RESEARCH PAPER
 
TOPICS
ABSTRACT
Introduction:
Smoking prevalence and age of smoking initiation (AOI) are two important variables for tobacco control programs. The study aimed to compare the prevalence of smoking between three WHO STEPS (STEPwise approach to surveillance) surveys and the AOI between males and females, using the Bayesian approach.

Methods:
We made three null hypotheses (H0) at a 5% level of significance: the smoking prevalence in the 2019 WHO STEPS survey is similar to the previous two surveys (2008 vs 2019, and 2013 vs 2019); mean AOI between males and females is similar within 2019 survey. Both classical and Bayesian hypotheses were tested. In the Bayesian hypothesis, the Bayes factor (BF) and robust analyses were performed through the Markov chain simulation-based estimation method.

Results:
We found no difference in smoking prevalence between the 2013 and 2019 surveys (BF0- =56.59). In contrast, there is strong evidence of the difference (BF0- =2.38×10-43) in smoking prevalence between the 2008 and 2019 surveys. Next, there is no evidence of a difference in the mean log AOI between males and females (BF01=12.54). The sequential analysis showed strong to very strong evidence for the H0 for AOI (BF10<1) and smoking prevalence (BF0- >1), respectively.

Conclusions:
Our findings go beyond classical hypothesis testing on smoking behaviors and highlight the importance of the BF for the decision-making process in the tobacco control program. Further, the findings suggest that immediate efforts should be made to understand the underlying cause behind the stationary prevalence rate of the smoking population in the last five years.

ACKNOWLEDGEMENTS
We would like to acknowledge everyone who took part in this survey for their efforts. We are grateful to the NHRC team for providing us with valuable data for this study.
CONFLICTS OF INTEREST
The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none was reported.
FUNDING
There was no source of funding for this research.
ETHICAL APPROVAL AND INFORMED CONSENT
This study utilized secondary data obtained from the three STEPS Surveys of Nepal (2008, 2013 and 2019) which are publicly available and do not contain any personally identifiable information. All sources have been properly cited in the manuscript and followed the ethical guidelines. All STEPS Surveys had mentioned obtaining ethical clearance from the Ethical Review Board of the Nepal Health Research Council. The surveys had maintained all ethical issues.
DATA AVAILABILITY
The data supporting this research are available from the authors on reasonable request.
AUTHORS' CONTRIBUTIONS
URA: wrote the manuscript and performed statistical analysis. DB and YS: critically revised the manuscript and provided valuable input. BB: arranged the data and revised the manuscript. MD and PG: revised final version of the manuscript. All authors read and approved the final version of the manuscript.
PROVENANCE AND PEER REVIEW
Not commissioned; externally peer reviewed.
 
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ISSN:2654-1459
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