Initial exploration of status and reason for tobacco use among out of school children in Karachi, Pakistan

Date of Award


Document Type


Degree Name

Master of Science in Health Policy & Management (MSc Health Policy & Mgmt)


Community Health Sciences


According to the World Health Organization tobacco kills half of its users. The increase in the use of tobacco causes several non-communicable diseases like cancer, lung disease, and ischemic heart diseases in the population which eventually leads to the burden of disease. The number of out-of-school children (OOSC) in the world is more than 50 million. Pakistan has the second-highest number of OOSC after Liberia. OOSC with no formal education at all are more prone to be involved in activities like substance abuse, drug use, and tobacco use. In a study in Pakistan, substance abuse is considered to be higher in street children although there is no literature on OOSC, the GYTS reports the use of smoke and smokeless tobacco in students in Pakistan. Tobacco use is likely to be higher in OOSC. Since there is no literature on tobacco use in OOSC, this study was conducted to assess the current status of tobacco use, among OOSC and to identify the factors of tobacco use in OOSC living in Karachi. METHOD: Sequential mixed-method study design was used, quantitative data were collected first, and then qualitative interviews were conducted. Participants were identified through the snowball sampling technique; the study setting was urban Karachi. Quantitative data was collected from 50 OOSC children by using a structured questionnaire. Qualitative data was collected from 10 children through indepth interviews using a semi-structured questionnaire. RESULTS: The study participants belonged to different OOSC categories; they were between the age of 5-18 years. OOSC belonged to different sociodemographic backgrounds. Tobacco use was higher in male children (72%) as compared to female children (28%). Eighty-four percent of the OOSC used Smokeless tobacco, 16% were dual users and 4% used smoke tobacco. The average age of initiation was 10.6 years in OOSC. The OOSC had less levels of addiction. Ninety-two percent had a single medium of access and 8% had multiple access. The reasons for tobacco use among OOSC were 84% had single and 16% had multiple reasons for tobacco use. Sixty-four percent did not know the harmful effects of tobacco and 34 % did know. Seventy percent of OOSC had never tried to stop using tobacco and 30% had tried. CONCLUSION: Smokeless tobacco use is more in OOSC as compared to smoke and dual users. Male children are more tobacco users as compared to female children. Tobacco use in OOSC starts at a much early age as compared to school-going children. Their lack of knowledge regarding the harmful effects is due to the lack of awareness and misconceptions which lead them to use tobacco. OOSC expressed willingness to quit tobacco use. Major factors like different mediums of tobacco access, awareness regarding the knowledge about the harmful effects, and encouragement to stop tobacco use are needed to be targeted for reducing tobacco use. Specific policies are required for the identification of the smokeless tobacco manufactures and their sale to minors. The policy implications need to propagate general awareness about the harmfulness of tobacco in OOSC. (Key-words: Access, knowledge, minors, Out of school children, reasons, tobacco)

This document is available in the relevant AKU library