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The 2015 GSHS was a school-based survey of students in Class 7-11, which are typically attended by students aged 13-17. A two-stage cluster sample design was used to produce data representative of all students in Class 7-11 in. At the first stage, schools were selected with probability proportional to enrollment size. At the second stage, classes were randomly selected and all students in selected classes were eligible to participate. The GSHS measured alcohol use; dietary behaviors; drug use; hygiene; mental health; physical activity; protective factors; sexual behaviors; tobacco use; and violence and unintentional injury. Students self-reported their responses to each question on a computer scanable answer sheet. The school response rate was 92%, the student response rate was 75%, and the overall response rate was 69%. A total of 6,529 students participated in the GSHS. Prevalence estimates (percentages) and 95% confidence intervals are presented below. Alcohol Use Percentage of students who currently drank alcohol (at least one drink of alcohol on at least one day during the 30 days before the survey) 4.6 (3.2-6.4) 5.5 (4.0-7.4) (2.4-5.7) 7.1 (5.5-9.1) 9.9 (7.7-12.7) 3.3 (2.0-5.4) 5.2 (4.0-6.9) 6.7 (5.4-8.4) 3.6 (2.4-5.4) Percentage of students who ever drank so much alcohol that they were really drunk one or more times during their life 4.2 (2.7-6.6) 5.5 (3.9-7.7) 2.8 (1.3-5.7) 7.5 (5.2-10.7) 11.1 (7.6-15.9) 2.9 (1.5-5.4) 5.1 (3.5-7.2) 7.1 (5.4-9.2) 2.8 (1.4-5.4) Percentage of students who drank alcohol before age 14 years for the first time, among students who ever had a drink of alcohol other than a few sips 82.0 (76.0-86.7) 86.6 (79.6-91.5) 71.9 (59.4-81.8) 57.4 (48.6-65.7) 52.1 (41.7-62.3) 72.9 (68.0-77.4) 73.3 (67.6-78.2) 69.6 (59.6-78.1) Dietary Behaviors Percentage of students who were underweight (<-2SD from median for BMI by age and sex) 10.8 (8.3-14.0) 13.6 (10.4-17.7) 8.4 (6.3-11.1) 11.4 (8.1-15.9) 16.4 (11.4-22.9) 5.4 (3.5-8.2) 11.0 (8.7-13.8) 14.4 (11.3-18.2) 7.7 (6.0-9.9) Indicates data were not available. 1

Dietary Behaviors Percentage of students who were overweight (>+1SD from median for BMI by age and sex) 6.7 (4.3-10.2) 7.8 (4.8-12.4) 5.7 (3.5-9.1) 4.6 (2.8-7.6) 5.2 (3.1-8.8) 3.8 (2.2-6.7) 6.1 (4.1-9.0) 7.0 (4.6-10.7) 5.3 (3.5-7.9) Percentage of students who were obese (>+2SD from median for BMI by age and sex) 0.5 (0.3-0.9) 0.5 (0.2-1.1) 0.6 (0.3-1.0) 0.9 (0.4-2.4) 1.5 (0.6-3.8) 0.2 (0.0-1.1) 0.6 (0.4-1.1) 0.8 (0.4-1.5) 0.5 (0.3-0.8) Percentage of students who usually drank carbonated soft drinks one or more times per day during the 30 days before the survey 32.9 (28.9-37.1) 30.7 (24.8-37.4) 34.6 (30.6-38.7) 29.4 (24.7-34.5) 25.8 (21.3-30.8) 33.9 (27.4-41.1) 32.0 (28.4-35.8) 29.4 (24.8-34.4) 34.4 (30.3-38.8) Drug Use Percentage of students who ever used marijuana one or more times during their life 3.1 (2.1-4.6) 4.0 (2.5-6.2) 2.1 (1.1-4.0) 5.8 (3.9-8.5) 7.7 (5.3-11.2) 3.5 (1.5-8.1) 3.8 (2.6-5.5) (3.6-7.0) 2.5 (1.4-4.4) Percentage of students who used drugs before age 14 years for the first time, among students who ever used drugs 87.6 (83.1-91.1) 89.3 (81.2-94.2) 64.1 (54.1-73.0) 62.6 (50.3-73.5) 79.5 (74.8-83.6) 79.2 (71.4-85.3) 78.4 (67.0-86.6) Hygiene Percentage of students who usually cleaned or brushed their teeth one or more times per day during the 30 days before the survey 86.5 (83.2-89.3) 88.4 (8-91.2) 85.5 (80.6-89.4) 86.5 (81.4-90.4) 88.4 (83.4-92.1) 84.4 (76.8-89.8) 86.5 (83.2-89.3) 88.4 (85.4-90.9) 85.3 (80.6-89.0) Indicates data were not available. 2

