Anti-Tobacco Media Exposure and Cessation Behaviors Among Tobacco Users in South Asia: Evidence From a Multi-Country Analysis of GATS Data
Amna Rauf, Fatima Miraj, Nosayaba Osazuwa-PetersPURPOSE
Tobacco use is among the leading causes of preventable death and disability globally, with South Asia ranking first for oral cavity cancer burden since 1990, a burden that has grown by 13% and reached an age-standardized DALY rate of 197 per 100,000 in 2023. Anti-tobacco media and health warning labels represent key FCTC-mandated interventions for driving cessation, yet quit rates remain low and evidence on their effectiveness across both smokers and smokeless tobacco (SLT) users in South Asia is limited. This study examines the association between anti-tobacco media exposure and quit attempts and quit intentions among smokers and SLT users in Pakistan, India, Bangladesh, and Sri Lanka.
METHODS
Using data from the Global Adult Tobacco Survey (GATS) from Pakistan (2014), India (2016-2017), Bangladesh (2017), and Sri Lanka (2019), we included adult tobacco users who smoked or used SLT. Quit attempts and quit intentions in the past 12 months were the outcomes of interest. Survey-weighted multivariable logistic regression estimated the odds of each outcome associated with anti-tobacco media exposure, adjusting for age, sex, education, residence, employment, and country.
RESULTS
The pooled sample included 29,694 tobacco users (14,664 smokers; 20,139 SLT users). Among smokers, anti-cigarette media exposure was associated with 56% higher odds of quit attempts (aOR = 1.56, 95% CI: 1.27 to 1.92) and 27% higher odds of quit intentions (aOR = 1.27, 95% CI: 1.01 to 1.60). Among SLT users, anti-SLT media exposure was associated with 50% higher odds of quit attempts (aOR = 1.50, 95% CI: 1.29 to 1.73). Country-stratified analyses revealed meaningful heterogeneity: significant associations were observed in Pakistan for both tobacco types and outcomes, and in India for smokers only; no significant associations were found in Bangladesh or Sri Lanka.
CONCLUSION
Anti-tobacco media exposure is associated with quit attempts among smokers and SLT users across South Asia, though effects are concentrated in Pakistan and India. Cross-country variation underscores the need for context-specific tobacco control strategies and highlights opportunities to strengthen media-based interventions where impact remains limited.