title: Assessment of nicotine dependence among smokers in Nepal: a community based cross-sectional study.
abstract: BACKGROUND
  The Fagerström Test for Nicotine Dependence (FTND) and Heaviness of Smoking Index (HSI) are extensively used methods to measure the severity of nicotine dependence among smokers. The primary objective of the study was to assess the nicotine dependence amongst currently smoking Nepalese population.
  
  
  METHODS
  A community based cross-sectional study was conducted between August and November 2014. Information was collected using semi-structured questionnaire from three districts of Nepal. Data on demographic characteristics, history of tobacco use and level of nicotine dependence were collected from 587 smokers through face to face interviews and self-administered questionnaires. Non-parametric test were used to compare significant differences among different variables.
  
  
  RESULTS
  The median age of respondents was 28 (Inter-Quartile Range: 22-40) years and the median duration of smoking was 10 (5-15) years. Similarly, the median age for smoking initiation was 16 (13-20) years and the median smoking pack year was 4.2 (1.5-12). One third of the respondents consumed smokeless tobacco products. Half of the respondents wanted to quit smoking. The median score for FTND and HSI was 4 (2-5) and 2 (0-3) respectively. There was significant difference in median FTND score with place of residence (p = 0.03), year of smoking (p = 0.03), age at smoking initiation (p = 0.02), smoking pack year (p < 0.001) and consumption of smokeless products (p < 0.05). Similarly, there was also significant difference in median HSI score with year of smoking (p = 0.002), age of smoking initiation (p < 0.001), smoking pack year (p < 0.001), and consumption of smokeless products (p < 0.05). As per FTND test score, two in ten current smokers had high nicotine dependence (FTND > 6), and HSI scored that three in ten current smokers had high nicotine dependence (HSI > 3).
  
  
  CONCLUSIONS
  Our finding revealed that nicotine dependence is prevalent among Nepalese smoking population. Further studies are required for assurance of tools through bio-markers. Next, smoking cessation program need to be developed considering level of nicotine dependence and pattern of tobacco use.
authors: Department of Community Medicine, Kathmandu Medical College, Sinamangal, Kathmandu Nepal.
authors: Umesh Raj
authors: UR
authors: Aryal
authors: Faculty of Medicine, Epidemiology Unit, Prince of Songkla University, Songkhla, Thailand ; Department of Public Health, Nobel College, Pokhara University, Sinamangal, Kathmandu Nepal.
authors: Dharma Nand
authors: DN
authors: Bhatta
authors: Department of Community Medicine, Kathmandu Medical College, Sinamangal, Kathmandu Nepal.
authors: Nirmala
authors: N
authors: Shrestha
authors: Department of Public Health, Nobel College, Pokhara University, Sinamangal, Kathmandu Nepal.
authors: Anju
authors: A
authors: Gautam
keywords: Current smoking; FTND; HSI; Nicotine dependence