Quantifying audio visual alcohol imagery in popular Indian films: A content analysis

Objectives Though exposure to alcohol imagery in films is a significant determinant of uptake and severity of alcohol consumption among young people, there is poor evidence regarding the content of alcohol imagery in films in low-income and middle-income countries. We have measured alcohol imagery content and branding in popular Indian films, in total and in relation to language and age rating. Design In this observational study we measured alcohol imagery semiquantitatively using 5-minute interval coding. We coded each interval according to whether it contained alcohol imagery or brand appearances. Setting India. Participants None. Content analysis of a total of 30 national box office hit films over a period of 3 years from 2015 to 2017. Primary and secondary outcome measures To assess alcohol imagery in Indian films and its distribution in relation to age and language rating has been determined. Results The 30 films included 22 (73%) Hindi films and 8 (27%) in regional languages. Seven (23%) were rated suitable for viewing by all ages (U), and 23 (77%) rated as suitable for viewing by children subject to parental guidance for those aged under 12 (UA). Any alcohol imagery was seen in 97% of the films, with 195 of a total of 923 5-minute intervals, and actual alcohol use in 25 (83%) films, in 90 (10%) intervals. The occurrence of these and other categories of alcohol imagery was similar in U-rated and UA-rated films, and in Hindi and local language films. Episodes of alcohol branding occurred in 10 intervals in five films. Conclusion Almost all films popular in India contain alcohol imagery, irrespective of age rating and language. Measures need to be undertaken to limit alcohol imagery in Indian films to protect the health of young people, and to monitor alcohol imagery in other social media platforms in future

Programme and policy perspectives towards a tobacco-free generation in India: findings from a qualitative study

Objective This study explored multistakeholder perspectives on existing adolescent-specific tobacco control policies and programmes, to advance India’s transition towards a tobacco-free generation.Design Qualitative semi-structured interviews.Setting Interviews were conducted with officials involved in tobacco control at the national (India), state (Karnataka), district (Udupi) and village level. Interviews were audio recorded, transcribed verbatim and analysed thematically.Participants Thirty-eight individuals representing national (n=9), state (n=9), district (n=14) and village (n=6) levels, participated.Results The study findings highlighted the need to strengthen and amend the existing Tobacco Control Law (2003) provisions, particularly in the vicinity of schools (Sections 6a and 6b). Increasing the minimum legal age to buy tobacco from 18 to 21 years, developing an ‘application’ for ‘compliance and monitoring indicators’ in Tobacco-Free Educational Institution guidelines were proposed. Policies to address smokeless tobacco use, stricter enforcement including regular monitoring of existing programmes, and robust evaluation of policies was underscored. Engaging adolescents to co-create interventions was advocated, along with integrating national tobacco control programmes into existing school and adolescent health programmes, using both an intersectoral and whole-societal approach to prevent tobacco use, were recommended. Finally, stakeholders mentioned that when drafting and implementing a comprehensive national tobacco control policy, there is a need to adopt a vision striving toward a tobacco-free generation.Conclusion Strengthening and developing tobacco control programmes and policies are warranted which are monitored and evaluated rigorously, and where adolescents should be involved, accordingly

Exposure to tobacco imagery in popular films and the risk of ever smoking among children in southern India

Background Exposure to smoking in films is a recognised cause of smoking uptake among children. In India, in an attempt to protect children, films containing smoking are required to include tobacco control messaging including audiovisual disclaimers, on-screen health warnings when tobacco imagery is displayed and antitobacco € health spots' before and during the film. We report a study of the association between ever smoking and exposure to tobacco imagery in locally popular films among children in Udupi district of Karnataka state in southern India. Methods A cross-sectional questionnaire survey of all students in grades 6-8 in schools in the Udupi district ascertained smoking status and potential confounders of smoking uptake, and whether children had seen any of 27 locally popular films we had coded and found to contain imagery of actual or implied tobacco use. Ever-smoking status was defined as any reported smoking of cigarettes, beedis or other tobacco products currently or at any time in the past. Independent effects on ever-smoking status were estimated using multiple logistic regression. Results Of 46 706 students enrolled in grades 6-8 in 914 participating schools, 39 282 (84.1%) provided questionnaire responses sufficiently complete for analysis. Ever smoking was reported by 914 (2.3%) participants and in a mutually adjusted model was significantly related to age, male sex, living in a home where smoking is allowed, having parents or siblings who smoke, low paternal education, low levels of family wealth, low self-esteem, rebelliousness and poor school performance. After allowing for these effects, the odds of ever smoking were not increased among students who had seen any of the listed films containing tobacco imagery when included in the analysis as a binary exposure (OR 0.9, 95% CI 0.4 to 2.0), and decreased in relation to level of exposure graded into tertiles of tobacco intervals seen. Conclusions In this cross-sectional study, children in southern India who had seen films containing tobacco imagery are no more likely to smoke than those who had not, indicating that the tobacco control messaging mandated by Indian law may be attenuating the effect of tobacco imagery in films on smoking uptake

