at the national level was driven by an increase among the poor and middle-income households. These trends resulted in the growing burden of tobacco expenditure among the poor and middle-income households relative to the wealthier households.
Highlights
Tobacco use is a major public health issue in Pakistan
This study examines how these tobacco control measures are associated with change in household-level tobacco consumption patterns in Pakistan over the decade (2005 to 2016) after Framework Convention on Tobacco Control (FCTC)
With regard to these tobacco control measures, we investigated the following changes from 2008 to 2016 in Pakistan: (i) Share of households consuming smoking and smokeless tobacco, (ii) household expenditure shares for smoking and smokeless tobacco at the extensive margin and at the intensive margin, (iii) smoking and smokeless tobacco consumption by economic status, (iv) average smoking and smokeless expenditure share by economic status, and (v) burden of tobacco expenditure by economic status
Summary
Tobacco use is a major public health issue in Pakistan. 15 million people (age 15+) consume tobacco every day, and more than 160 thousand are killed by tobacco-caused diseases every year in Pakistan [1]. About one in every five adults (19.1%) in Pakistan consumes some form of tobacco, and one in every ten adults (10.5%) is a cigarette smoker [2]. Mouth and oropharynx cancer and lung cancer, the two types closely related to tobacco use, are the leading causes (23%) of male cancer deaths in Pakistan [4]. The burden of diabetes and cardiovascular diseases, for which tobacco use is a key risk factor, are high in Pakistan [5]. The tobacco epidemic in Pakistan, is a serious public health concern and requires effective interventions to contain tobacco use at the population level
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