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A Qualitative Study from the Jhaukhel-Duwakot Health University of Southern Denmark Adolescents' knowledge and opinions about smoking a qualitative study from the Jhaukhel-Duwakot Health Demographic Surveillance Site, Bhaktapur District, Nepal Povlsen, Lene; Aryal, Umesh Raj; Petzold, Max; Krettek, Alexandra Published in: International Journal of Adolescent Medicine and Health DOI: 10.1515/ijamh-2015-0124 Publication date: 2018 Document version: Final published version Citation for pulished version (APA): Povlsen, L., Aryal, U. R., Petzold, M., & Krettek, A. (2018). Adolescents' knowledge and opinions about smoking: a qualitative study from the Jhaukhel-Duwakot Health Demographic Surveillance Site, Bhaktapur District, Nepal. International Journal of Adolescent Medicine and Health, 30(1), [20150124]. https://doi.org/10.1515/ijamh-2015- 0124 Go to publication entry in University of Southern Denmark's Research Portal Terms of use This work is brought to you by the University of Southern Denmark. Unless otherwise specified it has been shared according to the terms for self-archiving. If no other license is stated, these terms apply: • You may download this work for personal use only. • You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying this open access version If you believe that this document breaches copyright please contact us providing details and we will investigate your claim. Please direct all enquiries to [email protected] Download date: 27. Sep. 2021 Int J Adolesc Med Health 2018; 30(1): 20150124 Lene Povlsena,*, Umesh Raj Aryala, Max Petzold and Alexandra Krettek Adolescents’ knowledge and opinions about smoking: a qualitative study from the Jhaukhel- Duwakot Health Demographic Surveillance Site, Bhaktapur District, Nepal DOI 10.1515/ijamh-2015-0124 related to passive smoking. Most participants related Received December 12, 2015; accepted February 28, 2016; previously smoking initiation to the smoking behavior of peers and published online April 9, 2016 family members, but easy accessibility to cigarettes, inef- Abstract fective rules and regulations, and exposure to passive smoking also created environments for smoking. Some Background: The use of tobacco products among adoles- expressed confidence to resist peer pressure and refuse cents in Southeast Asia represents a major public health to start smoking, but also expressed the need for preven- burden. Two out of ten adolescents attending school are tion strategies in schools and for governmental initiatives, tobacco users and several factors influence them to initi- such as more strict implementation of tobacco control and ate tobacco use. Most studies related to tobacco use are regulations to prevent and reduce smoking. quantitative, whereas qualitative studies exploring ado- Conclusion: Curbing the tobacco epidemic in Nepal lescents’ smoking behavior and their views, knowledge requires healthy public policies and multifaceted inter- and experiences are scarce. ventions to address the knowledge gap on health conse- Objective: To gain a deep understanding of Nepalese ado- quences associated with smoking among adolescents, lescents’ knowledge and opinions about smoking and teachers and parents/adults. reasons for smoking initiation. Keywords: adolescents; health behavior; health promo- Subjects: Adolescents from four secondary schools in the tion; Nepal; smoking. Bhaktapur district, Nepal. Methods: Eight focus-group discussions were conducted with 71 adolescents aged 13–16 years and from grades 8–10. Data were analyzed using manifest qualitative Introduction content analysis. Results: The participants knew that smoking represents The use of tobacco products continues to rise among chil- health risks as well as socio-economic risks, but few dren and youth in Southeast Asia including Nepal, and described the addictive nature of tobacco and health risks is a major public health burden. Causes for this increase include limited knowledge about the harmful effects, the a Lene Povlsen and Umesh Raj Aryal: These authors contributed addictive nature of tobacco products, marketing strategies equally to this work. by tobacco companies, low prices and easy accessibility to *Corresponding author: Lene Povlsen, Unit for Health Promotion Research, University of Southern Denmark. Niels Bohrs Vej 9, tobacco products (1, 2). DK-6700 Esbjerg, Denmark, Phone: +45 2625 2264, In order to prevent/reduce the burden of noncommu- E-mail: [email protected] nicable diseases in Nepal, the Ministry of Health and Popu- Umesh Raj Aryal: Institute of Medicine, Department of Internal lation in 2011 passed the Tobacco Control and Regulatory Medicine and Clinical Nutrition, Sahlgrenska Academy at University Act, based on the WHO Framework Convention on