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What role can e-cigarettes play in helping adults in Pakistan to quit smoking? A qualitative exploratory study

There is now substantial evidence of the effectiveness and popularity of Electronic Nicotine Delivery Systems (ENDS) in helping smokers to quit in high-income countries (HIC). ENDS are also now available and becoming popular in low- and middle-income countries (LMIC), including Pakistan. However, their possible role in facilitating smoking cessation in LMIC has not been explored, and may be very different to LMIC because of social, cultural and economic differences as well as differences in access to ENDS.

We plan to investigate how ENDS are perceived and used in Pakistan, a high tobacco burden country. Using qualitative methods, we will explore perspectives of cigarette smokers, ENDS users and sellers, health practitioners, policy makers and civil society. We will ask users about their reasons for ENDS use, their role if any in smoking cessation, beliefs about potential health risks, social acceptability compared to smoking, affordability and access, brands and nicotine strengths and the factors which determine the choice to use ENDS and shape their perceptions of ENDS.

We will ask ENDS retailers about their customer profile (age, gender, socio-economic status, motivation etc.) and the types of products they sell. We will ask health professionals, policy makers and legislators about their views of ENDS as a smoking cessation tool, and any safety or health concerns and information needs regarding ENDS. We anticipate recruiting 12 – 18 smokers and ENDS users (4-6 ENDS users, 4-6 smokers and 4-6 dual users), 6-8 sellers and 6-8 health professional and policy makers to the study.

We will carry out media content analysis, which will involve collecting news reports about ENDS in Pakistan over the past few years and identifying the various narratives being presented around ENDS as either an opportunity or a threat to tobacco control and smoking cessation. Once the analysis of our qualitative data and media content is complete, project partners and stakeholders will meet to discuss the findings as the basis for further work.