Assessment of Smoking Behaviour of Adolescents in Two Districts of Nepal and Implications of the MPOWER Policy Measures: A Mixed Method Study.

Introduction: Tobacco use is the single most preventable cause of death and disease worldwide. This study aimed to assess the smoking behaviour of adolescents in two districts of Nepal and examine the implications of the MPOWER policy on their smoking behaviour.

Methods: An explanatory, mixed-method study was conducted in two districts of Nepal. Qualitative in-depth interviews were conducted among nine participants aged 35-50, representatives of the Ministry of Health, academic institutions, and managers of organisations working in tobacco control, using snowball sampling method. A total of 306 students of age 13-15 years, from six government schools were recruited through simple random sampling method using an adapted version of the Global Youth Tobacco Survey (GYTS). Findings of the qualitative and quantitative study were explained for concurrence and relevance to present overall study findings. Ethical approval was received from the Nepal Health Research Council and Mahidol University.

Results: Findings from the survey reported that a total of 25 (8.10%) of respondents were smokers, from which 13 (4.20%) were current smokers and 12 (3.90%) were ever smokers. Socio-economic status played a crucial role in the smoking behaviour. Although the survey among adolescents indicated an awareness of the policies, there was a lack of cessation services, which was concurrent with the qualitative findings. The interviews recommended improvements in the implementation of policy ban on public smoking, taxation, and availability of cessation services.

Conclusions: The MPOWER policies are not regulated strictly, especially in areas of the ban on public smoking, regulating the selling of cigarettes to adolescents <18 years, and availability of cessation services.