A cross-sectional study on the role of film stars and peers in smoking initiation and tobacco use among male adolescents aged 13–15 years in Chennai city, Tamil Nadu, India

Anusha Raghavan; Nishanthi B Murali; Dian Farhana Binti Alba; Aparna Sukumaran; Madan Kumar Parangimalai Diwakar

doi:10.4103/SDJ.SDJ_110_21

ORIGINAL ARTICLE

Year : 2022 | Volume : 6 | Issue : 1 | Page : 48-52

A cross-sectional study on the role of film stars and peers in smoking initiation and tobacco use among male adolescents aged 13–15 years in Chennai city, Tamil Nadu, India

Anusha Raghavan, Nishanthi B Murali, Dian Farhana Binti Alba, Aparna Sukumaran, Madan Kumar Parangimalai Diwakar
Department of Public Health Dentistry, Ragas Dental College and Hospital, Chennai, Tamil Nadu, India

Date of Submission	13-Oct-2021
Date of Decision	20-Nov-2021
Date of Acceptance	18-Dec-2021
Date of Web Publication	21-Feb-2022

Correspondence Address:
Anusha Raghavan
Department of Public Health Dentistry, Ragas Dental College and Hospital, 2/102, East Coast Road, Uthandi, Chennai 600119, Tamil Nadu.
India

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/SDJ.SDJ_110_21

Abstract

Background: Exposure to tobacco at a young age leads to a subsequent smoking habit in large proportions of the population in adulthood. Social and mass media have both positive and negative effects on adolescents’ behavior and social skills and therefore play vital roles in driving this behavior. Objectives: The purpose of this study was to assess the influence of film stars on smoking initiation and tobacco use among male adolescents aged 13–15 years in Chennai city, Tamil Nadu, India. Methods: The study adopted a cross-sectional design. In total, 200 students from schools that serve low-income households participated in the study. All the students completed a 20-item questionnaire on the perceived severity of smoking, perceived barriers to quitting, and factors affecting quitting. Results: None of the participants had a history of smoking. One (0.5%) participant stated that he smoked daily. All the participants agreed that exposure to media images of smoking behavior among their favorite film stars would not encourage them to smoke. In terms of peer pressure, one (0.5%) participant stated that he would accept a cigarette if offered one by a friend. Only descriptive information of the collected data was tabulated as the aim of the study was to collect the baseline data and not to test any prespecified hypothesis. Conclusion: In our study, peer pressure seemed to play more influence on the smoking initiation by adolescents than the film stars on mass media. Though all of them agreed that they would not be provoked by media images of film stars smoking, one participant was likely to initiate the habit on being offered by his friend. Hence, the evidence suggests the need for reorientation of research modalities to better identify early initiators of smoking.

Keywords: Adolescent, adolescent behavior, habits, mass media, smoking, tobacco

How to cite this article:
Raghavan A, Murali NB, Alba DF, Sukumaran A, Diwakar MK. A cross-sectional study on the role of film stars and peers in smoking initiation and tobacco use among male adolescents aged 13–15 years in Chennai city, Tamil Nadu, India. Sci Dent J 2022;6:48-52

How to cite this URL:
Raghavan A, Murali NB, Alba DF, Sukumaran A, Diwakar MK. A cross-sectional study on the role of film stars and peers in smoking initiation and tobacco use among male adolescents aged 13–15 years in Chennai city, Tamil Nadu, India. Sci Dent J [serial online] 2022 [cited 2023 Jun 5];6:48-52. Available from: https://www.scidentj.com/text.asp?2022/6/1/48/338003

Background

A review conducted by the World Health Organization (WHO) in 2011 stated that tobacco manufacturers are primarily targeting youth and adolescents, as they associate tobacco use with social and psychological needs, including peer approval, autonomy, masculinity, and the quest for adventure.^[1–3] The average age of tobacco initiation worldwide, including in India, is 13–15 years, with a prevalence of 5–25% of both smoking and smokeless tobacco users.^[4],[5]

As reported in previous research, in terms of developing norms in relation to concepts of adult identity, adolescents are influenced by their social environment, for example, the behavior of leaders, heroes, and film stars, as well as the media. Multiple factors may lead to early smoking initiation and tobacco use among adolescents.^[6],[7],[8] Insufficient data are available to determine the causes among the Indian population, especially in this specific age group of 13–15 years.^[5] Thus, this cross-sectional study aimed to determine the role of film stars and peers in smoking initiation and tobacco use among male adolescents aged 13–15 years in Chennai City, Tamil Nadu, India.

