Background:
Smoking habit is often picked up at early ages. Therefore, studying the pattern of smoking prevalence among the youth is critical for tobacco control. This paper explores how perception of smoking changes over time among the youth in Nepal. The paper also analyzes how youth’s perception of smoking and the surrounding environment influences youth’s initiation of smoking.

Methods:
The 2001, 2007 and 2011 Nepal Global Youth Tobacco Survey (GYTS) is used in this study. Logistic regression models are performed to examine various factors that affect initiation of cigarette smoking among the youth in Nepal.

Results:
The three Nepal GYTS surveys demonstrate increasing trends in percentages of youth who find boys and girls that smoke more attractive and have more friends. In the same group, belief that smoking helps people feel comfortable in social gatherings has also gone up. Although an increasing proportion of youth believes smoking is harmful for smokers’ health, a decreasing trend is observed regarding the harmful effects of second hand smoking. Results from logistic regression models reveal that any form of positive perception of smoking increases youth’s chance of smoking initiation.

Conclusions:
Findings of this paper demonstrate that over the years the perception of smoking has become more positive among the youth in Nepal. This is extremely alarming as positive perception of smoking leads to smoking initiation and eventually they become regular smokers at early ages. Awareness programs on harmful effects of smoking need to be designed to target the youth in order to educate them.