Traditional smokeless use in Pakistan

In Pakistan, traditional smokeless tobacco (SLT) is widely used, particularly among men. The current use prevalence was 14.6% among adult males and 3.4% among adult females in 2018, reflecting a notable gender gap. The most common forms of SLT in the country particulary in rural and tribal regions include Naswar (the most widely used), Chalia, Pan (betel leaf with tobacco), and Gutka. These products are easily found in markets, shops, and through informal vendors, making them highly accessible. While SLT is officially regulated as a tobacco product and its advertising is banned and restricted, there is a lack of specific laws tailored to these products. As noted by Irshad HA et al, in their study "Smokeless tobacco: knowledge, attitudes and usage in Pakistan", there are no clear or comprehensive legal frameworks specifically addressing smokeless tobacco. Despite this, SLT use and sales are considered legal, and products are actively marketed. Online purchases are also permitted, and the minimum legal age for purchase is 18, though enforcement is inconsistent. Health warnings on packaging are not required, and locally produced SLT is not taxed, which contributes to its low cost and continued widespread use.
In summary, smokeless tobacco remains a legal but under-regulated product in Pakistan, commonly used by both men and women, and widely available in various forms. The absence of clear legislation and weak enforcement mechanisms allow products like Naswar, Chalia, Pan, and Gutka to remain a significant public health concern.