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Kamath VG, Kulkarni MM, Kamath A, Lewis S, Bogdanovica I, Bains M, Cranwell J, Fogarty A, Arora M, Bahl D, Nazar GP, Naik AK, Ballal K, Bhagawath R, Britton J. Prospective study of exposure to smoking imagery in films and changes in susceptibility to smoking in a cohort of school students in Southern India. Tob Induc Dis 2024; 22:TID-22-88. [PMID: 38807710 PMCID: PMC11131361 DOI: 10.18332/tid/178442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 01/02/2024] [Accepted: 01/08/2024] [Indexed: 05/30/2024] Open
Abstract
INTRODUCTION India has unique tobacco-free film and TV rules designed to prevent tobacco uptake. In this study, we examined the potential influence of exposure to smoking imagery in regionally famous films, on susceptibility to smoke in teenagers enrolled in schools in a district in Southern India. METHODS A longitudinal survey of students, in grades 6 to 8 at baseline in 2017 and grades 7 to 9 one year later in 2018, ascertained prospective incident susceptibility to smoking during the study period in relation to baseline exposure to 27 locally popular films with actual or implied smoking imagery. RESULTS We analyzed linked data from 33676 participants, and 3973 (11.8%) of the adolescents reported incident susceptibility. There was a significant increase in susceptibility to smoking with increasing exposure at baseline to smoking imagery in films on univariable analysis, highest tertile of exposure relative to no exposure (OR=1.4; 95% CI: 1.0 -2.1, ptrend<0.001), and this trend remained significant (p=0.022) after mutual adjustment for recognized confounders, highest vs no exposure (AOR=1.3; 95% CI: 0.9-1.8). We found no statistically significant association between exposure to tobacco-free film rules and change in susceptibility. CONCLUSIONS Prospectively, watching films featuring smoking imagery increases adolescents' vulnerability to smoking. Further research revealed no difference in susceptibility change between youth who saw partially compliant films and those who watched non-compliant films. Our findings, thus, underscore the need to incorporate comprehensive approaches to prevent the inclusion of smoking imagery in films.
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Affiliation(s)
- Veena G. Kamath
- Department of Community Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Muralidhar M. Kulkarni
- Department of Community Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Asha Kamath
- Department of Data Science, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Sarah Lewis
- UK Centre for Tobacco and Alcohol Studies, University of Nottingham, Nottingham, United Kingdom
| | - Ilze Bogdanovica
- UK Centre for Tobacco and Alcohol Studies, University of Nottingham, Nottingham, United Kingdom
| | - Manpreet Bains
- UK Centre for Tobacco and Alcohol Studies, University of Nottingham, Nottingham, United Kingdom
| | - Jo Cranwell
- Department for Health, University of Bath, Bath, United Kingdom
| | - Andrew Fogarty
- UK Centre for Tobacco and Alcohol Studies, University of Nottingham, Nottingham, United Kingdom
| | - Monika Arora
- HRIDAY – Promoting Sustainable Health, New Delhi, India
- Health Promotion Division, Public Health Foundation of India, Gurugram, India
| | - Deepika Bahl
- Health Promotion Division, Public Health Foundation of India, Gurugram, India
| | - Gaurang P. Nazar
- HRIDAY – Promoting Sustainable Health, New Delhi, India
- Health Promotion Division, Public Health Foundation of India, Gurugram, India
| | - Ashwath K. Naik
- Department of Data Science, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Kirtinath Ballal
- Department of Community Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Rohith Bhagawath
- Department of Community Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - John Britton
- UK Centre for Tobacco and Alcohol Studies, University of Nottingham, Nottingham, United Kingdom
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Age of initiation of cigarette smoking and smokeless tobacco use among western Alaska Native people: Secondary analysis of the WATCH study. Addict Behav Rep 2019; 9:100143. [PMID: 31193747 PMCID: PMC6541901 DOI: 10.1016/j.abrep.2018.100143] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 10/29/2018] [Accepted: 11/08/2018] [Indexed: 12/28/2022] Open
Abstract
Objective This study examined self-reported age of tobacco initiation (cigarette smoking and smokeless tobacco [ST] use) and explored potential sex and generational group influences on tobacco use onset among Alaska Native (AN) adult ever tobacco users. Methods Secondary analysis of consolidated data from the Western Alaska Tribal Collaborative for Health (WATCH) study comprised 2800 AN adult ever tobacco users (1490 women, 1310 men; mean age = 39.2 years) from two rural western Alaska regions. ST use data were limited to one region. Logistic regression was used to examine potential sex and generational group (age 18–29, 30–49, ≥50) effects on initiation at ≤13 years of age. Results Thirty-seven percent of the sample reported using any tobacco product by age 13 years. Initiation of any ST use by age 13 was greater than for cigarette smoking (52.7% vs. 18.2%), and women were more likely than men to report initiation of any ST use at ≤13 years (52.6% vs. 38.4%). Nearly one-third of ever smokers (31%) initiated in young adulthood (ages 18–29). For ST use, logistic regression analyses revealed significant sex differences (women more likely to initiate by 13 years of age than men) and generational group effects with younger and middle age groups more likely to report initiation ≤13 years compared to the eldest participants. For smoking, no sex differences were observed but the youngest generational group was more likely to report initiation by age 13 compared to the eldest group. Conclusions Earlier age of tobacco initiation is found among younger generations of AN people. Findings highlight the need to focus prevention efforts on initiation of smoking in young adulthood and uptake of ST use among girls. Younger Alaska Native (AN) adults reported earlier tobacco initiation than older adults. Women reported earlier age of smokeless tobacco (ST) initiation than men. Almost one third of ever smokers (29%) had initiated in young adulthood (age 18–29). Prevention efforts are needed for ST use in AN girls and smoking in young adults.
