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Using a smokeless tobacco control mass media campaign and other synergistic elements to address social inequalities in India

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Abstract

The burden of tobacco-related morbidity and mortality in India is substantial, with smokeless tobacco being the predominant form of tobacco use. Use of smokeless tobacco (for example gutkha, paan, khaini, and pan masala) is linked to a host of socioeconomic and cultural factors including gender, regional differences, educational level, and income disparities. Given the scale of the problem, a national social marketing campaign was developed and implemented. The creative approach used testimonials from a surgeon and patients at Tata Memorial Hospital in Mumbai. The communication message approach was designed to reflect the realities of disfiguring, disabling, and fatal cancers caused by smokeless tobacco. Evaluation of the campaign identified significant differences across a range of campaign behavioral predictors by audience segments aware of the campaign versus those who were “campaign unaware”. Significant findings were also identified regarding vulnerable groups by gender (female/male) and rural/urban disparities. Findings are discussed in relation to the powerful impact of using graphic, emotive, and testimonial imagery for tobacco control with socially disadvantaged groups.

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Notes

  1. The PSA may be viewed at http://www.worldlungfoundation.org/ht/d/sp/i/7218/pid/7218

  2. We used the modern SES definition which uses education and occupation of the chief wage earner to classify households in urban areas. The chief wage earner is defined as the person who contributes the most to the total family income. On the basis of various combinations of these variables, the households are classified into different socioeconomic classes from A–E (in that order, from affluent to deprived). Households in rural areas are classified using the chief wage earner’s education and type of house (“pucca” houses are those built of concrete and steel; “kaccha” include thatched houses or huts; and, “semi pucca” are those that are a mix of concrete and thatching). Occupation as a variable is not used in rural areas because this can be similar in most households across most Indian villages. Rural SEC is categorized into four groups on the basis of the education and type of household, viz. R1, R2, R3 and R4. R1 denotes the upper-most rural SEC and R4 the lowest SEC.(The definition can be viewed at: http://www.mruc.net/images/stories/Glossary_KeyIRSDefinitions.pdf.) Socio-economic status was further categorized into “High” (A and R1), “Medium” (B, C and R2), and “Low” (D, E, R3 and R4).

  3. The website may be viewed at http://www.chewonthis.in/

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Acknowledgments

The authors gratefully acknowledge senior staff at the Ministry of Health and Family Welfare, Government of India (GOI), the management of TATA Memorial Hospital, India, and Dr Vinayak Prasad (formerly at GOI and currently with the World Health Organization), for their vision in supporting the Surgeon campaign; Bloomberg Philanthropies and the Bill and Melinda Gates Foundation, as part of the Bloomberg Initiative to Reduce Tobacco Use, for their generous support that enabled several aspects of the Surgeon campaign, including pretesting research, advertisement production, and the impact evaluation study; the dedicated researchers and field staff at ORG Centre for Social Research, most particularly Mr Prasad, for his guidance in the development of the rigorous methodology and analysis for this study; and, World Lung Foundation communications staff, particularly Alexey Kotov and Rebecca Perl, for their input and review through the campaign and publication process.

Conflicts of interest

The following are all the competing financial interests among authors of this paper. Ranjana Saradhi: ORG Center for Social Research (The Nielsen Company) received payment from the World Lung Foundation for conducting the impact evaluation study described in this paper. Dr Tahir Turk, World Lung Foundation, Dr Nandita Murukutla, World Lung Foundation, Shefali Gupta, formally World Lung Foundation, Sandra Mullin, World Lung Foundation, Dr Jagdish Kaur, Ministry of Health and Family Welfare, (GOI), Dr Pankaj Chaturvedi, Tata Memorial Hospital, declare they have no conflict of interest. The smokeless campaign was primarily funded by the Ministry of Health and Family Welfare, Government of India (GOI). The World Lung Foundation supported the campaign by providing campaign materials and by evaluating the campaign. The author declares there are no other conflicts of interest.

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Authors and Affiliations

  1. World Lung Foundation, 61 Broadway, Suite 2800, New York, NY, 10006, USA

    Tahir Turk, Nandita Murukutla, Shefali Gupta & Sandra Mullin

  2. National Tobacco Control Programme, Ministry of Health and Family Welfare, New Delhi, India

    Jagdish Kaur

  3. ORG Center for Social Research (The Nielsen Company), New Delhi, India

    Ranjana Saradhi

  4. Tata Memorial Hospital, Mumbai, India

    Pankaj Chaturvedi

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  1. Tahir Turk
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  2. Nandita Murukutla
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  3. Shefali Gupta
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  4. Jagdish Kaur
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  5. Sandra Mullin
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  6. Ranjana Saradhi
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  7. Pankaj Chaturvedi
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Correspondence to Tahir Turk.

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Turk, T., Murukutla, N., Gupta, S. et al. Using a smokeless tobacco control mass media campaign and other synergistic elements to address social inequalities in India. Cancer Causes Control 23 (Suppl 1), 81–90 (2012). https://doi.org/10.1007/s10552-012-9903-3

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