Prevalence and predictors of tobacco use among older people in Eastern Nepal: a community-based study

The tobacco epidemic remains a major global public health threat, responsible for more than 8 million deaths annually, including 1.2 million attributable to secondhand smoke. Smokers face nearly twice the risk of dying from cancer compared to nonsmokers, whereas quitting tobacco use reduces cancer risk at any age. In South Asia, including Nepal, tobacco consumption remains widespread due to cultural acceptance, easy availability, and weak enforcement of control measures. Against this backdrop, the present study aimed to determine the prevalence and predictors of tobacco use among older adults in Eastern Nepal.

A community-based cross-sectional study was conducted among 400 elderly individuals, selected through multistage cluster sampling from four wards of Biratnagar Metropolitan City, located in Eastern Nepal. Data were collected via face-to-face interviews using a structured questionnaire. Descriptive statistics (mean, median, and standard deviation) were used to summarize the data, while inferential statistics (chi-square test) assessed associations between tobacco use and sociodemographic variables. Variables with a p-value ≤ 0.1 in the bivariate analysis were included in the multivariable logistic regression model. A backward elimination strategy was applied to derive the final model, and statistical significance was set at p < 0.05.

The prevalence of tobacco use among older people was 61% (95% CI = 56.2%-65.8%), of which 51.5% were smokeless tobacco users and 35.8% were tobacco smokers. Significant predictors of tobacco uses were observed among older age groups (age >80 years), male (OR = 5.80; 95%CI = 3.29-10.22); those with lower education levels (for illiterate OR = 2.15;95% CI = 1.41-4.45), people influenced by advertisement about tobacco (OR = 5.06; 95% CI = 3.82-10.11) and people who exposed to media (OR = 1.87; 95% CI = 1.00-3.50).

This study demonstrates a high prevalence of tobacco use among older adults in Eastern Nepal. Factors contributing to the high prevalence of tobacco smoking include older age, male gender, illiterate population, exposure to tobacco advertising, and media exposure. These findings highlight tobacco use as a significant public health concern among older populations, who are often overlooked in tobacco control strategies. Hence, targeted interventions are urgently needed to reduce tobacco consumption in this vulnerable group, including community-based awareness programs, stricter regulation of tobacco advertising, and age-appropriate cessation support.