Tobacco use and associated factors among adolescent students in Dharan, Eastern Nepal: a cross-sectional questionnaire survey

Introduction: The tobacco use among the youth, in both smoking and smokeless forms, is quite high in the South East Asian region. Tobacco use is a major proven risk factor and contributes substantially to the rising epidemic of non-communicable diseases. Objectives: To estimate the prevalence of tobacco use and determine associated factors among adolescent students of Dharan municipality. Design: Cross-sectional study. Setting: Secondary and higher secondary schools of Dharan municipality in Sunsari district of Nepal. Participants: Students in middle (14-15 years) and late adolescence (16-19 years) from grades 9, 10, 11 and 12 were included. Primary outcome measure: Ever tobacco use which was defined as one who had not used any form of tobacco in the past 1 month but had tried in the past. Methodology: Self-administered questionnaire adapted from Global Youth Tobacco Survey was used to assess tobacco use among the representative sample of 1312 adolescent students selected by stratified random sampling from July 2011 to July 2012. Results: Out of 1454 students, 1312 students completed the questionnaires with a response rate of 90.23%. Prevalence of ever use of any tobacco product was 19.7% (95% CI 17.7 to 21.6). More than half of the tobacco users (51.9%) consumed tobacco in public places whereas almost a third (75.6%) of the consumers purchased tobacco from shops. Multivariate analysis showed that tobacco use was associated with late adolescence (OR: 1.64; 95% CI 1.17 to 2.28), male gender (OR: 12.20; 95% CI 7.78 to 19.14), type of school (OR=1.72; 95% CI 1.01 to 2.94), Janajati ethnicity (OR: 2.05; 95% CI 1.39 to 3.01) and receiving pocket money >= Nepalese rupees 500/month (OR: 1.45; 95% CI 1.04 to 2.03). Conclusions: Tobacco-focused interventions are required for school/college going students to promote cessation among users and prevent initiation, focussing on late adolescence, male gender, government schools, Janajati ethnicity and higher amount of pocket money.