For many smokers, quitting is not a single moment of decision but a journey that can involve repeated attempts, challenges and setbacks. While some individuals are able to stop smoking after their first attempt, many others continue to struggle despite a genuine desire to quit. This raises an important question for healthcare professionals: when every smoker’s experience with nicotine dependence is different, can a single approach truly meet the needs of everyone?
Pakistan has made progress in reducing tobacco use over the past decade. According to the Global Adult Tobacco Survey (GATS) Pakistan 2024, tobacco use among adults aged 15 years and older declined from 19.1% in 2014 to 16.1% in 2024, representing a relative decline of 15.5%. Similarly, tobacco smoking prevalence decreased from 12.4% in 2014 to 9.8% in 2024.
However, the survey also highlights an important challenge. The percentage of smokers who attempted to quit in a span of 12 months remained almost unchanged, declining slightly from 24.7% in 2014 to 24.1% in 2024. These findings suggest that while fewer people are smoking, many smokers who want to quit may still require additional support to successfully move away from combustible tobacco.
For healthcare professionals, this reflects the complexity of nicotine dependence. Quitting smoking is influenced by multiple factors, including an individual’s smoking history, level of dependence, previous quit attempts and personal health circumstances. As a result, experts believe that smoking cessation should not always follow a single pathway but should involve personalised, evidence-based guidance based on each individual’s needs.
“As physicians, we should move beyond a one-size-fits-all approach to smoking cessation. Every patient follows a unique journey, and our responsibility is to provide evidence-based guidance tailored to individual circumstances. For adults who have been unable to quit smoking despite repeated, well-supported attempts, tobacco harm reduction may be an appropriate topic for discussion as part of a comprehensive smoking cessation strategy,” said Dr. Prof. Syed Iqbal Shah, Consultant Physician.
Dr. Shah’s perspective reflects a broader shift in healthcare, where personalised treatment has become an important principle across medical fields. Just as doctors consider individual factors when managing chronic conditions, experts believe smoking cessation discussions should also take into account the different challenges faced by adult smokers attempting to quit.
This is where tobacco harm reduction (THR) becomes part of the broader conversation. While completely stopping tobacco use remains the best possible outcome, some adult smokers continue to smoke despite repeated and supported attempts to quit. For these individuals, THR focuses on exploring evidence-based alternatives that eliminate the combustion process, which is responsible for producing many of the harmful chemicals associated with cigarette smoke. The approach is intended for adult smokers who would otherwise continue smoking and does not promote nicotine use among non-smokers or young people.
International evidence has contributed to discussions around these approaches. In the United Kingdom, evidence reviews by the Office for Health Improvement and Disparities (OHID) have concluded that vaping poses only a small fraction of the risk of smoking, while emphasising that it is not risk-free and should not be used by people who do not smoke, particularly young individuals.
Clinical evidence has also examined the role of alternative nicotine products in smoking cessation. A Cochrane systematic review analysing 88 completed studies involving 27,235 participants found high-certainty evidence that nicotine e-cigarettes increased smoking cessation rates compared with nicotine replacement therapy (NRT). The review found that nicotine e-cigarettes could result in approximately four additional people quitting per 100 users compared with NRT. Experts note that these findings should be considered alongside appropriate regulation, product standards and strong measures to protect young people.
For Pakistan, experts believe reducing the burden of smoking-related disease requires a comprehensive approach that combines prevention, cessation support and access to accurate scientific information. Recognising that every smoker’s journey is different can help healthcare professionals have more meaningful conversations and provide guidance that reflects individual circumstances.
By combining evidence-based medicine, personalised care and appropriate public health safeguards, Pakistan can continue strengthening its tobacco control efforts while supporting adult smokers in their efforts to move away from combustible tobacco.
