RESEARCH PAPER
Bayesian analysis on smoking prevalence and age of smoking initiation in Nepalese population: Findings from the STEPS national surveys
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1
Karnali Academy of Health Sciences, Jumla, Nepal
2
School of Nursing and Midwifery, University of Monash, Melbourne,
Australia
3
Nepal Health Research Council, Ramshah Path, Kathmandu, Nepal
4
Tri-Chandra College, Department of Statistics, Tribhuwan University,
Nepal
Submission date: 2023-01-08
Final revision date: 2023-08-25
Acceptance date: 2024-07-30
Publication date: 2024-08-30
Popul. Med. 2024;6(August):23
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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