{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T00:40:55Z","timestamp":1792802455243,"version":"4.5.0"},"reference-count":24,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2022,4,8]],"date-time":"2022-04-08T00:00:00Z","timestamp":1649376000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Nepal Health Research Council","award":["1583"],"award-info":[{"award-number":["1583"]}],"id":[{"id":"https:\/\/ror.org\/02swwnp83","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Nicotine dependence is an addiction to tobacco products caused by the chemical nicotine present in tobacco. 80% of premature deaths due to nicotine dependence come from low-and middle-income countries. Since most of the public health studies have focused solely on psychological and behavioral factors associated with tobacco smoking, this study aims to assess the nicotine dependence and stages of change of quitting smoking.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methodology<\/jats:title>\n                    <jats:p>A community based quantitative cross-sectional study was conducted among 280 smokers aged 15\u201369 years in Bharatpur metropolitan, Nepal. A semi-structured and validated questionnaire was used during the face-to-face interviews. Nicotine dependence among participants was assessed using the six-item Fagerstrom Test for Nicotine Dependence (FTND). Chi-square test and multivariate logistic regression analysis were performed to assess the associations between variables at the significance level \u03b1 = 0.05.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Result<\/jats:title>\n                    <jats:p>In the study population, the mean score of FTND was 5.15 \u00b1 2.34. 33.9% participants had a high level of nicotine dependence and nearly half of the participants felt difficulty to refrain smoking even in No-smoking areas. Almost three out of ten respondents were prepared for smoking cessation. It was found that age group 20\u201339 years were more likely to have nicotine dependence (AOR 3.308, 95% CI = 1.039\u201310.534), those who initiated smoking before age of 15 were associated with a greater risk of nicotine dependence (AOR 3.68, 95% CI = 1.826\u20137.446), participants spending more on tobacco products (more than Rs 2400 monthly) were associated with an increased risk of nicotine dependence (AOR 4.47, 95% CI = 2.225\u20138.991), those who initiated smoking due to mental stress were more likely to have nicotine addiction (AOR 2.522, 95% CI = 1.004\u20136.028), and those who had no thought of quitting smoking were more associated with nicotine dependence (AOR 4.935, 95% CI = 1.458\u201316.699).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our study showed that high level of nicotine dependence is a major public health problem in low-and middle-income countries like Nepal. It also highlights that effective smoking cessation programs should be developed considering the level of nicotine dependence with more focus on early interventions of its associated factors.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0266661","type":"journal-article","created":{"date-parts":[[2022,4,8]],"date-time":"2022-04-08T13:24:00Z","timestamp":1649424240000},"page":"e0266661","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":6,"title":["Nicotine dependence and quitting stages of smokers in Nepal: A community based cross-sectional study"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7856-0564","authenticated-orcid":true,"given":"Janaki Kumari","family":"Timilsina","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bimala","family":"Bhatta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amrit","family":"Devkota","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,4,8]]},"reference":[{"issue":"3","key":"pone.0266661.ref001","doi-asserted-by":"crossref","first-page":"155","DOI":"10.4103\/0019-557X.89943","article-title":"Tobacco use: a major risk factor for non communicable diseases in South-East Asia region","volume":"55","author":"J Thakur","year":"2011","journal-title":"Indian journal of public health"},{"key":"pone.0266661.ref002","unstructured":"World Health Organization. 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Available from: https:\/\/www.mayoclinic.org\/diseases-conditions\/nicotine-dependence\/symptoms-causes\/syc-20351584."},{"issue":"4","key":"pone.0266661.ref005","doi-asserted-by":"crossref","first-page":"813","DOI":"10.4103\/jfmpc.jfmpc_42_17","article-title":"Nicotine dependence and its correlates among the adult tobacco users in a slum of Burdwan district, West Bengal, India","volume":"6","author":"I Saha","year":"2017","journal-title":"Journal of family medicine and primary care"},{"key":"pone.0266661.ref006","unstructured":"World Health Organization, Control RfIT. WHO report on the global tobacco epidemic, 2008: the MPOWER package: World Health Organization; 2008."