The association of tobacco use in adolescents with their interpersonal surroundings and assessing tobacco vendor compliance with COPTA policies: A cross-sectional study

Introduction: The prevalence of tobacco consumption is increasing globally and in South-east Asian countries. Despite the government's efforts in passing the laws for monitoring tobacco consumption, their effectiveness is questionable. The study's objectives are to investigate the association of tobacco use among the study participants as a function of community, interpersonal and individual factors.& nbsp;Methadology: A conceptual framework was drawn based on Bronfenbrenner's theory of the ecology of human development, the social learning theory, and the social control theory. An observational study was conducted in 13 government and 26 private pre-university colleges in the Shimoga district of Karnataka, India. The study was conducted in two stages. First at the student level and the second at the tobacco vendor level. Ethical approval from the institutional board and informed consent from the participants were obtained. A descriptive, comparative and multivariate analysis was performed.& nbsp;Results: Of the 726 participants, 19.6% had used tobacco at least once. The most common type being flavoured cigarettes (54.3%). The average compliance of permanent tobacco outlets was 6.1/10, while the mobile tobacco outlet scored 3.8/10. Active tobacco use was strongly associated with peer tobacco use (r =-0.439, p < 0.001), community compliance (r =-0.365, p = 0.004), family educating against tobacco use (r =-0.269, p < 0.038) and age of initiation of tobacco use (r =-0.327, p = 0.011).& nbsp;Conclusion: Our study shows us that the issue of adolescent tobacco use is multipronged. It centres on community, interpersonal and individual factors. We need a mixed-methods approach focusing on improving compliance with COPTA laws and effective anti-tobacco education in schools and immediate interpersonal surroundings.