Prospective cohort study of exposure to tobacco imagery in popular films and smoking uptake among children in southern India.
Prospective cohort study of exposure to tobacco imagery in popular films and smoking uptake among children in southern India.
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DOI：
10.1371/journal.pone.0253593
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发表时间：
2021
期刊：
影响因子：
3.7
通讯作者：
Britton J
中科院分区：
文献类型：
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作者：
Kulkarni MM;Kamath A;Kamath VG;Lewis S;Bogdanovica I;Bains M;Cranwell J;Fogarty A;Arora M;Nazar GP;Ballal K;Naik AK;Bhagawath R;Britton J
接触电影中的烟草图像会导致年轻人开始吸烟。受欢迎的印度电影含有大量的烟草图像，但法律要求那些含有烟草图像的电影在出现吸烟图像时显示有害健康的警告，并在电影之前和期间包括其他健康促进信息。我们报告了一项前瞻性队列研究，在印度南部的一组儿童中，吸烟事件与接触电影烟草图像和反烟草信息有关。我们在2018年对印度卡纳塔克邦乌杜皮区学校的39，282名6年级，7年级和8年级（年龄在10至15岁之间）的学生进行了为期一年的纵向随访问卷调查，他们参加了2017年关于电影中吸烟暴露和吸烟状况的横断面研究。我们在2018年从39，282名参与者中的33，725名（86%）中获得了2017年的数据。382名（1.1%）参与者报告了吸烟事件。在调整了年龄、性别和与吸烟事件显著相关的常见混杂因素后，无论是作为二元（比值比1.6，95%置信区间（CI）0.5至4.9）还是作为分级变量，暴露于胶片吸烟对吸烟摄取都没有显著的独立影响。一项探索性分析表明，完全符合印度法律的屏幕健康警告的存在与吸烟率显著降低相关（相对于没有合规警告的相同暴露，比值比为0.8（0.6至1.0，p = 0.031））。接触印度电影中的烟草图像与南印度儿童吸烟事件的风险显着增加无关。虽然这一发现可能是假阴性，但也有可能是由于屏幕上的健康警告或其他印度无烟电影规则的存在而减弱了电影曝光的影响。因此，我们的研究结果支持在其他国家更广泛地实施类似的无烟薄膜措施。
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. 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. 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. 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.