Materials and Methods

This cross-sectional study analyzed data from a cohort of male adolescents attending schools serving low-income households. The participants were asked about their perceptions of cigarette smoking and tobacco use and personal histories of cigarette smoking/tobacco use. The study was carried out in a 6-month period between September 2019 and March 2020. The study commenced after obtaining approval from the Institutional Review Board of Ragas Dental College (TN/RDC20190701) Permission from the heads of the schools and parents of the adolescents and verbal consent of the participants were obtained. All standards in conducting the study were carried in accordance with Helsinki’s declaration.

The choice of schools was based on the following criteria: (1) schools that included students in 9–10th grades (adolescents aged 13–15 years), (2) schools that served communities from low-income households, and (3) schools located in Chennai, Tamil Nadu. The survey was carried out in the following government schools: Uthandi, Panaiyur, and Kovalam, Tamil Nadu, India.

The internal consistency of the modified questionnaire was first assessed using test–re-test reliability among a pilot sample of 30 participants students from the study population (Cronbach’s alpha value was 0.8). The face and content validation of the questionnaire was checked by a team of four experts based on Lawshe’s criteria.^[8] The experts who followed the test had 95% agreement. The sample size was determined using the following parameters: alpha = 0.05, power = 80%, and an incidence of smoking initiation and tobacco use among male adolescents of one in five persons based on a global survey.^[4] The total sample size was estimated to be 173. All students who were present on the day of the survey and were willing and gave their consent to participate were included in the study. In total, 200 students participated in this study, of which 42 students were from Uthandi Government School, 20 students from Panaiyur Government School, and 138 students from Kovalam Government School.

All the participants completed a 20-item questionnaire, adopted from Tickle et al.^[9] The 20-item questionnaire was divided into eight sections, labeled A–H, as follows, with the numbers in parentheses denoting the number of questions in each section. Section A (3) was on demographic details, section B (2) focused on smoking behavior, and section C (3) addressed perceived susceptibility to smoking. Sections D (1), E (1), and F (1) focused on the perceived severity of smoking, perceived benefits of quitting smoking, and perceived barriers to quitting, respectively. Section G (4) focused on cues to action, and section H (5) addressed perceived self-efficacy. The questionnaire included the following free-response item: “Who is your favorite movie star?” This was followed by the question: “Do you think your favorite movie star smokes?” The answers to the free-response item were definitely not, probably not, probably yes, or definitely yes. Participants who did not name a favorite movie star were excluded from the analysis. The demography questions (1–3) and the response to the free-response item about the students’ favorite movie star were modified to take account of the local setting. Most of the responses were based on Likert scale. Demography-related questions and those related to benefits of quitting smoking were given multiple choices as responses from which the participants can choose. Each question and their response are given in [Table 1]. All questionnaires were completed and analyzed, including the free-response item.

Table 1: Distribution of participants according to their responses

Click here to view

Statistical analysis

The data were analyzed using SPSS (version 20) (IBM Corp., Armonk, NY, USA) software. Descriptive statistics are presented for all demographic study variables, and frequency distributions are presented.

Results

In the study group, 117 (58.5%) participants were aged 13–14 years, and the remaining 83 participants were aged 14–15 years. Most of the students’ parents were employed in non-governmental sectors (65%) or self-employed (33.5%). The incomes of 54% of the participants’ families were lower than Rs. 47,000 per year (629.13 USD). [Table 1] shows the distribution of the participants according to their responses to the questionnaire. Only one participant (0.5%) reported a daily smoking habit. All the students (100%) agreed that exposure to images of their favorite film stars smoking would not encourage them to smoke. In terms of peer pressure, one (0.5%) participant stated that he would accept a cigarette if offered one by a friend.

