Adolescent Tobacco Use and Role Model Influence: Interpreting it Right!

Sir,

We read with interest the original research article titled “Tobacco use among adolescent students and the influence of role models.”(1) We wish to add a few points that may affect the interpretation of study findings and have not been discussed by authors.

First, South Delhi is a relatively affluent part compared with the rest of Delhi. This may have contributed to the unusually higher prevalence of smoking seen in the female sample. It is well known that women who are more affluent, well educated, and live in urban areas are more likely to initiate smoking.(2)

Second, the study observed an association of tobacco use in adolescents with having seen the role models (elders, friends, sibling, and celebrity) smoking. However, it should not lead to an assumption that “role modeling” per se is the reason for smoking initiation. For example, a permissive family atmosphere, dysfunctional family, stressors, and shared personality traits may explain the smoking initiation in both the adolescent and the other “role model” family member. Similarly, one may choose one's friends based on common values and compatibility. The study has not addressed these issues in the discussion.

Third, we felt that the references to several important Indian studies were conspicuously missing. Particularly worthy of mention are a pioneering study of adolescent tobacco use in Delhi college population(3) and another study which was part of the Global Youth Tobacco Survey and in addition to prevalence, it also evaluated the influence of role model smoking.(4)

Not-so-long-ago, all of us have witnessed a nationwide controversy regarding the influence of celebrity role models on teenage smoking. Putting this issue into context, the answers to such controversies and debate lies in carefully conducted, large-sample studies exploring the various factors responsible for onset of smoking behavior.