by Sadia Gulzar
The migration of young people from Gilgit-Baltistan to distant urban centres in pursuit of academic excellence and employment might be a choice for few but a compulsion for many. It is the inevitable result of sheer state neglect, lack of quality education, scarce economic prospects, and vanishing job opportunities in their native areas.
Forced to leave in search of knowledge and livelihoods, they arrive in Pakistan’s cities only to face a different environment of alienation, economic hardship, and social dislocation. Many of them are seduced into self-destructive habits such as smoking as a glamour of fashion or the hollow promise of stress relief. Unaware of its deeper, insidious consequences, they gamble away their health, their potential, their meagre resources, and the very future they set out to build.
Pakistan is facing an alarming tobacco epidemic, claiming an estimated 13,600 lives every month. Smoking rates remain high, particularly among youth, including those from Gilgit-Baltistan (G-B).
According to the WHO report of 2022, the world’s 1.3 billion tobacco users (80%) live in low- and middle-income countries. Pakistan ranks fifth globally in tobacco use, with 25.4 million people (20.7 million males and 4.6 million females) aged 15 years and older using tobacco.
The Global Burden of Disease 2024 report places Pakistan’s smoking-related deaths to around 450 deaths daily or 91.1 per 100,000 which is higher than any other Asian country. The economic toll is very shocking, with an annual cost of over Rs700 billion in healthcare and productivity losses. As per reports, Pakistan produces over 133,600 tons of raw tobacco by cultivating on 62,400 hectares of land.
In June a study revealed that second hand cigarettes are sold in market which is used by 95% of children in Pakistan and Bangladesh. Furthermore, report also clarified, 13.3% boys and 6.6% girls are using tobacco.
Gilgit-Baltistan on the edge
The rising smoking crisis in Pakistan extends beyond urban centres, posing a growing public health threat in Gilgit-Baltistan, especially among youth. Studies reveal that 43.7% of men and 5.5% of women in the region smoke, while 10.3% of local doctors are also smokers.
A survey conducted between December 2021 and May 2022, involving 102 physicians from public and private hospitals, including Aga Khan Health Services, Sehat Foundation, provincial headquarter hospital (PHQ) Gilgit and district headquarters hospitals (DHQs) in Ghizer, and Hunza, found that 11 of 66 male doctors smoked. Tobacco spending in Gilgit-Baltistan, recorded at Rs2.5 billion in 2019, has escalated sharply by 2025, indicating a worsening trend.
The rise of vaping
The global tobacco industry has evolved, producing new forms of smoking designed to lure younger audiences. One of the most alarming trends is the electronic cigarette, or vape. A typical vape consists of a lithium battery, a heating coil, and a liquid-filled reservoir. When heated, it delivers nicotine in vapour form.
First introduced in Karachi in 2008, e-cigarettes have gained alarming popularity in Pakistan. A recent joint study by Aga Khan University (AKU) and Multan Medical and Dental College (MMDC) found that 43.4% of participants had tried e-cigarettes—up from 24% in 2017. Another study, reported by Dawn, revealed that 68% of surveyed university and college students in Karachi were vaping. Researchers also found a 40% increase in vaping over just five years, with hundreds of vape shops now operating openly in major cities, making access easier than ever.
Also read: Cardiovascular disease — a growing health crisis in Gilgit-Baltistan
Gilgit-Baltistan (G-B), a remote mountainous region, is undergoing rapid social change. Many young people face a growing generational gap and struggle to openly communicate their thoughts or problems within their families. This often leads to psychological stress, with smoking—and now vaping—seen as a coping mechanism.
In G-B, vaping has become a fashionable trend among adolescents, driven by aggressive marketing, enticing flavours, peer influence, and widespread availability. Social media platforms play a central role in promoting e-cigarettes, often portraying them as trendy and harmless.
Causes and risks
A recent report found that 39.3% of youth would try vaping if pressured by friends. Research has identified over 2,000 harmful toxins in each puff, including extremely high nicotine levels—often four times greater than in traditional cigarettes. Health experts warn of severe consequences: lung damage, DNA alterations, cognitive decline, and immune system disorders.
Flavoured liquids ranging from fruit and candy to mint and menthol are among the top brands youth are drawn to vaping. Vape companies claim their products are safer than traditional cigarettes, but evidence shows they can be even more harmful.
Dr Javaid Khan, senior professor and pulmonologist at AKU, warns that “tobacco companies are targeting adolescents and the youth to promote their products.”
Some vape liquids also contain marijuana derivatives, such as tetrahydrocannabinol (THC), which can alter brain function, damage DNA, reduce antioxidant levels, and impair enzyme activity. Vaping has also been linked to oral tissue damage and chronic immune disorders.
Pakistan has no enforceable laws restricting the sale of tobacco or vape products. There is no minimum age for purchase, allowing even children to buy them freely from small roadside shops. With no regulation of vape liquid ingredients, consumers remain unaware of the potentially dangerous chemicals they inhale.
The main addictive component, nicotine, poses particular danger to developing brains. While traditional cigarettes contain around 11.9–14.5 mg of nicotine, many modern e-cigarettes contain up to 60 mg/ml—leading to rapid addiction and long-term harm to brain function.
The way forward
Health experts and practitioners warn that without decisive policy action, the smoking and vaping crisis will intensify.
Pulmonologist Prof (Dr) Javaid Khan has recommended a range of measures, including strict age restrictions and licensing requirements for sales, bans on public smoking and vaping, prohibitions on advertising, higher tobacco taxation, and full implementation of the WHO’s MPOWER (Monitor tobacco use and prevention policies, Protect people from tobacco smoke, Offer help to quit tobacco use, Warn about the dangers of tobacco, Enforce bans on tobacco advertising, promotion and sponsorship, and Raise taxes on tobacco) framework for tobacco control.
Revisiting and rigorously enforcing the Gilgit-Baltistan Tobacco Control Act 2020 could be a critical step toward reducing the prevalence of smoking and vaping, particularly among young people. Without urgent intervention, Pakistan faces the prospect of an even heavier public health and economic burden in the years ahead.
Government authorities and policymakers hold a central role in addressing this crisis. Comprehensive laws should regulate product usage, establish firm age limits, ban hazardous tobacco and nicotine products, and restrict their promotion. Many European Union countries have already set strong precedents by prohibiting smoking and vaping in public spaces—an approach Pakistan could adapt.
Healthcare professionals, too, play an essential part through education, early intervention, and patient-focused cessation programs. By combining robust policy enforcement with active medical engagement, society can significantly reduce smoking rates and protect communities from the devastating health impacts of tobacco and vaping.
These measures, if implemented effectively, can safeguard the health of individuals and future generations, shielding them from preventable disease and premature death.
Sadia Gulzar, a dedicated nursing student from Yasin Valley, is currently pursuing her BScN at Ziauddin University, Karachi. Passionate about health advocacy, she writes on critical medical issues to raise awareness and promote wellness in underserved communities.
The High Asia Herald is a member of High Asia Media Group — a window to High Asia and Central Asia