Hygiene Percentage of students who never or rarely washed their hands after using the toilet or latrine during the 30 days before the survey 4.1 (3.2-5.4) (2.6-5.3) 4.2 (3.0-5.9) 4.6 (3.0-7.0) 3.5 (2.2-5.7) 5.5 (2.8-10.4) 4.3 (3.3-5.5) (2.7-) 4.5 (3.2-6.3) Mental Health Percentage of students who seriously considered attempting suicide during the 12 months before the survey 13.1 (10.8-15.9) 12.9 (9.8-16.8) 12.7 (10.4-15.5) 15.3 (11.5-20.1) 12.3 (8.3-17.7) 17.8 (13.2-23.5) 1 (11.2-16.6) 12.7 (9.8-16.3) 13.9 (11.4-16.9) Percentage of students who attempted suicide one or more times during the 12 months before the survey 10.1 (7.7-13.1) 9.4 (6.7-13.0) 10.4 (7.7-13.8) 9.8 (7.4-12.8) 7.4 (5.2-10.4) 11.7 (8.5-15.9) 10.0 (7.7-12.8) 8.9 (6.5-11.9) 10.7 (8.2-1) Percentage of students who did not have any close friends 4.5 (3.1-6.3) 3.6 (2.4-5.4) 5.1 (3.6-7.1) 4.4 (2.9-6.4) (2.5-5.5) 4.8 (2.9-7.8) 4.4 (3.2-6.1) (2.6-5.2) (3.6-6.9) Physical Activity Percentage of students were physically active at least 60 minutes per day on all 7 days during the 7 days before the survey 14.3 (10.9-18.6) 15.8 (11.6-21.1) 13.3 (9.4-18.3) 17.9 (14.3-22.3) 21.8 (16.9-27.7) 1 (9.9-18.8) 15.2 (12.1-19.0) 17.4 (13.4-22.3) 13.4 (9.9-17.8) Percentage of students who attended physical education classes on three or more days each week during this school year 42.4 (38.9-46.1) 43.1 (38.1-48.3) 42.4 (38.1-46.9) 47.1 (42.4-51.7) 51.4 (45.4-57.3) 42.9 (38.0-48.0) 43.6 (40.5-46.8) 45.4 (41.2-49.7) 42.5 (38.7-46.4) 3

Physical Activity Percentage of students who spent three or more hours per day sitting and watching television, playing computer games, or talking with friends, when not in school or doing homework during a typical or usual day 10.4 (8.2-13.1) 11.6 (9.1-14.7) 9.5 (7.2-12.6) 12.8 (10.0-16.3) 14.7 (10.9-19.5) 10.3 (6.7-15.5) 11.0 (8.8-1) 12.5 (10.0-15.4) 9.7 (7.3-12.9) Protective Factors Percentage of students who missed classes or school without permission on one or more days during the 30 days before the survey 26.1 (22.4-30.1) 25.5 (21.7-29.7) 26.3 (21.8-31.4) 31.8 (27.9-36.1) 29.0 (24.1-34.5) 35.5 (30.3-41.2) 27.5 (24.2-31.1) 26.5 (23.2-30.0) 28.4 (24.0-33.3) Percentage of students who reported that their parents or guardians most of the time or always understood their problems and worries during the 30 days before the survey 54.2 (49.6-58.8) 53.1 (47.8-58.5) 55.6 (50.7-60.4) 51.3 (45.9-56.6) 51.3 (46.5-56.1) 51.6 (43.0-60.2) 53.5 (48.8-58.1) 52.6 (48.0-57.2) 54.7 (49.1-60.2) Percentage of students who reported that their parents or guardians most of the time or always really knew what they were doing with their free time during the 30 days before the survey 51.3 (46.2-56.4) 46.8 (41.4-52.2) 55.9 (49.9-61.7) 48.7 (44.5-52.9) 50.3 (46.0-54.6) 48.4 (42.5-54.2) 50.7 (46.1-55.3) 47.7 (43.3-52.2) 54.2 (48.6-59.6) Sexual Behaviors Percentage of students who ever had sexual intercourse 18.7 (14.6-23.5) 20.3 (16.3-24.9) 16.7 (12.2-22.4) 22.8 (18.2-28.1) 26.2 (20.3-33.1) 18.0 (13.2-24.1) 19.7 (15.8-24.3) 21.9 (17.8-26.7) 17.0 (12.9-21.9) Percentage of students who had sexual intercourse before age 14 years for the first time, among students who ever had sexual intercourse 77.7 (68.8-84.6) 69.3 (61.9-75.9) 43.0 (28.7-58.5) 39.3 (26.9-53.4) 64.3 (52.7-74.4) 56.1 (46.3-65.4) 77.1 (59.2-88.7) Indicates data were not available. 4

