title: Adolescents' knowledge and opinions about smoking: a qualitative study from the Jhaukhel-Duwakot Health Demographic Surveillance Site, Bhaktapur District, Nepal.
abstract: BACKGROUND
  The use of tobacco products among adolescents in Southeast Asia represents a major public health burden. Two out of ten adolescents attending school are tobacco users and several factors influence them to initiate tobacco use. Most studies related to tobacco use are quantitative, whereas qualitative studies exploring adolescents' smoking behavior and their views, knowledge and experiences are scarce.
  
  
  OBJECTIVE
  To gain a deep understanding of Nepalese adolescents' knowledge and opinions about smoking and reasons for smoking initiation.
  
  
  METHODS
  Adolescents from four secondary schools in the 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 content analysis.
  
  
  RESULTS
  The participants knew that smoking represents health risks as well as socio-economic risks, but few described the addictive nature of tobacco and health risks related to passive smoking. Most participants related smoking initiation to the smoking behavior of peers and family members, but easy accessibility to cigarettes, ineffective rules and regulations, and exposure to passive smoking also created environments for smoking. Some expressed confidence to resist peer pressure and refuse to start smoking, but also expressed the need for prevention strategies in schools and for governmental initiatives, such as more strict implementation of tobacco control and regulations to prevent and reduce smoking.
  
  
  CONCLUSIONS
  Curbing the tobacco epidemic in Nepal requires healthy public policies and multifaceted interventions to address the knowledge gap on health consequences associated with smoking among adolescents, teachers and parents/adults.
authors.affiliation: Unit for Health Promotion Research, University of Southern Denmark. Niels Bohrs Vej 9, DK-6700 Esbjerg, Denmark, Phone: +45 2625 2264.
authors.forename: Lene
authors.initials: L
authors.lastname: Povlsen
authors.affiliation: Institute of Medicine, Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy at University of Gothenburg, Sweden.
authors.forename: Umesh Raj
authors.initials: UR
authors.lastname: Aryal
authors.affiliation: Centre for Applied Biostatistics, Occupational and Environmental Medicine, University of Gothenburg, Sweden.
authors.forename: Max
authors.initials: M
authors.lastname: Petzold
authors.affiliation: Institute of Medicine, Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy at University of Gothenburg, Sweden.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Krettek
keywords: Nepal; adolescents; health behavior; health promotion; smoking