Background Nepal has the highest mortality rate from chronic lung diseases globally. The World Bank reports that over 30 percent of Nepalese patients currently use tobacco products. Yet, the smoking epidemic is still under-researched in Nepal. This research seeks to understand the Nepalese peoples’ attitudes towards smoking, in order to develop sustainable, culturally appropriate smoking cessation programs in Nepal.

Methods Participants were recruited from outpatient multispecialty clinics at the Tribhuvan University Teaching Hospital in July 2023. Participants (n= 250) met eligibility requirements if they were 18+ years of age and had used a tobacco product in the last 15 years. Participation was voluntary and both verbal and written consent was obtained. The 46-question survey was administered verbally using interpreters and answers were entered into data management application Qualtrics. Data analysis was conducted using R statistical analysis software, and results are reported as numbers and proportions.

Results Participants included 231 (92.4%) males, 18 (7.2%) females, and one participant who identified with neither (0.4%). Of the participants, 36 were 18-24 years old (14.4%), 82 were 25-39 (32.8%), 64 were 40-54 (25.6%), and 68 were 55-89 (27.2%). Approximately 69% of participants were married, and 17% did not attend any formal schooling. Peer pressure by friends or family (friends smoking by 78%, and family smoking by 21%) was given as a reason for smoking initiation, and curiosity was selected by 48% of participants. The most prevalent reason for delaying smoking initiation was lack of peer pressure (friends do not smoke (66.8%). Continued smoking was attributed to killing time (22.4%), energy and euphoria (21.2%), and dealing with anger and anxiety (18.8%) as the most popular reasons. The large number of male participants supports previous results that men are three times as likely to smoke as women. Social pressures were the most dominant factors that accounted for smoking initiation. Similarly, lack of social pressures resulted in delayed smoking initiation. Friends smoking was not offered as an option for continued smoking. Participants continuation reasoning points to stress and boredom as contributing factors.

Conclusion The results of our cross-sectional study suggest a potential for public health interventions to reduce social pressure to smoke or introduce measures to replace the habit and decrease stress.