Sexual Behaviors Percentage of students who used a condom during last sexual intercourse, among students who ever had sexual intercourse 49.2 (37.1-61.3) 58.2 (43.0-72.0) 69.0 (57.0-79.0) 70.3 (56.6-81.1) 56.4 (46.8-65.4) 63.0 (52.8-72.1) Tobacco Use Percentage of students who currently used any tobacco products (used any tobacco products on at least 1 day during the 30 days before the survey) 7.2 (5.4-9.4) 9.5 (7.1-12.6) 4.8 (3.4-6.7) 10.8 (8.4-13.8) 14.9 (11.4-19.1) 5.9 (3.4-10.2) 8.1 (6.4-10.2) 11.0 (8.7-13.8) (-6.9) Percentage of students who currently smoked cigarettes (smoked cigarettes on at least 1 day during the 30 days before the survey) (3.6-6.7) 6.8 (-9.2) 3.0 (1.8-4.9) 8.8 (6.9-11.3) 12.6 (9.6-16.4) 4.5 (2.7-7.3) 5.9 (4.6-7.7) 8.4 (6.4-11.0) 3.3 (2.2-5.1) Percentage of students who reported that people smoked in their presence on one or more days during the 7 days before the survey 54.1 (50.5-57.6) 57.9 (53.1-62.6) 50.7 (45.4-56.1) 57.4 (53.3-61.4) 59.7 (55.3-63.9) 54.8 (49.0-60.5) 54.9 (51.8-58.0) 58.4 (54.9-61.8) 51.7 (46.8-56.5) Violence and Unintentional Injury Percentage of students who were in a physical fight one or more times during the 12 months before the survey 39.9 (36.9-43.0) 45.2 (40.9-49.6) 35.1 (30.9-39.4) 39.6 (35.8-43.6) 42.8 (37.1-48.6) 35.8 (29.2-43.1) 39.9 (37.0-42.8) 44.6 (41.1-48.1) 35.2 (31.4-39.2) Percentage of students who were seriously injured one or more times during the 12 months before the survey 64.0 (59.1-68.5) 67.9 (63.0-72.5) 60.0 (53.0-66.6) 64.3 (58.6-69.6) 63.4 (57.2-69.3) 64.3 (57.5-70.5) 64.1 (59.3-68.5) 66.7 (62.5-70.6) 60.9 (54.4-67.1) Indicates data were not available. 5

Violence and Unintentional Injury Percentage of students who were bullied on one or more days during the 30 days before the survey 50.6 (46.5-54.6) 56.2 (50.6-61.7) 45.4 (41.4-49.4) 52.4 (48.2-56.7) 55.9 (51.2-60.5) 48.1 (42.0-54.3) 51.0 (47.4-54.6) 56.1 (51.5-60.6) 46.0 (42.5-49.5) For additional information, please contact: Dr Krishna Aryal, Research Officer Ministry of Health Complex, Kathmandu,, krish.aryal@gmail.com For general information about the GSHS, please visit: http://www.who.int/chp/gshs/en/ or http://www.cdc.gov/gshs 6