To assess the influence of tobacco use by family members, peers and role models on tobacco use status of adolescents living in urban slums of Delhi, India: Results from a longitudinal study

Objective: To assess the longitudinal relationship between tobacco use by family members, peers and role models on tobacco use behavior of adolescents living in low socio-economic communities of Delhi, India. Methods: Project ACTIVITY (Advancing Cessation of Tobacco in Vulnerable Indian Tobacco Consuming Youth), a community-based cluster-randomized trial. Adolescents (n=1720) belonging to low socio-economic status from control communities of Project ACTIVITY, including resettlement colonies and adjacent Jhuggi-Jhopris (JJs), who were non-tobacco users at baseline and participated in all the three repeated surveys (2009, 2010, 2011). The main outcome measure in the study was current tobacco use at the endline. Tobacco use by family members, friends and role models was measured at baseline. Results: The influence of tobacco use by friends on the onset of youth tobacco use was significant (OR=2.68, 95% CI=1.27-5.64) and by brother was even stronger (OR=4.36, 95% CI=1.66-11.45). Both effects were consistent across gender, age group and were also stronger than the effects of tobacco use by father (OR=1.51, 95% CI=0.70-3.23). Conclusion: Thus, study highlights the need to engage siblings and peers in efforts to prevent tobacco use and promote tobacco cessation among adolescents in resourcepoor, slum communities in India