Longitudinal study of adolescent tobacco use and tobacco control policies in India

Abstract Background This project will use a multilevel longitudinal cohort study design to assess whether changes in Community Tobacco Environmental (CTE) factors, measured as community compliance with tobacco control policies and community density of tobacco vendors and tobacco advertisements, are associated with adolescent tobacco use in urban India. India’s tobacco control policies regulate secondhand smoke exposure, access to tobacco products and exposure to tobacco marketing. Research data about the association between community level compliance with tobacco control policies and youth tobacco use are largely unavailable, and are needed to inform policy enforcement, implementation and development. Methods The geographic scope will include Mumbai and Kolkata, India. The study protocol calls for an annual comprehensive longitudinal population-based tobacco use risk and protective factors survey in a cohort of 1820 adolescents ages 12–14 years (and their parent) from baseline (Wave 1) to 36-month follow-up (Wave 4). Geographic Information Systems data collection will be used to map tobacco vendors, tobacco advertisements, availability of e-cigarettes, COTPA defined public places, and compliance with tobacco sale, point-of-sale and smoke-free laws. Finally, we will estimate the longitudinal associations between CTE factors and adolescent tobacco use, and assess whether the associations are moderated by family level factors, and mediated by individual level factors. Discussion India experiences a high burden of disease and mortality from tobacco use. To address this burden, significant long-term prevention and control activities need to include the joint impact of policy, community and family factors on adolescent tobacco use onset. The findings from this study can be used to guide the development and implementation of future tobacco control policy designed to minimize adolescent tobacco use.https://deepblue.lib.umich.edu/bitstream/2027.42/144539/1/12889_2018_Article_5727.pd

Dual Impact of Comorbidities And Symptoms of Coronavirus on Mental Health During COVID-19 Pandemic Among Males And Females In India: Online cross sectional study

Background: The novel coronavirus disease 2019(COVID-19) has become a pandemic affecting health and wellbeing worldwide. In addition to the physical health, economic, and social implications, the psychological impacts of this pandemic are increasingly being reported in the scientific literature. Individuals with certain pre-existing comorbidities have been identified as a high-risk group for fatalities of COVID-19 infection. Thus, this study aimed to analyze the association of COVID-19 symptoms and the presence of comorbidities with the mental health of the population during this pandemic. Method: A cross-sectional web-based online study was conducted from 13thJune to 31stJuly 2020 and link was circulated using social media platforms. Participants were of age ≥18 and residents of India were included. HERO’s scale was used to assess the mental health status. A multivariate logistic regression was performed to examine associations. Results: Out of 1021 eligible individuals (460-females, 561-males), 15.2% females and 11.2% males reported poor mental health status. The COVID-19 symptoms such as nausea, vomiting, cough, shortness of breath, runny nose, fever, and sore throat were associated with poor mental health among males, while only nausea, vomiting was associated among females. Also, the presence of any one or more comorbidities was associated with poor mental health across gender. Conclusion: Poor mental health was reported by both genders across the study population. Comorbidities and COVID-19 symptoms were significantly associated with poor mental health among males than females. These findings strongly support the need for an infrastructure to comprehend the gender-specific mental well-being as a core component of health across all the sections of Indian society.

Factors associated with intention to quit among tobacco users in India: findings from TCP India survey - Wave 1 and Wave 2

Background In India, it is important to understand the factors that promote intention to quit as quitting is rather uncommon. Data from International Tobacco Control Policy (TCP) Project conducted in four states (Maharashtra, Bihar, Madhya Pradesh and West Bengal) were used to investigate the factors associated with intention to quit tobacco. Methods Data from Wave 1 (Aug 2010-Dec 2011) comprising 8,051 tobacco users and Wave 2 (Aug 2012-Dec 2013) comprising 7,401 users were analysed. Respondents reporting planning to quit using tobacco in the next month, in the next six months, or sometime in the future, were categorized as having an intention to quit. Bivariate analysis and multivariable logistic regression was used to study the relationship between intention to quit and factors associated with intention to quit among tobacco users. All analyses were performed using SPSS V.20.0. Results Intention to quit decreased from 19.6% in Wave 1 to 13.5% in Wave 2. In both waves, education, advice from doctors to quit and exposure to warning messages on tobacco packages were associated with intention to quit tobacco. Exposure to anti-tobacco messages on public transportation vehicles (OR=2.13, CI=1.49-3.08), in restaurants (OR=1.63, CI=1.11-2.40), in bars (OR=1.81, CI=1.07-3.06) and at workplaces (OR=1.73, CI=1.23-2.44) were associated with intention to quit in Wave 1. However, these relationships were not significant in Wave 2. Conclusions Perceptions of individuals leading to intention to quit are rapidly changing over the years. Future tobacco control efforts could emphasize on making warnings more effective that depict the harm of tobacco, taking into consideration, education of individuals. Also, involving doctors to advise patients to quit might increase motivation to quit tobacco use

