Estimating Female Adolescent Smoking Behavior in Nepal

Adolescence, for both boys and girls, is a critical period for smoking initiation. Although there is extensive literature on smoking initiation in the developed world, there is less known about this process in the developing world. This lack of solid evidence on understanding why youths smoke creates a missing link in understanding adult smoking patterns. This consequence is well illustrated in Nepal where women have the highest smoking rates of all women in South Asia. Understanding why girls begin using cigarettes, in addition to other tobacco products, can identify potential policy levers to mitigate smoking initiation. Using 2007 and 2011 data from the Global Youth Tobacco Surveillance survey from Nepal, we develop a model to identify girls who are at risk of starting to smoke, ever smokers, quitters, and the number of cigarettes smoked. The model will be estimated using multiple econometric techniques including factor analysis, conditional mixed process modeling, and will address underreporting of smoking behaviors. For this analysis, we investigate the role positive and negative enforcement, attitude, and peer influence have on smoking decisions. Positive enforcement refers to messages that promote anti-smoking sentiments and includes if her school or parents discuss the dangers of smoking and exposure to anti-smoking media messages. Negative enforcement are exposures to experiences that would promote smoking behaviors including pro-smoking media, seeing actors smoke, and being approached by a cigarette representative. Attitude represents how girl’s perceive other girls and boys who smoke, if they think smoking makes someone attractive, or if smoking makes someone feel more comfortable at a party. Lastly, peer influence includes if her close friends smoke or if she would smoke if her best friend offered her a cigarette. Where the data allow, we will also explore how these factors influence other non-cigarette tobacco use, such as chewing tobacco, which girls might be more inclined to use because it is a less obtrusive form of tobacco