Influence of tobacco industry advertisements and promotions on tobacco use in India: Findings from the Global Adult Tobacco Survey 2009-2010.

INTRODUCTION: The developing world, including countries like India, has become a major target for the tobacco industry to market its products. This study examines the influence of the marketing (advertising and promotion) of tobacco products on the use of tobacco by adults (ages 15 and over) in India. METHOD: Data from Global Adult Tobacco Survey 2009–2010 was analyzed using methods for complex (clustered) sample designs. Multivariate logistic regression was employed to predict the use of different tobacco products by level of exposure to tobacco marketing using adults who have never used tobacco as the reference category. Odds ratios (ORs) were adjusted for education, gender, age, state of residence, wealth index, and place of residence (urban/rural). RESULTS: Adults in India were almost twice as likely to be current smokers (versus never users) when they were exposed to a moderate level of bidi or cigarette marketing. For bidis, among adults with high exposure, the OR for current use was 4.57 (95% confidence interval [CI]: 1.6, 13.0). Adults were more likely to be current users of smokeless tobacco (SLT) with even a low level of exposure to SLT marketing (OR = 1.24 [95% CI: 1.1, 1.4]). For SLT, the ORs showed an increasing trend (P for trend < 0.001) with greater level of exposure (moderate, OR = 1.55 [95% CI: 1.1, 2.2]; high, OR = 2.05 [95% CI: 0.8, 5.1]). The risk of any current tobacco use rose with increasing level of exposure to any marketing (minimum, OR = 1.25 [1.1–1.4]; moderate, OR = 1.38 [1.1–1.8]; and high, OR = 2.73 [1.8–4.2]), with the trend highly significant (P < 0.001). CONCLUSION: Exposure to the marketing of tobacco products, which may take the form of advertising at the point of sale, sales or a discounted price, free coupons, free samples, surrogate advertisements, or any of several other modalities, increased prevalence of tobacco use among adults. An increasing level of exposure to direct and indirect advertisement and promotion is associated with an increased likelihood of tobacco use.

Tobacco Use Among Drug Dependent Patients in Treatment Setting.

Tobacco use is widely prevalent in substance using patients in treatment settings. Nearly three times as many individuals with alcohol and drug problems smoke cigarettes compared to the general population. In addition to addressing the primary drug of abuse, it is important to systematically assess characteristics and patterns of tobacco use and treat tobacco dependence in these patients as they are at high risk of mortality from tobacco related illnesses..Consecutive patients presenting to the Tobacco Cessation Clinic of a national level deaddiction centre were assessed in detail using a semi-structured proforma. Most were males(97.3%) and majority (61.8%) of patients belonged to the 21-40 yrs age group. Most were self employed and primary drug of abuse was heroin in 47 (42.3%) and alcohol in 44 (39.6%) subjects. 53 (47.7%)used smoking tobacco only, 16 (14.7%) used only smokeless tobacco and 40 (36%) used a combination of both. Majority of smokable tobacco use was in the form of bidi (69.4%). Majority of the subjects (56.7%) were in the contemplation stage of change whereas 36 (32.7%) of subjects had taken steps towards quitting the use of tobacco products and qualified for the action stage as per RTCQ. The majority of patients qualified for moderate [56 (50.9%) dependence] to high dependence [37 (33.3%)] as per FTND score. This has obvious treatment implications.