Tobacco has become a major global public health problem, killing more than 8 million people a year. It remains one of the world’s leading cause of preventable premature deaths. Not limited to death, it contributes to poverty by diverting household spending from basic needs to tobacco. Nepal witnesses 27100 deaths every year due to tobacco use and is living in huge economic loss of 23,000 billion Nepali rupees per year, which constitutes 0.86% of Nepal’s GDP (2017/18). Though tobacco use has devastating health and economic costs, more young people are still taking up tobacco every day. To protect new and future generation of people from detrimental effects of tobacco, effective policy and actions are vital. Further, the evidence of increased risk of getting COVID-19 among smokers urge for the priority to reduce prevalence of smoking.
Evidences have shown that vast majority of tobacco users, especially smokers begin using tobacco in their teenage years. STEPS survey of World Health Organization (WHO) has also shown the average age of starting tobacco use by Nepali, as 17 years. Therefore, teenage years, when one goes through different physical and psychological changes, is equally critical period when it comes to tobacco use. This is the age when teenagers generally begin tobacco use and once it is started, they find it difficult to stop due to addiction issues. This age group is more likely to be influenced by friends and family members to try risky behaviours like tobacco, alcohol, and drug use. In order to reduce prevalence of all tobacco use, it is crucial to stop young people from starting to use tobacco.
Recent nation-wide survey NSEPT2020,on tobacco use by Nepal Development Research Institute has shown the prevalence of tobacco use among men aged 18-40 is 43%. For men aged 18-30 its 38.5% and it rises to 51.1% for aged 31-40. Tobacco use for women 18-40 is 6%, with 4.1% for 18-30 group and 10.7% for aged 31-40. According to Global School Based Health Survey of WHO, the prevalence among 13-15 aged men is 9.5% and women is 4.8%. These data show that, the gender gap in prevalence and men tobacco use is increasing with increasing age. The focus group discussions among 330school students aged 13-18across Nepal by NDRI, to understand more about their attitude has suggested that teen tobacco use is likely to be substantially higher than shown by survey data. We found boy studentsreluctant to admit using tobacco themselves but sharing with their peers, and teachers and girl students reporting the evidence of their tobacco use inside toilet and outside school. Two grade 10 girl students, shared to us, “During lunch hours students especially boys of grade 9 and 10 go to market, hotels to use tobacco products.” There were many girl studentswho shared that boys of their class use tobacco.
Our survey showed that the awareness level of youth regarding harmful effects of tobacco use is quite high. Around 9 out of 10 youths are aware of health impacts of tobacco use, 72% about second hand smoking, and 95% are concerned about the level of tobacco use among young people, yet the number of taking up the habit of tobacco are high. The mismatch of awareness level and tobacco usebehaviour is triggered by peer pressure, addiction, affordability, availability and accessibility of the tobacco products.
Peer pressures and family influence were the key players in motivating the young people in starting tobacco use, especially smoking. NDRI survey found that 100% of youth smoker under age 25 were influenced by peer and family members to start smoking. Our FGD among teenage also support this evidence. A grade 9 boy aged 14 said, “I started to try its taste once and seeing my friends using it”, another grade 10 boy aged16 shared, “I was forced to use tobacco by friends outside my school”. These are the representative cases out of many. Moreover, the addiction issue was hindering them behind to quit tobacco use. Survey finds, 26% of youth smokers and 25% of youth smokeless tobacco users tried to quit tobacco use in the last 12 months but majority could not give up due to addiction issue. This is relevant among teenage students as well, where few students were so addicted only after couple of months of use.
Affordability, accessibility, and availability are not an issue for teenage and youths. Here comes into play the tactics of tobacco industries. They are selling tobacco products near the eyesight of youth anywhere easily even in groceries. Single stick cigarettes can be purchased, which makes it cheap and easy to school children to access tobacco products. NDRI survey finds, increase in affordability of the current generation of youths compared to their parents since they have more disposable cash than previous generations. Even for high school students’ current cost of tobacco and accessibility is not a big deal as they can buy tobacco anywhere and the pocket money is enough to purchase cigarettes. A grade 10 boy student said, “I purchase from the shops outside school area. Our parents give 30-50 rupees per day as pocket money and we usually spend this money to purchase cigarettes. I have never been stopped by anyone from buying”.Easy availability of tobacco products in almost all local shops makes easy access to purchase tobacco to school students and youths.
Nepal ratified the WHO Framework Convention on Tobacco Control (FCTC) on7th November 2006. In line with the FCTC, the Government of Nepal passed the “Tobacco Products (Controland Regulatory) Act (2011)” to make legal provisions to reduce, control and regulate the import, production,sales and distribution and consumption of tobacco products. Under the Act, there are various demand reduction measures, when implemented properly, can protect youths from tobacco epidemic. For instance, prohibition of sales to and by minors, prohibition of tobacco sale within 100 meters of educational institutions. However, the policies don’t seem to effectively implemented as students in our study reported not being stopped from buying tobacco even, they are minors. Further, the policy implementation and regulation regarding sale and distribution is even worse as observed in our survey.
Tobacco epidemic among youths is a huge challenge. The early age of initiation underscores the urgent need to intervene and protect youths from falling prey to the tobacco addiction. The strict implementation of tobacco policies to deal with the accessibility and availability of tobacco products is urgent. Further, increase in tobacco taxes are seen as the most cost-effective way to curbing tobacco use, particularly among youth by reducing its affordability. Beholding the situation of youth tobacco use in Nepal, it’s really a high time to draw attention of government for the strict regulation, awareness, and bahaviour change and individuals to follow it.
Program manager for Tobacco control program/Research Associate, Nepal Development Research Institute, Lalitpur, Nepal