Discussion

Smoking/tobacco use among the youth is a health concern worldwide, as it makes a major contribution to the increasing burden of cancers, chronic diseases, and associated mortality.^[1] Previous studies reported that the influence of technology, mass media, family, and peers leads a large majority of the population to begin smoking at an early age, especially in India.^[2],[4] The results of the present study clearly show the absence of self-reported tobacco use, with none of the participants reporting a history of smoking and only one participant reporting a current smoking habit. With respect to the smoking behavior of their peers, the majority of the students (88.5%) reported that their peers did not use tobacco, although this could have been falsely reported. When asked about their self-smoking behavior, it is possible that the students modified their responses due to a desire for social acceptance or fear of condemnation. Although all the participants considered themselves not to be susceptible to smoking initiation, one student said “probably not” if he was asked to smoke by a friend. This shows the necessity to identify peer influence on tobacco initiation, especially among adolescents who are trying to prove their identity in the society. In the present study, more than 50% of the participants perceived that their favorite movie stars smoke, with 9 (4.5%) students responding “definitely yes” and 108 (54%) participants stating “probably yes.” The findings of the present study are in accordance with those of earlier research, which support the existence of a significant association between cognitive media effects and perceptions of descriptive and injunctive norms for tobacco use and smoking behavior. According to the previous research, this association contributes to the normalization of cigarette smoking and tobacco use, thereby encouraging these behaviors among adolescents.^[6],[9] Furthermore, as reported previously, male adolescents who associate smoking/tobacco use by characters in television shows with masculinity and a sense of pride are likely to adopt the behaviors shown by these characters.^{[9],[10],[11]}

In the present study, 154 (77%) of the students answered “agree” and 46 (23%) answered “strongly agree” to the question on perceived self-efficacy and self-control, even if their favorite film stars smoke. The preceding sentence infers that lack of self-control was not an issue and that media exposure (smoking behavior among films) would not influence the students in terms of smoking initiation or tobacco use. By using the same platform in a positive way, we can show warning signs about the harmful effects of tobacco, with cinema stars as ambassadors improving the capability and self-control of youngsters.^[6],[9],[10]

Other than cognitive media effects, other factors influence youngsters’ perceptions of tobacco use and smoking behavior, with parents and peers playing equally important roles in social learning.^[11–14]

In terms of the limitations of the present study, the external validity of our results is limited due to the small sample size and cross-sectional nature of the study. It is recommended in future to reorient studies to assess this change in behavior of adolescents to better understand the implication of early initiation of tobacco. It is possible that peer norms, parental restrictions, and self-perceptions on social platforms change over time. According to the recent surveys, nearly 72% of teenagers interact with their friends on a daily basis via social media.^[14–16] For the most part, smoking and tobacco use are behaviors that are learnt from the immediate social environment. Improving positive health behavior cues is important for reducing smoking initiation and tobacco use among adolescents. Encouraging adolescents to question the intentions and accuracy of media portrayals of tobacco use, irrespective of whether in advertisements or movies, as well as peer network attitudes toward smoking and tobacco use, can have a positive effect on their perceptions of tobacco use.^[17],[18]

Parallel with the goal of the WHO to create a smoke-free environment,^{[15],[16],[17]} the creation of a social platform, which is more credible than current platforms, where young people can discuss sensitive issues, such as addiction, could help to combat early initiation and result in a healthier future generation. As suggested in earlier studies, various activities, such as youth training programs focusing on creating a smoke-free environment, blogs where adolescents can share their personal stories, and community events, can serve as social platforms to engage adolescents in positive behaviors.^[19],[20]

Conclusion

Within the limited scope of this study, the role of film stars and peers is not the only factor that influences smoking/tobacco initiation among 13–15-year-old male adolescents. Adolescents today are exposed to wider social networks and have more friendship groups than ever before. Among adolescent age groups, peer pressure is invariably more important than parental or external influences. Even though only 1 among the 200 participants said he would smoke if he was asked by his friend, this could lead to a chain reaction wherein each person influencing his closest friend. Thus, it is imperative to establish effective methods to control the role of peers in smoking initiation among adolescents. This involves identifying the social environment of every susceptible adolescent to avert early initiation of tobacco use.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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