The Use of Electronic Cigarettes: A Personality Gig for the Youth of Pakistan
This report is a preliminary policy draft prepared to collect and share information ahead of a final policy report on electronic cigarette use among Pakistani youth. INTRODUCTION & BACKGROUND E-cigarettes are devices that heat a liquid held in a cartridge or reservoir, converting it into an aerosolised vapour that the user inhales through a mouthpiece. The liquid typically contains water, propylene glycol and/or vegetable glycerine as a base carrier, along with flavouring and, in most cases, nicotine. The modern electronic cigarette traces back to the early 2000s, when Chinese pharmacist Hon Lik developed the device reportedly in response to his father's death from lung cancer, building on an earlier smokeless tobacco-free patent by Herbert Gilbert in 1963. Commercial e-cigarettes reached Europe in 2006 and the United States in 2007. Growth since then has been extraordinary. Between August 2012 and December 2013 alone, 215 new e-cigarette brands were launched; by January 2014, there were 466 brands and 7,764 flavours on the market. In 2014, "vape" was named the Oxford Dictionary's Word of the Year. THE GLOBAL RISE OF ADOLESCENT VAPING In the United States, 27.5% of high school students report using e-cigarettes. The global e-cigarette market, valued at $20.4 billion in 2021, is projected to reach $30 billion by 2027 — and use among youth rose by a staggering 1,800% between 2011 and 2019. Adolescent e-cigarette use is a particular concern because it is associated with a heightened risk of adolescents and young adults going on to smoke traditional tobacco. Across OECD countries, roughly 20% of 15-year-olds reported using an e-cigarette in the past month in 2022, with some countries — including Lithuania, Hungary, Poland, and Bulgaria — exceeding 30% usage, compared to under 10% in Portugal and the Netherlands. Usage tends to be somewhat higher among girls (21%) than boys (18%), with especially wide gaps in Estonia, Ireland, and the United Kingdom. WHY PAKISTAN IS AT RISK In Pakistan, an estimated 6.2% of individuals use e-cigarettes. Originally marketed as a "less harmful" alternative to smoking and a cessation aid, Electronic Nicotine Delivery Systems (ENDS) gained additional popularity in Pakistan partly because some smoking-cessation medications are themselves carcinogenic. National statistics suggest that 23.9 million Pakistanis (19.1%) smoke regularly, 6.2% use vaping products, and a further 15.9 million (12.4%) use smokeless tobacco in the form of naswar. A separate study in Sindh found that while 65.6% of participants were aware of e-cigarettes, 6.2% reported actively using them. WHY THE BOOM? Several converging factors explain the rapid rise in e-cigarette use, particularly among Pakistani youth: • According to the CDC's 2024 National Youth Tobacco Survey, 5.9% of middle and high school students in the US — roughly 1.63 million individuals — reported current e-cigarette use, with 38.4% of those users reporting frequent use and 26.3% reporting daily use, a strong signal of nicotine addiction. • Flavoured e-cigarettes disproportionately appeal to younger users; many public health advocates argue they should be restricted entirely to adult smokers seeking to quit, with stricter age-verification in place. • Pakistan's comparatively liberal restrictions on vaping's use, advertising, promotion, sponsorship, and packaging have made it far more accessible than in more tightly regulated markets. • Socio-economic factors — education levels, urbanization, and media exposure — significantly shape adolescent uptake of these products. • Urban adolescents in particular encounter greater availability of vape shops and social environments that normalise use, while platforms like Instagram and TikTok amplify vaping's image as fashionable and harmless. • Initiation is commonly linked to the transition into university life, driven by curiosity, peer influence, stress management, and exposure to pro-vaping content online. • Motives differ by gender: young women more often cite curiosity, social influence, and flavours, while young men more often cite image, peer bonding, or boredom. • Students who perceive that their peers are vaping — even discreetly, in defiance of campus policy — are significantly more likely to do so themselves. • Despite widespread use, including among health sciences students, real knowledge gaps and misconceptions persist about e-cigarettes' chemical composition, addictive potential, and health risks. • Aggressive marketing of flavoured e-liquids, easy online accessibility, and weak policy enforcement all compound the risk of continued uptake. • Peer influence — both from friends and family members who already vape — remains one of the single strongest predictors of e-cigarette use. • Price is a major factor: e-cigarettes are often significantly cheaper than traditional cigarettes, particularly where regulation is weak. • Cross-country comparisons show a clear pattern: nations with stronger, better-enforced regulation report consistently lower usage rates than those with limited oversight — a pattern also borne out in a systematic review across Southeast Asia. These findings make clear that policy — or the lack of it — plays a defining role in shaping e-cigarette use patterns, both within Pakistan and across the wider region. This remains a working draft ahead of a fuller policy report, and we welcome input from our community as this research continues.