|Year : 2010 | Volume
| Issue : 5 | Page : 53-58
Reach of mass media among tobacco users in India: A preliminary report
T Rooban1, PD Madan Kumar2, K Ranganathan1
1 Department of Oral & Maxillofacial Pathology, Ragas Dental College and Hospital, Uthandi, Chennai, India
2 Department of Public Health Dentistry, Ragas Dental College and Hospital, Uthandi, Chennai, India
|Date of Web Publication||9-Jul-2010|
Department of Oral & Maxillofacial Pathology, Ragas Dental College and Hospital, Uthandi, Chennai
Source of Support: None, Conflict of Interest: None
Background : Tobacco use is a health hazard and its use is attributed to a lack of knowledge regarding the ill effects of tobacco. Aim and Objective : To identify the exposure of different mass media among a representative cohort population in the Indian subcontinent and compare the reach of the different mass media among tobacco users and nonusers using the "reach of HIV information" as a model. Design : Secondary Data Analysis of Indian National Family Health Survey-3. Predictor Variables : Any tobacco use, gender, source of HIV information. Outcome Variables : Use of mass media. Results : Of the study group, 27% of males and 54.4% of females never read newspaper or magazine; 29.3% of males and 52.6% of females never heard radio; 12.4% of males and 25% of females never see television; and 79.3% of males and 93.46% of females did not see a movie at least once a month. The most common source of information of HIV was television among males (71.8%) and females (81%), whereas the least common source was leaders among males (0.8%) and females (0.2%). Discussion : Television is the single largest media used by both genders and was a major source of HIV information dissemination. A well-designed tobacco control program similar to HIV awareness program will help to curb tobacco use. Conclusion : The reach of different media among Indian tobacco users is presented and HIV model of information dissemination may prove to be effective in tobacco control.
Keywords: HIV awareness, mass media, television, tobacco users
|How to cite this article:|
Rooban T, Madan Kumar P D, Ranganathan K. Reach of mass media among tobacco users in India: A preliminary report. Indian J Cancer 2010;47, Suppl S1:53-8
Publication of the supplement was supported by the funds from the 14th World Conference on Tobacco or Health, March 8-12, 2009, Mumbai. The Guest Editors, Editors, Authors and others involved with the journal did not get any financial or non-financial benefit from the sponsors.
| » Introduction|| |
India has been the second largest producer and third largest consumer of tobacco worldwide.  Of the 1.1 billion tobacco smokers worldwide in 2003, 182 million (16.6%) lived in India accounting for the consumption of 102 billion cigarettes per year.  It had been estimated that 47-65% of Indian men and 14-33% of Indian women consumed some form of tobacco and among them 35% of men and 3% of women smoked tobacco. The World Health Organization estimated that tobacco use may account for more than 1.5 million deaths in India by 2020. ,
Mass media, particularly television, influences the perceptions of youth toward the real world, social behavior, and helps to mould cultural norms and convey important and believable messages about the behaviors it depicts. 
Varying reports of the effectiveness of mass media campaigns in influencing smoking behavior in young people is found in the literature. , However, these reviews have also reported inconclusive findings about the reach of mass media. There have been other reviews of the literature that had concentrated exclusively on the mass media, but smoking cessation in adult smokers had been the focus.  These reviews of smoking cessation had concluded that mass media campaigns can reduce smoking rates, particularly campaigns that were intense, in terms of reach, frequency, and duration of tobacco use. 
Mass media had been successfully used in India to create an awareness regarding AIDS/HIV among the general population. It had been documented that 97.7% of Indian men and 94% of Indian women have heard about HIV/AIDS; 81.8% of men and 42.1% of women knew that consistent use of condom can reduce the chances of acquiring HIV.  Such high level of awareness could be due to the reach of the mass media and other sources of information.
