Dataset Information

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

ABSTRACT:

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.

SUBMITTER: Kulkarni MM

PROVIDER: S-EPMC8341541 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BACKGROUND AND AIMS:Exposure to tobacco, alcohol and fast-food use in films is associated with initiation of these behaviours. India is the world's largest film producer, but the extent of such imagery in Bollywood (Hindi cinema) films is unclear. We therefore aimed to describe the extent of and trends in tobacco, alcohol and fast-food imagery in Bollywood films, between 1994-2013. METHODS:For the 15 top-grossing films each year between 1994-2013, the number of five-minute intervals containing product images were determined separately for tobacco, alcohol and fast-food. Both the proportion of films containing at least one image occurrence, and occurrences per film, were described overall and by year. Negative binomial regression described associations between film rating and occurrences/film, and estimated time-trends in occurrences/film, adjusted for rating. RESULTS:We analysed 93 U-rated (unrestricted), 150 U/A-rated (parental guidance for children aged <12 years) and 55 A-rated (restricted to adult audience) films, containing 9,226 five-minute intervals (mean intervals/film 30.8, SD 4.0). 70% (n = 210), 93% (n = 278) and 21% (n = 62) of films contained at least one tobacco, alcohol and fast-food occurrence, respectively. Corresponding total mean occurrences/film were 4.0 (SD 4.9), 7.0 (4.7) and 0.4 (0.9). Tobacco occurrences were more common in U/A films (incidence rate ratio 1.49, 95% confidence interval 1.06-2.09) and A films (2.95; 1.95-4.48) than U-rated films. Alcohol occurrences were also more common in A-rated films than U-rated films (1.48; 1.15-1.85). Tobacco occurrences/film became less common over the observed period (adjusted trend -4% per annum; -2 to -7%; p <0.001), while alcohol (+2%; 0-3%; p = 0.02), and fast food (+8%; 2-14%; p = 0.01) occurrences/film became more common. CONCLUSIONS:Although the extent of tobacco imagery in Bollywood films fell over 1994-2013, it is still frequently observed. Alcohol imagery is widespread, even in U-rated films, and trends in both alcohol and fast-food imagery are upwards.