Results from Momentary Prompts (MP)
A third of the participants (33.7 %, n = 69) reported tobacco use when they were promoted through the MP assessment, at least once during the study period. All of the participants who reported tobacco use smoked some form of tobacco and 38 (55.1 %) of them also reported using smokeless tobacco. Among the 69 people who used tobacco, 26 (37.7 %) only reported use at a single MP, 9 (13.1 %) at two prompts, and 34 (49.3 %) at three or more prompts. Similar frequencies appeared for the use of smokeless tobacco. Among those 38 dual users, 11 (28.9 %) of them reported tobacco use at a single MP, 5 (13.2 %) at two prompts and 22 (57.9 %) at 3 or more prompts. Only sex was associated with self-reported use of tobacco; 40.7 % of males compared to 20.0 % of females used tobacco at least once (Χ
2 (df = 1) = 8.9, p < 0.01). Tobacco use occurred most frequently when participants were at home or in a car (53.6 %, n = 37), less frequently when they were outside or in other places (47.8 %, n = 33) or public settings (44.9 %, n = 31), and least frequently when at work or at school (40.6 %, n = 28). In terms of companionship, tobacco use occurred most frequently when participants were with friends, coworkers and others (71.0 %, n = 49) and less frequently when alone (46.4 %, n = 32) and least frequently when with families (40.6 %, n = 28).
Through MP assessments, about half (48.8 %, n = 100) of the sample indicated that they had been in the presence of another tobacco user during the study period. Among those who reported others using tobacco, 34 (34.0 %) of them reported such presence once, and 66 (66.0 %) reported more than once. Presence of other tobacco users was most frequently seen outside or in other places (60.0 %, n = 60) and private places (59.0 %, n = 59), less frequently in public settings (31.0 %, n = 31) and school and workplaces (29.0 %, n = 29). Of these 100 participants who reported seeing other tobacco users, half (51.0 %, n = 51) of them reported seeing these tobacco users in their immediate group, and most (88.0 %, n = 88) reported seeing these tobacco users in their view. Males (31.1 %, n = 42) were more likely to be with other tobacco users in their immediate group, compared to females (12.9 %, n = 9, Χ
2 (df = 1) = 8.2, p < 0.01). A much higher percentage of tobacco users (81.2 %, n = 56) reported this social cue compared to non-tobacco users (32.4 %, n = 44) (Χ
2 (df = 1) = 43.6, p < 0.001).
More than half encountered visual (58.1 %, n = 119) and the majority of the participants experienced olfactory (79.5 %, n = 163) cues of tobacco use, during the 10 day study period. Among these who encountered visual cues, around 28.6 % of them (n = 34) had this exposure just once, while 71.4 % (n = 85) of them had this exposure two or more times. Among those reporting olfactory cues of tobacco use, around 23.3 % of them (n = 38) had the exposure once, while many more (76.7 %, n = 125) had experienced this exposure two or more times. Visual cues were most frequently reported in private settings (62.2 %, n = 74), slightly less frequently outside or in other places (52.9 %, n = 63), and least frequently in public settings (30.3 %, n = 36). Similarly, olfactory cues were most frequently reported in private settings (73.6 %, n = 120), less frequently outside or in other places (48.5 %, n = 79), and least frequently in public settings (31.3 %, n = 51). No demographic variables were associated with reported visual cues, but a significantly higher percentage of tobacco users (73.9 %, n = 51) encountered this type of cue than non-tobacco users (50.0 %, n = 68, Χ
2 (df = 1) = 20.8, p < 0.01). Sex was related to encountering olfactory cues (87.4 % of males vs. 64.3 % of females, Χ
2 (df = 1) = 15.1, p < 0.001) as was employment (89.7 % of employed, 64.3 % of unemployed, and 78.2 % of students, Χ
2 (df = 2) = 78, p < 0.05). Tobacco use status was also related to reporting olfactory cues, with all (100 %) the tobacco users having this experience compared to 69.1 % of the non-tobacco users (Χ
2 (df = 1) = 26.9, p < 0.001).
From the MP data, slightly more than half of the sample (56.6 %, n = 116) reported that they had at least once been in the presence of pro-tobacco messaging. Of these 116 participants, 38 (32.8 %) reported such exposure one time and 78 (67.2 %) saw such messages two or more times. Seeing pro-tobacco messages most frequently happened in private settings (78.4 %, n = 91), less frequently outside or in other places (35.3 %, n = 41), and least frequently in a public setting (26.7 %, n = 31). Sex was related to encountering pro-tobacco messages (63.0 % of males vs. 44.3 % of females, Χ
2 (df = 1) = 6.6, p < 0.05). Other demographics were not significant. Around three-quarters of the tobacco users (76.8 %, n = 53) compared to less than half of the non-tobacco users (46.3 %, n = 63) reported seeing such cues (Χ
2 (df = 1) = 17.3, p < 0.001).
Most participants (76.6 %, n = 157) reported seeing anti-tobacco messages through at least one MP. Among those who saw these messages, around 21.0 % of them (n = 33) said they saw messages at just one MP, while 79.0 % (n = 124) of them had seen such messages two or more times. Anti-tobacco messages were encountered most frequently in private settings (82.2 %, n = 129), less frequently outside or in other places (47.8 %, n = 75), and least frequently in public settings (28.7 %, n = 45). No demographic variables were associated with seeing anti-tobacco messages. Tobacco use was related to seeing anti-smoking messages; interestingly, a higher percentage of tobacco users reported seeing anti-smoking messages compared to non-tobacco users (85.5 % vs. 72.1 %, Χ
2 (df = 1) = 4.6, p < 0.05).