Despite increasing tobacco use among Indian men, women, and children, there are few studies assessing the reach of mass media among the Indian population who use them. An understanding of the current use of mass media among users of tobacco products is necessary to design and implement effective tobacco legislation or to design successful intervention programs to combat increasing tobacco use. The aim of this study is to identify the use of different mass media among a representative cohort population in the Indian subcontinent and compare the reach of the different mass media among tobacco users and nonusers, using the reach of HIV information as a model.
| » Materials and Methods|| |
A secondary data analysis of the National Family Health Survey-3 (NFHS-3) of India conducted during 2005-2006 was performed. This study was conducted by a door-to-door survey questionnaire answer for men and women fielded under NFHS-3, a nationally representative, cross-sectional, household sample survey. A uniform sample design was adopted in all the states, which has been described earlier.  NFHS-3 had collected information from a nationally representative sample of 109,041 households consisting of 1,124,385 women aged 15-49 years and 74,369 men aged 15-54 years. The NFHS-3 sample covered 99% of the Indian population living in all of the 29 states. The data regarding the use of tobacco in any form were collected. The use of various mass media and the source of information on AIDS was also collected from the same survey. Use of each type of mass media-newspaper and magazines were classified as never, less than once a week, at least once a week, almost daily; radio as never, less than once a week, at least once a week, almost daily; television as never, less than once a week, at least once a week, almost daily; and visit to a cinema as at least once a month or not (Yes/No) were analyzed separately for tobacco use.
Source of information on HIV/AIDS were classified as follows: religious leaders, political leaders, spouses, adult education programs, exhibitions, community meetings, school teachers, work place, health worker, cinema, poster/hoardings, friends and relatives, newspaper and magazines, radio, television, and other sources. Multiple sources of information were also considered.
SPSS (SPSS Inc., Chicago, IL, USA) version 16.0 was used to carry out statistical analysis. Point estimates of tobacco users, among both genders were presented. Chi-square test was employed to find the association between the differences among each media. A P value of less than 0.001 was taken as significant difference.
| » Results|| |
The study included 74,369 males and 1,24,385 females aged 15-54 and 15-49 years, respectively. Among 1,98,369 people who answered for this question, 38,896 (19.58%) used one or another form of chewable tobacco; 5.13% used Pan masala, 5.52% used gutka, and 12.13% used other forms of chewing tobacco; and 13.4% of the participants used tobacco as cigarettes and beedis.
Of all the male participants, 57.6% used tobacco in any form; 25,587 (34.42%) used one or another chewing products; 8.1% used Pan masala, 11.8% used gutka, and 21.4% used other chewable tobacco products; and 24,875 (33.4%) smoked cigarettes or beedis. Of all the female participants, 13,309 (10.7%) used one or another chewing products; 3.3% used Pan masala, 1.8% used gutka, and 6.6% used other chewable tobacco products; and 1707 (1.4%) smoked cigarettes or beedis.
The use of tobacco among males and females were compared with levels of literacy, use of newspaper, radio, television, and cinemas as listed in [Table 1]. Of the study group, 17.6% of males and 35.3% of females could not read at all; 27% of males and 54.4% of females had never read a newspaper or magazine; 29.3% of males and 52.6% of females had never heard radio; 12.4% of males and 25% of females had never seen the television; and 79.3% of males and 93.46% of females did not see a movie even once a month.
Of the 74,369 males and 1,24,385 females, 74,273 (99.9%) males and 88,254 (71%) females were willing to share their source of information of AIDS. The most common source of information was television among males (71.8%) and females (81%), whereas the least common source was leaders among males (0.8%) and females (0.2%). [Figure 1] lists the various sources of information of AIDS/HIV and tobacco use among them. Television was the primary source of HIV information in 36% of males and 7% of females with tobacco use. On the contrary, 35.7% of males and 74% of females without tobacco habit had acquired information of HIV through television.
| » Discussion|| |
Effective advertising and promotion through various channels of media had created new categories of products whose use extended beyond the basic survival, which, in turn, have fueled the economic growth of media, including newspapers, magazines, radio, and television. With the bridging of many isolated societies via these media, a huge impact of the media is felt on the health scenario as well.