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Patten C, Wang XQ, Ebbert JO, Little MA, Talcott GW, Hryshko-Mullen AS, Klesges RC. Influence of gender and peer tobacco use on tobacco use intentions after a period of involuntary tobacco abstinence among U.S. Air Force trainees. Prev Med Rep 2019; 13:270-276. [PMID: 30723662 PMCID: PMC6351393 DOI: 10.1016/j.pmedr.2019.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 01/09/2019] [Accepted: 01/14/2019] [Indexed: 11/21/2022] Open
Abstract
This study examined gender, prior tobacco use, and social-environmental factors as predictors of intentions to use tobacco (cigarette smoking and/or smokeless tobacco [ST]) after a forced period of abstinence among U.S. Air Force (USAF) trainees. Trainees completed 8½ weeks of basic military training (BMT), then 4 weeks of Technical Training; both required abstinence from tobacco. A cross-sectional survey of 13,514 USAF trainees (73% male, 90% age 18–24, 43% prior tobacco use) was conducted at the beginning of the 4-week Technical Training period. Overall, 17% of the sample reported future tobacco use intentions. Intentions for future tobacco use were less prevalent among non-tobacco users before BMT (1%) than those reporting any tobacco use (37%). From a multivariable logistic regression model predicting intentions to use any tobacco after Technical Training, significant two-way interaction effects were detected between gender, and tobacco use prior to BMT (p = 0.0001), and number of close friends who smoked cigarettes (p = 0.018), and number of close friends who used ST (p = 0.029). Among non-tobacco users before BMT, females were more than twice as likely as males to report tobacco intentions (Odds Ratio = 2.2, Bonferroni corrected 95% CI: 1.14.4, p = 0.011); no gender differences were detected among tobacco users. For females, but not males, having more friends who smoked was associated with greater likelihood of tobacco intentions (Bonferroni corrected p ≤ 0.05). In contrast, for males, but not females, having more friends using ST was associated with greater likelihood of tobacco intentions (Bonferroni corrected p < 0.05). In this sample of USAF trainees, the study provides novel findings on how males and females are influenced differently by their prior tobacco use and peers' tobacco use in predicting tobacco intentions. Prevention efforts focused on uptake and resumption of tobacco use, along with gender-specific strategies, may be warranted. Prior tobacco use predicts tobacco use intentions among U.S. Air Force trainees. Male and female trainees are influenced differently by their peers' tobacco use. Gender-specific strategies targeting social norms about tobacco may be warranted.
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Affiliation(s)
- Christi Patten
- Department of Psychiatry and Psychology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
- Corresponding author at: Mayo Clinic, BioBusiness 5, 200 1st Street SW, Rochester, MN 55905, USA.
| | - Xin-Qun Wang
- Department of Public Health Sciences, University of Virginia School of Medicine, P.O. Box 800717, Charlottesville, VA 22908, USA
| | - Jon O. Ebbert
- Department of Internal Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA
| | - Melissa A. Little
- Department of Public Health Sciences, University of Virginia School of Medicine, P.O. Box 800717, Charlottesville, VA 22908, USA
| | - Gerald W. Talcott
- Department of Public Health Sciences, University of Virginia School of Medicine, P.O. Box 800717, Charlottesville, VA 22908, USA
| | - Ann S. Hryshko-Mullen
- Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio-Lackland, TX 78236, USA
| | - Robert C. Klesges
- Department of Public Health Sciences, University of Virginia School of Medicine, P.O. Box 800717, Charlottesville, VA 22908, USA
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