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News — As the westernization of India accelerates, tobacco advertising and marketing have been linked to increased tobacco use by urban Indian children as young as 11, according to a study by researchers at The University of Texas School of Public Health.

The study, "Associations Between Tobacco Marketing and Use Among Urban Youth In India," is published in the May/June issue of the American Journal of Health Behavior.

Findings from an earlier published study by the researchers revealed that in 2004, Indian sixth graders were using three times the amount of tobacco as eighth graders, which the authors found might indicate a new wave of increased tobacco use. The second study sought to discover the reason for the jump.

"As India becomes more westernized, more teens will use tobacco," said the study's principal investigator Cheryl Perry, Ph.D., professor and regional dean of The University of Texas School of Public Health Austin Regional Campus. "The sixth graders as a group are already thinking that smoking is cool while the eighth graders haven't been as exposed to the Western message."

After the major tobacco company settlements of 1998 that included more stringent laws banning pro-smoking advertising, smoking has dropped among American youth. According to The Monitoring the Future study, daily smoking among eighth graders dropped from 8.8 percent in 1998 to 3 percent in 2007.

"The current study is the first in India to demonstrate a strong, dose-response relationship between exposure and receptivity to tobacco advertising and promotions and tobacco use among Indian youth. These associations clearly suggest a need to strengthen policy and program-based interventions to reduce tobacco use among youth in India," said Melissa Stigler, Ph.D., assistant professor at the UT School of Public Health and study co-author, who did much of the ground work in India.

Chewing tobacco and aromatic cigarettes called "bidis" account for the majority of tobacco use in India with cigarettes taking 20 percent of the market. While tobacco advertising was banned in India in 2004, the year the study began, cigarette companies are coming up with new ways to reach a relatively untapped audience, Stigler said. Event sponsorship and lifestyle stores centered on tobacco products are slipping through the cracks of the law.

As part of the 2004 law, smoking is also banned in public areas such as indoor malls, but tobacco companies have responded with air-conditioned mobile smoking lounges.

"On a visit there shortly after the 2004 law was enacted, I witnessed a long line of college age students lined up for one of the mobile lounges, which was parked outside an upscale shopping mall." Stigler said.

The government is still working through the courts to determine the extent of the ban. For example, Stigler said, actors have started to stop smoking cigarettes in Bollywood movies but they now sing and dance about it instead. The researchers found the link between advertising and tobacco use among the Indian youth to be alarming.

"I was surprised that they were so strongly influenced," Perry said. "The more exposed the youth were to tobacco advertising, the more likely they were to have ever used or be currently using tobacco."

The study, which included 11,642 sixth and eighth graders, was produced in collaboration with Indian organizations Health Related Information Dissemination Amongst Youth in Delhi and Tamil Nadu Voluntary Health Association in Chennai.The researchers found that 37 percent of youth in the study had seen tobacco advertising in more than four places while 50 percent had seen advertising in one to four places.

Tobacco use rose 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 new research, published in the New England Journal of Medicine's Feb. 13 issue, which predicts that in India, by the year 2010, one million deaths per year will be the result of smoking.Funding for the UT School of Public Health study came from the Fogarty International Center of the National Institutes of Health.