Tobacco Promotion and Availability in School Neighborhoods in India: a Cross-sectional Study of their Impact on Adolescent Tobacco Use

Background: Adolescent tobacco use is a major public health problem. However, there is little informationabout the impact of tobacco advertising and availability near schools on adolescent tobacco use in India.
Methods: The various tobacco products and brands available in outlets within 100 meters of two high schoolsin an Indian town were identified. A stratified random sample of 172 participants from these two schoolscompleted a questionnaire on tobacco use and socioeconomic status.
Results: Eighteen outlets selling tobaccoproducts were identified. In the two schools the current use of smoked and smokeless tobacco was 9.1% and17.4% respectively. School location and low socio-economic status of adolescents were associated with tobaccoawareness of advertisements (p=0.001) and the receipt of a free sample (p= 0.032). Advertisements on billboards,posters and the receipt of a free tobacco sample were significant factors (p=0.031, p=0.016, p=0.017 respectively)in current tobacco use.
Conclusion: In this study a significant proportion of adolescents used tobacco. Tobacco–promotion activities (advertising, the receipt of a free sample), school location and economic status were foundto be associated with adolescent tobacco initiation. The local environment should be included in the preventionof adolescent tobacco initiation.