Normalized Vaping Among Pakistani University Students: A Narrative Review of Its Toll on Academic Performance and Respiratory Health

Abstract

Background: Vaping has become increasingly visible among Pakistani university students, but evidence concerning its respiratory, cognitive, and academic consequences remains methodologically uncertain. Objective: To synthesise Pakistan-specific evidence on the social normalisation of vaping and its reported associations with respiratory health, cognitive functioning, and academic performance. Methods: A structured narrative review integrated Pakistan-focused quantitative studies and contextual literature with selected international mechanistic and policy evidence. Findings were synthesised thematically, and greater weight was assigned to studies with identifiable samples, denominators, exposure definitions, comparator groups, and objective measurements. Results: A convenience-sampled Karachi survey enrolled 389 students, of whom 266 (68.4%) reported vaping; among these users, 35.5% vaped daily, 60.9% had vaped for more than one year, and 25.6% reported breathing problems. A Lahore study restricted to 160 current vapers reported cough in 38 participants (23.8%), shortness of breath in 24 (15.0%), and palpitations in 18 (11.3%). Friends, social media, perceived social status, and beliefs that vaping was preferable to smoking were prominent reported influences. Both studies were cross-sectional, used non-probability sampling, and relied on self-report. No sufficiently supported Pakistan-specific evidence established objective pulmonary dysfunction, cognitive impairment, or reduced academic achievement. Conclusion: Vaping is established in selected Pakistani student populations and is accompanied by self-reported health concerns, but causal and nationally representative conclusions are not justified. Longitudinal studies using objective exposure, respiratory, cognitive, and academic measures are required