The mass media (television, radio, newspapers, billboards, and similar media) had increasingly been used as a way of delivering preventive health messages, including tobacco cessation. They have the potential to reach a large proportion of the population, particularly groups that may be difficult to access through more traditional approaches, and are a relatively inexpensive way of exposing the population to information regarding their health. They also have the potential to modify the knowledge or attitudes of a large section of the community simultaneously. They also have an added advantage of reinforcement by means of repetition.
It had been reported that the mass media is appropriate for delivering antitobacco messages to young people because they are exposed to and often greatly interested in the media. For example, young adults are estimated to spend almost twice as many hours watching television (22,000 h) as they spend in formal education (12,000 h). By the age of 18 years, a young person would have spent more time being entertained by the media than by any other activity except sleeping. 
The use of mass media for advocacy of tobacco control increased in developed countries in the 1990s, particularly in the United States, Canada, Australia, and the United Kingdom. The emergence of significant funding sources, particularly legal statements with tobacco companies and earmarked tobacco taxes, has allowed the implementation of sustained, mass media campaigns with sufficient audience reach to be effective. 
Media had been used to promote smoking cessation and smoke-free spaces, to raise awareness of health effects and unethical tobacco industry behavior, and to create support for various policy measures. Although these campaigns have occurred almost exclusively in developed countries, the lessons learned had been consistent enough to be potentially applicable globally. In India, although tobacco advertising was banned in 2004, cigarette companies are coming up with new ways to reach a relatively untapped young audience. Event sponsorship and lifestyle stores centered on tobacco products are slipping through the cracks of the law. 
Researchers have found the link between advertising and tobacco use among the Indian youth and described the situation to be alarming. The study, which included 11,642 sixth and eighth graders, found that 37% of the study participants had seen tobacco advertisements in more than 4 places, whereas 50% had seen tobacco advertisements in 1-4 places. Tobacco use increased with measures of receptivity, including having a favorite tobacco advertisement, believing misleading imagery created by tobacco advertisements, and being willing to use a tobacco promotional item (such as wearing a T-shirt that advertises tobacco).  The news comes on the heels of research reports, which predicts that in India, by the year 2010, one million deaths per year will be due to smoking. 
In the present study, a high percentage of tobacco users were found to be illiterate. This finding was similar to the study conducted by Gavarasana et al,  who found that among the illiterates, the smoking rate was high (56%) and 47.7% were ignorant of health hazards of smoking. The report further proceeds to recommend that research is necessary to design health education material for 413.5 million illiterates living in India (based on the 1991 Indian Census). A community health worker, trained in the use of mass media coupled with a person-to-person approach, may help the smoker to quit smoking. 
The reach of print media (newspaper and magazines) is limited as 27% males, and 54.4% females were not exposed to print media. It could be observed from [Table 1] that with more exposure to print media, there is a decrease in tobacco use; 69.1% of males and 16.5% of females who were not exposed to print media used tobacco in some form, whereas this drops to 44.5% males and 6.5% females in the group who were regularly exposed to print media. This difference was statistically significant in both genders (P = 0.000). On the contrary, frequency of exposure to radio (audio media) does not significantly alter the tobacco use among both genders. Regular television watching is observed to be associated with decrease in the use of tobacco. Of those who never watch television, 76.5% males and 17.5% females use tobacco, whereas only 46.7% males and 8.6% of the regular viewers use tobacco. This difference was statistically significant (P = 0.00). Data of a visit to a cinema hall indicate the poor reach of cinema for a large population, although the effect of stardom on tobacco use is an issue of contention by itself.