Tobacco of Gothenburg, Sweden; and Public Health and Environment Control (3). The major features are ban on smoking and Research Centre, Katmandu, Nepal Max Petzold: Centre for Applied Biostatistics, Occupational and tobacco use in public places, work places and public trans- Environmental Medicine, University of Gothenburg, Sweden portation; pictorial health warnings covering 75% of the Alexandra Krettek: Institute of Medicine, Department of Internal packet of cigarettes and other tobacco products; complete Medicine and Clinical Nutrition, Sahlgrenska Academy at University ban on tobacco advertising, promotion and sponsorship; of Gothenburg, Sweden; Department of Biomedicine and Public sales ban of children under 18 years; sales ban within the Health, School of Health and Education, University of Skövde, Sweden; and Faculty of Health Sciences, Department of Community span of 100 m distance from educational and health insti- Medicine, UiT The Arctic University of Norway, Tromsø, Norway tutions; a ban on free distribution of tobacco products; and Brought to you by | University Library of Southern Denmark - Syddansk Universitetsbibliotek Authenticated Download Date | 11/1/18 8:59 AM 2 Povlsen et al.: Adolescents’ knowledge and opinions about smoking provision of health tax funds from tobacco products (3). district in Nepal, 13 km east of Kathmandu. This is a peri-urban area However, there are still a number of challenges and barri- shifting towards urbanization, where the population has adopted a modern life style. ers for successful implementation of the law due to limited As the study aimed to describe the adolescents’ general knowl- resources, weak intersectoral coordination and insuffi- edge and opinions about smoking, a representative sample was cient political commitment, as well as low priority given to recruited. It consisted of adolescents aged 13–16 years and from tobacco control in non-health sectors, low level of public grades 8–10, because these are known to be vulnerable to initia- awareness and lack of relevant research (4). tion of smoking and using other tobacco products (6, 20). Moreover, The Global Youth Tobacco Survey revealed that two an equal number of girls and boys from private as well as public schools and from different castes were recruited. All students aged out of ten Nepalese adolescents attending school were 13–16 years in the surveillance site go to school, but schools were tobacco users (5), while a community-based study revealed also chosen due to the ease of obtaining the cooperation of school that nearly five out of ten adolescents were susceptible to authorities and accessing the adolescents. smoking (6). Psychosocial factors such as sex, age, socio- Focus-group discussions (FGDs) were conducted in four schools, economic status, peer-pressure and parental smoking, as including two governmental and two randomly selected private secondary schools (21). Author URA visited the selected schools to well as knowledge about health risks of smoking, refusal establish contact with school principals and concerned classteach- skills and tobacco control policies are likely to influence ers, and later selected six students (three males and three females) young people to initiate tobacco use (6–11). of each grade using a lottery method and with the subsequent help Smoking behavior can be understood through several of the teachers to check the representativity of the sample. Thus, 72 theories. According to the Health Belief Model (12), health students, an equal number of boys and girls, aged 13–16 years and behavior is closely related to an individual’s belief about from grades 8–10 were enrolled; but one boy did not participate in the FGDs (Table 1). perceived threats (risk and seriousness) and outcome expectations (barriers and benefits). The Theory of Rea- soned Action and Theory of Planned Behavior explain Data collection an individual’s behavioral intention as a combination of attitudes, subjective norms and perceived control (13, Eight FGDs, each containing nine students, three from each grade, 14). In contrast to these intrapersonal theories, the Social were conducted. Open-ended questions from a semi-structured inter- view guide were asked. The guide was developed using relevant lit- Cognitive Learning Theory is interpersonal and focuses on erature and health behavior theories, just as public health experts cognitive factors, behaviors and the environment (obser- were consulted and amendments made based on their comments. vational learning), and how these factors dynamically The guide was pretested in a private school in the Kathmandu district and reciprocally affect each other and shape self-efficacy similar to the study site. This only resulted in minor changes
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