ArticleBMC public health2020
The role of tobacco and alcohol use in the interaction of social determinants of non-communicable diseases in Nepal: a systems perspective.
Article in BMC public health, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 2 of them syntheses that pooled it.
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Who cites it
11 citing papers in PubMed, 2 syntheses or guidelines pooled it, 22 citations in OpenAlex.
- Systems thinking in public health interventions: a systematic review of barriers and facilitators.BMC health services research · 2026Pooled it
- Participatory systems mapping: a review of population health research practice.Health research policy and systems · 2026Pooled it
- Risk factors associated with non-communicable diseases among government employees in Nepal: insights from a cross-sectional study.Frontiers in public health · 2025Article
- The use of participatory systems mapping as a research method in the context of non-communicable diseases and risk factors: a scoping review.Health research policy and systems · 2023Article
- Adherence to '5-2-1-0' guidelines and multiple risky behaviours among adolescents in nine sub-Saharan African countries: evidence from Global School-based Student Health Survey 2012-2017.BMJ nutrition, prevention & health · 2023Article
- Dietary practices, physical activity and social determinants of non-communicable diseases in Nepal: A systemic analysis.PloS one · 2023Article
- How to do (or not to do)…using causal loop diagrams for health system research in low and middle-income settings.Health policy and planning · 2022Article
- Nicotine dependence and quitting stages of smokers in Nepal: A community based cross-sectional study.PloS one · 2022Article
- Prevalence of Tobacco Use in Young Adult Literate Girls of 18-25 Years in Meghalaya, India: A Cross-Sectional Study.Asian Pacific journal of cancer prevention : APJCP · 2021Article
- A Latent Class Analysis of Health Lifestyles in Relation to Suicidality among Adolescents in Mauritius.International journal of environmental research and public health · 2021Article
- A Systems Perspective of How Community-Engaged Public Health Addresses Social Determinants of Health: A Case Study of a Population-Based COVID-19 Testing Program.Journal of public health management and practice : JPHMPArticle
Corrections and comments
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Authors and funding
7 authors at 7 institutions in 4 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundTobacco and alcohol use are major behavioural risks in developing countries like Nepal, which are contributing to a rapid increase in non-communicable diseases (NCDs). This causal relationship is further complicated by the multi-level social determinants such as socio-political context, socio-economic factors and health systems. The systems approach has potential to facilitate understanding of such complex causal mechanisms. The objective of this paper is to describe the role of tobacco and alcohol use in the interaction of social determinants of NCDs in Nepal.
methodThe study adopted a qualitative study design guided by the Systemic Intervention methodology. The study involved key informant interviews (n = 63) and focus group discussions (n = 12) at different levels (national, district and/or community) and was informed by the adapted Social Determinants of Health Framework. The data analysis involved case study-based thematic analysis using framework approach and development of causal loop diagrams. The study also involved three sense-making sessions with key stakeholders.
resultsThree key themes and causal loop diagrams emerged from the data analysis. Widespread availability of tobacco and alcohol products contributed to the use and addiction of tobacco and alcohol. Low focus on primary prevention by health systems and political influence of tobacco and alcohol industries were the major contributors to the problem. Gender and socio-economic status of families/communities were identified as key social determinants of tobacco and alcohol use.
conclusionTobacco and alcohol use facilitated interaction of the social determinants of NCDs in the context of Nepal. Socio-economic status of families was both driver and outcome of tobacco and alcohol use. Health system actions to prevent NCDs were delayed mainly due to lack of system insights and commercial influence. A multi-sectoral response led by the health system is urgently needed.
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