Introductions: The large prevalence of tobacco usage in Nepal is a significant public health concern. This cross-sectional survey investigates the differences in demographic and tobacco education levels between current daily, someday, and former smokers. Additionally, the study explores participants’ motivations for initiating tobacco use and their smoking behaviors.

Methods: Recruitment took place at multispecialty clinics at Tribhuvan University Teaching Hospital in Kathmandu, Nepal, in August 2023. 250 participants were surveyed. Eligible participants were current smokers or had used tobacco in the last 15 years. Bivariate associations between smoking status and participant characteristics were assessed using Chi-squared tests or Fisher’s exact test, as appropriate.

Results: Among participants, 34.4% of participants smoked daily, 20.8% of participants were someday smokers, and 44.8% were former smokers. Former smokers were older, with the highest proportion of participants (34.8%) aged 55-89. A significant proportion of former smokers reported higher rates of hypertension (22.3%) and kidney disease (13.4%). Educational attainment varied: daily smokers were most likely to have completed grade 12; someday smokers were more likely to have attended undergraduate school; former smokers had the highest proportion with no formal education. Overall, 59.6% of participants learned about tobacco through schooling. However, 57.2% reported never being informed by a physician about the dangers of tobacco usage. While 84.4% of participants believed smoking was very harmful to their health, 78% cited friends smoking as their primary motivation to start. Conversely, 66.8% delayed smoking initiation because their friends did not smoke, and 17.6% delayed due to social stigma.

Conclusions: More efforts are needed to raise awareness about the risks of tobacco in this patient population. Social influence plays a key role in both smoking initiation and delay, highlighting the need for targeted prevention and cessation programs addressing cultural and social dynamics in Nepal.