Prospective cohort study of exposure to tobacco imagery in popular films and smoking uptake among children in southern India

Background Exposure to tobacco imagery in films causes young people to start smoking. Popular Indian films contain high levels of tobacco imagery, but those that do are required by law to display onscreen health warnings when smoking imagery occurs and to include other health promotion messaging before and during the film. We report a prospective cohort study of incident smoking in relation to exposure to film tobacco imagery and anti-tobacco messaging in a cohort of children in southern India. Methods We carried out a one-year longitudinal follow up questionnaire survey in 2018 of a cohort of 39,282 students in grades 6, 7 and 8 (aged between 10 and 15 years) in schools in the Udupi district of Karnataka State in India who participated in a 2017 cross-sectional study of exposure to smoking in films and ever smoking status. Results We obtained usable linked data in 2018 from 33,725 of the 39,282 (86%) participants with data from 2017. Incident smoking was reported by 382 (1.1%) participants. After adjusting for age, sex and common confounders significantly associated with incident smoking there was no significant independent effect of exposure to film smoking, either as a binary (Odds Ratio 1.6, 95% Confidence Interval (CI) 0.5 to 4.9) or as a graded variable, on smoking uptake. An exploratory analysis indicated that the presence of on-screen health warnings that complied fully with Indian law was associated with a significantly lower odds of smoking uptake (Odds Ratio 0.8 (0.6 to 1.0, p = 0.031) relative to the same exposure sustained in absence of compliant warnings. Conclusion Exposure to tobacco imagery in Indian films was not associated with a significantly increased risk of incident smoking in South Indian children. While it is possible that this finding is a false negative, it is also possible that the effect of film exposure has been attenuated by the presence of on-screen health warnings or other Indian tobacco-free film rules. Our findings therefore support the wider implementation of similar tobacco-free film measures in other countries

Potential risk factors of smokeless tobacco consumption among adolescents in South India

Introduction: Although most of the disease burden is due to tobacco smoking, smokeless tobacco (SLT) use contributed to an estimated 76,000 deaths in 2017. We have studied the potential risk factors for SLT use among adolescents in South India. Methods: A cross-sectional questionnaire survey of all students in grades 6 to 8 in schools in the Udupi district of Karnataka State ascertained SLT use status and potential determinants of SLT uptake. Ever SLT use was defined as any reported consumption of any SLT products, currently or at any time in the past. Independent effects on ever-SLT use status were estimated using multiple logistic regression. Results: Of 46,706 students from 914 participating schools, 39,282 (84.1%) provided questionnaire responses sufficiently complete for analysis. Ever SLT use was reported by 775 (2.0%) participants and in a mutually adjusted model was significantly related to age, male sex, family use or friend’s use of SLT, low socio-economic status, high rebelliousness and low self-esteem. After controlling for these effects, the odds of ever-SLT use were significantly higher among students who had least awareness of the harmful effects of tobacco use [OR 3.7 95% CI (2.9,4.7)] and significantly lower among those not exposed to tobacco advertising [OR 0.7 95% CI (0.5,0.8). Conclusions: The prevalence of SLT use among children in Karnataka is relatively low as compared to other studies in India. The significant potential risk factors of SLT use include low awareness of the harmful effects of tobacco and tobacco control policies and exposure to tobacco advertising

Quantifying audio visual alcohol imagery in popular Indian films: a content analysis