},{"issue":"Suppl_3","key":"pone.0266661.ref007","doi-asserted-by":"crossref","first-page":"S447","DOI":"10.1080\/14622200701587078","article-title":"Tobacco control in developing countries: Tanzania, Nepal, China, and Thailand as examples","volume":"9","author":"S Sussman","year":"2007","journal-title":"Nicotine & Tobacco Research"},{"key":"pone.0266661.ref008","author":"SR Sharma","year":"2020","journal-title":"The role of tobacco and alcohol use in the interaction of social determinants of non-communicable diseases in Nepal: a systems perspective"},{"key":"pone.0266661.ref009","doi-asserted-by":"crossref","first-page":"254","DOI":"10.3389\/fpsyt.2017.00254","article-title":"Prevalence of cigarette smoking and nicotine dependence in men and women residing in two provinces in China","volume":"8","author":"Y Ma","year":"2017","journal-title":"Frontiers in psychiatry"},{"issue":"9","key":"pone.0266661.ref010","doi-asserted-by":"crossref","first-page":"1171","DOI":"10.1046\/j.1360-0443.2002.00198.x","article-title":"Assessing \u2018stage of change\u2019in current and former smokers","volume":"97","author":"JF Etter","year":"2002","journal-title":"Addiction"},{"key":"pone.0266661.ref011","first-page":"125","article-title":"The transtheoretical model and stages of change","author":"JO Prochaska","year":"2015","journal-title":"Health behavior: Theory, research, and practice"},{"issue":"1","key":"pone.0266661.ref012","doi-asserted-by":"crossref","first-page":"7","DOI":"10.4278\/0890-1171-17.1.7","article-title":"Applying the transtheoretical model to tobacco cessation and prevention: a review of literature","volume":"17","author":"L Spencer","year":"2002","journal-title":"American Journal of Health Promotion"},{"issue":"2","key":"pone.0266661.ref013","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1111\/j.1360-0443.2007.02068.x","article-title":"Associations between the transtheoretical processes of change, nicotine dependence and adolescent smokers\u2019 transition through the stages of change","volume":"103","author":"M Kleinjan","year":"2008","journal-title":"Addiction"},{"issue":"3","key":"pone.0266661.ref014","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1177\/0193945906295528","article-title":"Stages and processes of smoking cessation among adolescents","volume":"29","author":"OK Ham","year":"2007","journal-title":"Western Journal of Nursing Research"},{"issue":"8","key":"pone.0266661.ref015","doi-asserted-by":"crossref","first-page":"325","DOI":"10.47102\/annals-acadmedsg.V41N8p325","article-title":"Smoking and nicotine dependence in Singapore: findings from a cross-sectional epidemiological study","volume":"41","author":"L Picco","year":"2012","journal-title":"Annals of the Academy of Medicine, Singapore"},{"issue":"2","key":"pone.0266661.ref016","first-page":"115","article-title":"Fagerstrom test for nicotine dependence: reliability in a Turkish sample and factor analysis","volume":"52","author":"MA Uysal","year":"2004","journal-title":"Tuberk Toraks"},{"issue":"1","key":"pone.0266661.ref017","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/0306-4603(94)90049-3","article-title":"Reliability of the Fagerstrom tolerance questionnaire and the Fagerstrom test for nicotine dependence","volume":"19","author":"CS Pomerleau","year":"1994","journal-title":"Addictive behaviors"},{"issue":"6","key":"pone.0266661.ref018","doi-asserted-by":"crossref","first-page":"2663","DOI":"10.7314\/APJCP.2012.13.6.2663","article-title":"Assessment of nicotine dependence among smokers in a selected rural population in Kerala, India","volume":"13","author":"R Jayakrishnan","year":"2012","journal-title":"Asian Pacific Journal of Cancer Prevention"},{"key":"pone.0266661.ref019","article-title":"Cross-Sectional study to characterise nicotine dependence in central Vietnamese men","volume":"13","author":"G K\u00f5ks","year":"2019","journal-title":"Substance abuse: research and treatment"},{"issue":"1","key":"pone.0266661.ref020","doi-asserted-by":"crossref","first-page":"159","DOI":"10.3390\/brainsci3010159","article-title":"Neuroadaptive changes associated with smoking: structural and functional neural changes in nicotine dependence","volume":"3","author":"C. Martin-Soelch","year":"2013","journal-title":"Brain sciences"},{"issue":"1","key":"pone.0266661.ref021","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1186\/s12888-016-1123-z","article-title":"Cigarette smoking, nicotine dependence, and motivation to quit smoking in South African male psychiatric inpatients","volume":"16","author":"JL Du Plooy","year":"2016","journal-title":"BMC psychiatry"},{"issue":"1","key":"pone.0266661.ref022","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1186\/1471-2458-12-515","article-title":"Tobacco use and nicotine dependency in a cross-sectional representative sample of 18,018 individuals in Andaman and Nicobar Islands, India","volume":"12","author":"SP Manimunda","year":"2012","journal-title":"BMC Public Health"},{"key":"pone.0266661.ref023","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1186\/1471-2458-9-493","article-title":"Fagerstrom test for nicotine dependence vs heavy smoking index in a general population survey","volume":"9","author":"M Perez-Rios","year":"2009","journal-title":"BMC Public Health"},{"issue":"2","key":"pone.0266661.ref024","doi-asserted-by":"crossref","DOI":"10.2427\/13075","article-title":"Prevalence of nicotine dependence among university students in Jordan: a cross-sectional study","volume":"16","author":"MM Khatatbeh","year":"2019","journal-title":"Epidemiology, Biostatistics and Public Health"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0266661","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,19]],"date-time":"2023-11-19T15:34:36Z","timestamp":1700408076000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0266661"}},"subtitle":[],"editor":[{"given":"Abraham","family":"Salinas-Miranda","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2022,4,8]]},"references-count":24,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2022,4,8]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0266661","relation":{"has-review":[{"id-type":"doi","id":"10.3410\/f.742004630.793592971","asserted-by":"object"}]},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,4,8]]}}}