||5R01CA201415-04 Interpret this number
||University Of Michigan At Ann Arbor
||Longitudinal Study of Adolescent Tobacco Use and Tobacco Control Policy in India
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 advertisement, are associated with adolescent tobacco use
initiation in urban India. The project will also assess how family level factors moderate and individual level
factors mediate the associations between CTE factors and adolescent tobacco use. Annually, an estimated 1
million deaths in India are attributable to tobacco use making it a leading cause of premature mortality. India
became an early adopter of the WHO Framework Convention for Tobacco Control. A key set of India's tobacco
control policies pertain to Articles 8, 13 and 16 of the FCTC regarding secondhand smoke exposure, access to
tobacco products and tobacco promotion. India's policies include smoke-free laws; restrictions on tobacco
advertisements; bans on the sale of tobacco products to minors and within 100 yards of educational
institutions, recent bans on the sale of gutkha (a particularly dangerous smokeless tobacco product), and new
requirements for highly prominent warning labels on tobacco packaging. In addition, the recent emergence of
e-cigarettes in the Indian tobacco marketplace will require new policy responses. Research data about
community level compliance with tobacco control policies, access to and promotion of emerging products like
e-cigarettes, and their association with youth tobacco use, are largely unavailable, and are needed to inform
policy development. Therefore, we aim to: (1) Administer a comprehensive longitudinal population-based
tobacco use risk factors survey on a cohort of 2,040 12-13 year old adolescents (and their parent) for four
waves form baseline (Wave 1) to 36 months follow-up (Wave 4). (2) Concurrently, measure Community
Tobacco Environmental factors in the 68 communities from where the adolescent sample will be drawn. We
will use Geographic Information Systems data collection to map and audit tobacco vendors, COTPA defined
public places, tobacco advertisements, availability of e-cigarettes, and compliance with tobacco control and
smoke-free laws. (3) Estimate the longitudinal associations between CTE factors and adolescent tobacco use,
and assess whether the associations are moderated by family level factors (e.g., parent tobacco use,
household tobacco use policy, parenting factors, and household socioeconomic status), and meditated by
individual level factors (e.g., perceived ease of access to tobacco including access to gutkha and e-cigarettes,
perceived tobacco use norms, perceived tobacco use harms, exposure to tobacco ads, and exposure to
secondhand smoke).The geographic scope will include Mumbai and Kolkata, India, cities that span from the
West to the East coast of India, and represent large variations in adolescent tobacco use, socioeconomic
development, cultural factors and Community Tobacco Environmental factors.
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