Understanding the role of mass communications in tobacco control and tobacco promotion requires a multilevel approach. At the individual level, one must examine how individual-level factors, such as knowledge, beliefs, and attitudes influence and are influenced by tobacco-related media messages and the channels in which the messages are telecast. At the organizational level, attention needs to be focused on the structure, practices, and tactics employed by various mass media organizations, attempts to influence the news and entertainment media, and the role of regulation and public policy in influencing tobacco communications. Finally, at the population level, it is important to consider the larger cultural environment that is shaped by the interplay of the tobacco industry, mass media, tobacco control researchers, advocates, and policymakers. 
A well-designed public education campaign that is integrated with community- and school-based program, strong enforcement efforts, and help for tobacco users who want to quit, can successfully counter market the tobacco industry. Such integrated programs have been demonstrated to lower smoking among young people by as much as 40%. A study conducted in 1997 found that, in terms of cost per years of life gained, education campaigns through the mass media were the most cost-effective methods to reduce tobacco use. A 2-year antismoking television and radio campaign conducted in Greece between 1978 and 1980 is credited with reducing tobacco sales and increasing the number of smokers attempting to stop smoking. In the years before the campaign, the annual tobacco sales had increased at approximately 6% per year. During the campaign, tobacco sales were flat, indicating cessation activities by 6%. 
In the present study, most of the tobacco users were found to watch television either once or more than once a week. The percentage accessing televisions were found to be more than those reading newspaper, listening to radio, or watching movies. This might re-establish the fact that television is a useful mass media tool and has a better reach among the Indian population who use tobacco products. Surrogate advertisements for tobacco-related products may be a potential harmful event under the given circumstances. 
Television has been widely used for disseminating health-related information and its success as an effective mass media has been proved in disseminating information regarding HIV and AIDS among the Indian population.  The latter is also substantiated by the findings of this study that most of the tobacco users had got information regarding AIDS from television, rather than radio, newspapers, or other sources. The effectiveness of HIV/AIDS awareness program when extrapolated for tobacco awareness program will be useful. The distribution of males in general population, categorized by the source of HIV information and tobacco use is comparable as seen in Graph 1. However, for females, the trend is different.
Gupta et al,  in their study on 36,471 tobacco chewers and smokers selected from rural population in 3 areas of India found that health education by personal advice and by the mass media encouraged them to give up their tobacco habits. A study has reflected that tobacco use among adolescents was influenced by television or movies (26.4%) and advertisement in the print/video media (8.3%) even in the period of prohibition. 
The growing socioeconomic disparity in tobacco use is another important aspect that needs to be considered along with implications for study of tobacco-related media communications. In general, tobacco users are more likely to be among the groups that are disproportionately deprived in social and economic areas.  At the same time, increasing globalization, proliferation of communication channels, and movement across cultural borders mean that society with weaker tobacco control efforts, usually rural, uneducated, and illiterate societies are most susceptible to the effects of tobacco. A more vigorous, systematic, and empirical research agenda can further enable the understanding of how mass media communications contribute to tobacco use. Research is needed to assess the effects and efficacy of corporate-image campaigns and tobacco company-sponsored smoking prevention campaigns on smoking-related attitudes and behaviors among adults in different socioeconomic subgroups.
| » Conclusion|| |
Within the constraints of secondary data analysis, it can be concluded that television is the most commonly used mass media among tobacco users in India. Furthermore, television is the most common source of information regarding AIDS among tobacco users. Hence, television could be used as a viable tool for disseminating information regarding the ill effects of the use of tobacco products. The model of HIV awareness campaign shall be extrapolated to tobacco cessation initiative. However, further longitudinal studies have to be done to assess the impact of such campaigns in television on the tobacco users, to help them stop the habit.
| » Acknowledgment|| |
We thank the Macro International, USA, for their kind permission to use the data of NFHS-3 specifically for this purpose. We would like to thank Dr. A. Kanagaraj, Chairman, Dr. S. Ramachandran, Principal, Dr. M. Shivakumar and Colleagues at the Department of Oral and Maxillofacial Pathology and Community and Preventive Dentistry at our institution for their support and encouragement.
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