During the study period, most participants (88.3 %, n = 181) had been in a setting with known tobacco use restrictions, at least once when signaled with the MP. Among those who reported awareness of restrictions, only 17 (9.4 %) of them reported being in a place with tobacco restrictions once, and most of them (90.6 %, n = 164) reported awareness of restrictions more than once. Reporting restrictions of tobacco use occurred most frequently when one was in a private setting (85.1 %, n = 154), and less frequently in work/school setting (50.3 %, n = 91), outside or other places (44.8 %, n = 81), and public settings (40.3 %, n = 73). Neither demographic variables nor tobacco use status were associated with being in settings with restrictions. If we consider this subsample of those in areas with reported restrictions, 15.4 % (n = 28) were using tobacco themselves and 27.6 % (n = 50) could see another using tobacco at that moment.
Results from End of Day (EOD)
Around a third of the participants (37.6 %, n = 77) reported tobacco use when they completed the EOD assessment, at least once during the 10-day study period. All participants who used tobacco reported smoking tobacco and about 41.6 % (n = 32) of them also reported using smokeless tobacco. Among the 77 people who used tobacco, slightly less than half (44.2 %, n = 34) only reported use at a single EOD, 14.3 % (n = 11) at two EODs, and 41.6 % (n = 32) at 3 or more EODs. Compared to the use of the overall tobacco, the use of smokeless tobacco was less frequent. Among 32 people who reported using smokeless tobacco from EOD assessment, most of them (75.8 %, n = 25) only reported use at a single EOD, two (6.3 %) people and five (15.6 %) people reported the use at two and three or more EODs, respectively. Through the EOD reports, only age was associated with self-reported use of tobacco; the average age for tobacco users was 26.3 (SD = 6.8) years while the age was 24.2 (SD = 5.6) years for non-tobacco users (t = -2.5, p < 0.05).
According to EOD assessments, most (76.1 %, n = 156) of the sample indicated that they had been in the presence of another tobacco user during the study period. Of these 156 participants, 51 (32.7 %) reported such exposure one time and 105 (67.3 %) reported two or more times. Notably, participants in Hyderabad (81.4 %, n = 96), had a higher percentage of reporting seeing presence of others using tobacco, compared to those from Kolkata (69.0 %, n = 60, Χ
2 (df = 1) = 4.2, p < 0.05). A higher percentage of tobacco users were in the presence of other tobacco users compared to non-tobacco users (96.1 % vs. 64.1 %, Χ
2 (df = 1) = 27.1, p < 0.01). About half (48.3 %, n = 99) of the participants reported being with other tobacco users in their immediate group, and more than half (57.1 %, n = 117) reported seeing other tobacco users in their view. Of these participants who reported other tobacco users in their immediate group, 34 (34.3 %) and 53 (45.2 %) participants reported the exposure once, respectively, and 65 (65.7 %) and 64 (54.7 %) two or more times, respectively. In the one analysis where females had higher exposure than males, more females (71.4 %, n = 50) reported in the EOD surveys that they had seen tobacco users in their view compared to males (49.6 %, n = 67, Χ
2 (df = 1) = 8.9, p < 0.001). While no socio-economic differences were found for reporting presence of tobacco users in one’s immediate group, a higher percentage of tobacco users said there were other tobacco users in their immediate group compared to non-tobacco users (83.1 % vs. 27.3 %, Χ
2 (df = 1) = 59.9, p < 0.001). Likewise, a higher percentage of tobacco users said that other tobacco users were in their view compared to non-tobacco users (71.3 % vs. 48.4 %, Χ
2 (df = 1) = 10.4, p < 0.01).
Many of the participants (68.3 %, n = 140; 70.2 %, n = 144) reported exposure to visual and olfactory cues, respectively. Of those who were exposed to visual and olfactory cues, 42 (30.0 %) and 40 (27.8 %) reported the cues once, respectively, and 98 (70.0 %) and 104 (72.2 %) reported two or more times, respectively. No socio-economic characteristics were associated with visual or olfactory cues. A higher percentage of tobacco users were exposed to visual and olfactory cues compared to non-tobacco users, respectively (89.6 % vs. 55.5 %, Χ
2 (df = 1) = 25.9, p < 0.001; 90.9 % vs. 57.8 %, Χ
2 (df = 1) = 25.2, p < 0.001).
About one fourth (26.8 %, n = 55) of the participants saw pro-tobacco messages and slightly more than half (58.5 %, n = 120) saw anti-tobacco messages at least once during the 10-day study period. Of these participants who saw pro- and anti-tobacco messages, 26 (47.3 %) and 54 (45.0 %) reported seeing them one time and 29 (52.7 %) and 66 (55.0 %) saw reported seeing them two or more times. Males reported at a higher percentage seeing pro-tobacco messages compared to females (31.9 % vs.17.1 %, Χ
2 (df = 1) = 5.1, p < 0.05). No socio-economic characteristics were found to be associated with seeing anti-tobacco messages. A higher percentage of tobacco users saw pro-tobacco messages compared to those who did not use tobacco (48.1 % vs. 14.1 %, Χ
2 (df = 1) = 28.3, p < 0.01). Likewise, a higher percentage of tobacco users saw anti-smoking messages compared to non-tobacco users (80.5 % vs. 45.3 %, Χ
2 (df = 1) = 24.6, p < 0.01).