Objectives Though exposure to alcohol imagery in films is a significant determinant of uptake and severity of alcohol consumption among young people, there is poor evidence regarding the content of alcohol imagery in films in low-income and middle-income countries. We have measured alcohol imagery content and branding in popular Indian films, in total and in relation to language and age rating.Design In this observational study we measured alcohol imagery semiquantitatively using 5-minute interval coding. We coded each interval according to whether it contained alcohol imagery or brand appearances.Setting India.Participants None. Content analysis of a total of 30 national box office hit films over a period of 3 years from 2015 to 2017.Primary and secondary outcome measures To assess alcohol imagery in Indian films and its distribution in relation to age and language rating has been determined.Results The 30 films included 22 (73%) Hindi films and 8 (27%) in regional languages. Seven (23%) were rated suitable for viewing by all ages (U), and 23 (77%) rated as suitable for viewing by children subject to parental guidance for those aged under 12 (UA). Any alcohol imagery was seen in 97% of the films, with 195 of a total of 923 5-minute intervals, and actual alcohol use in 25 (83%) films, in 90 (10%) intervals. The occurrence of these and other categories of alcohol imagery was similar in U-rated and UA-rated films, and in Hindi and local language films. Episodes of alcohol branding occurred in 10 intervals in five films.Conclusion Almost all films popular in India contain alcohol imagery, irrespective of age rating and language. Measures need to be undertaken to limit alcohol imagery in Indian films to protect the health of young people, and to monitor alcohol imagery in other social media platforms in future

Ban on Sale of Loose Cigarettes: Awareness, Perceptions and Practices among Vendors and Smokers in Karnataka, India

Background: The Government of Karnataka banned loose cigarettes sale effect from September 2017 and is punishable under Cigarettes and Other Tobacco Products Act (COTPA) with fine and imprisonment in case of violation. Aim & Objective: Study aims to assess awareness, perceptions and practices about ban among tobacco vendors and smokers. Methods and Material: Cross sectional survey was carried using pre-tested questionnaire to collect information regarding awareness about ban among vendors and smokers. Data were analyzed using SPSS version 15.0. Results: Ninety-five percent of the tobacco vendors continued to sell loose cigarettes despite the ban. Among vendors, 49.7%, were aware of ban and of them 53.5% knew it is a punishable offense. Vendors opined that they would stop selling loose cigarettes if ban is strictly enforced with frequent checks on periodical basis. One-fourth smokers opined they will reduce cigarettes consumption with few making an attempt to quit. Conclusions: Awareness about ban on sale of loose cigarettes was unsatisfactory among vendors and smokers including lack of knowledge regarding legal actions in case of violation. However, vendors responded favorably towards obeying the law. Smokers are likely to reduce or even quit smoking if the law is strictly enforced which highlights the need for creating awareness drives and strong enforcement of the policy

Awareness and utilisation of quitline among current tobacco users in a district in southern india

Background: Tobacco use not only increases mortality, but also causes enormous burden to the Nation’s health and economy. The WHO -Framework Convention on Tobacco Control implemented “MPOWER”, comprising of an important entity of ‘offering help to tobacco users’ to quit. Quitline provides evidence-based treatment services to tobacco users and advertising those services has the potential to increase their utilisation. Objectives: Our objective was to assess the awareness and utilisation of the newly introduced quitline on tobacco packs among tobacco users. Materials and Methods: After obtaining Ethics Committee approval, this cross-sectional study was conducted from March-June 2019 in a purposive sample of tobacco users aged 18 years and above at the point of sale with prior informed consent. The questionnaire included questions on the users’ knowledge and utilisation of the quitline. Results: Most of the tobacco users (84.6 %) had not observed the quitline on tobacco pack. Amongst those who observed the quitline, 65.5% were smokers, while the smokeless tobacco users who comprised half of the study population were unaware of the quitline. More than 97% of illiterates were unaware of the quitline.  Only three tobacco users who were aware of quitline had tried using it. Conclusion: Most of the tobacco users had basic education but were not aware of the quitline on the tobacco packs and only a very few of them used the services, highlighting the need to increase its awareness for effective tobacco control

Prospective study of exposure to smoking imagery in films and changes in susceptibility to smoking in a cohort of school students in Southern India

Background: 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 teenagers enrolled in schools in a district in Southern India on susceptibility to smoke. Methods: A longitudinal survey of all 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 imageryResults: We analysed linked data from 33,676 participants, and 3,973 (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 (OR for highest tertile of exposure relative to no exposure = 1.4 (95% Confidence Interval 1.0 to 2.1, ptrend < 0.001), and this trend remained significant (p= 0.022) after mutual adjustment for recognised confounders (AOR for highest vs no exposure = 1.3 (95% CI 0.9 to 1.8)). We found no statistically significant association between exposure to tobacco-free film rules, and change in susceptibility. Conclusion: Prospectively, watching films featuring smoking imagery increases adolescents vulnerability to smoking. Further research revealed no difference in susceptibility change between kids who saw partially compliant films and who watched non-compliant films. Our findings, thus underscore the need to incorporate comprehensive approaches to prevent the inclusion of smoking imagery in films