Awareness of tobacco advertising, promotion and sponsorship in four states: findings from TCP India survey - Wave 1 and Wave 2

Background India's Cigarette and Other Tobacco Products Act (COTPA) of 2003 prescribes a complete ban on all forms of tobacco advertisements, promotions and sponsorships (TAPS) of events by tobacco companies across India. We examined the level of variation and predictors of awareness of TAPS in four Indian states. Methods We used data from the International Tobacco Control Policy (TCP) Survey India from Wave1 (Aug 2010- Dec 2011) and Wave2 (Aug 2012-Dec 2013) consisting of 10,585 and 10,501 respondents, respectively, surveyed from Madhya Pradesh (MP), Bihar (BR), Maharashtra (MH) and West Bengal (WB). Bivariate analysis and multivariable logistic regression was used to investigate associations between sociodemographic factors, states and TAPS awareness. All analyses were performed using SPSS V. 20.0 Results Noticing tobacco advertisements was highest in MH (78.5%) and lowest in WB (50.1%) in Wave 1, while in Wave 2, it was highest in MP (83.5%) and lowest in WB (32.6%). Noticing tobacco promotions and sponsorships was highest in MP (promotions: 35.7%, sponsorships: 14.4%) in Wave 1, while in Wave 2, it was highest in WB (promotions:15.0%, sponsorships:10.8%). Across waves, education was a predictor of noticing tobacco advertisements, promotions and sponsorships. In Wave 1, but not Wave 2, noticing tobacco advertisements (OR:2.11) and promotions (OR:2.02) was highest among the youngest age group (15-17yrs) compared to corresponding oldest age group (55yrs+). Noticing advertisements and sponsorships remained consistent in urban areas across both waves. In Wave 1 tobacco promotions were observed twice as frequently among rural population as compared urban population but the association was reversed in Wave 2. Conclusions Awareness of tobacco marketing varied across the four states of India to observe a greater impact of the tobacco control legislation. This study suggests that even though policies are the same in all states, a coordinated effort is required to implement the law on TAPS ban consistently

Evaluation of the effectiveness of the Indian government's policies to strengthen health warning labels on smokeless tobacco products: findings from the 2010-2019 Tobacco Control Project India Surveys.

Peer reviewed: TrueFunder: Healis Sekhsaria Institute for Public HealthBACKGROUND: Smokeless tobacco (SLT) packaging in India had a single symbolic (a scorpion) health warning label (HWL) in 2009 covering 40% of the front surface. In 2011, it was replaced with four pictorial images. In 2016, HWLs were enlarged to 85% on the front and back. This study aimed to assess the effectiveness of the old (symbolic and smaller images) and larger HWLs. METHODS: Data were from the Tobacco Control Project India Survey and included respondents who used SLT in Wave 1 (2010-2011, n=5911), Wave 2 (2012-2013, n=5613) and Wave 3 (2018-2019, n=5636). Using a repeated-measures design, weighted logistic regression models assessed whether there were changes in seven HWL effectiveness measures within the domains of awareness, salience, cognitive and behavioural responses. A cohort design was employed to test whether HWL effectiveness in Waves 1 and 2 was associated with quitting SLT in Waves 2 and 3, respectively. RESULTS: The 2011 HWL revision did not result in any significant changes in HWL effectiveness. There was no significant change in HWL awareness and salience after larger HWLs were introduced in 2016, but respondents were more likely to consider SLT health risks (Wave 2=17.9%, Wave 3=33.6%, p<0.001) and quitting SLT (Wave 2=18.9%, Wave 3=36.5, p<0.001). There was no change in HWLs stopping SLT use (Wave 2=36.6%, Wave 3=35.2%, p=0.829); however, respondents were more likely to avoid looking at HWLs (Wave 2=10.1%, Wave 3=40.2%, p<0.001). Effectiveness of older, symbolic and smaller pictorial HWLs was not associated with quitting SLT. DISCUSSION: There was no significant change in HWL effectiveness following the revision from a symbolic to a pictorial image, but enlarging pictorial images resulted in some improved cognitive and behavioural effects. Results suggested wear-out of HWL salience and that the effectiveness of warnings depends on both their design and time since implementation

Additional file 1 of Evaluation of tumor-infiltrating lymphocytes (TILs) in molecular subtypes of an Indian cohort of breast cancer patients

Additional file 1