Exposure to surrogate tobacco advertising and its association with tobacco use and perceptions among young adults in Chennai, India: a cross sectional study

Surrogate tobacco advertising, used to bypass advertising bans, is not well understood in relation to tobacco use patterns among young adults in the Indian context. This study assessed the association between exposure to surrogate advertising, tobacco use, and related perceptions among young adults in Chennai. A cross-sectional study was conducted among 1002 participants aged 18–25 years using a dual-track convenience sampling approach. A structured, self-administered, validated questionnaire was used to collect data on exposure to surrogate advertisements, tobacco use, attraction to advertisements, and perceptions. Associations were tested using chi-square analysis with a significance level of p < 0.05. Multivariable logistic regression was used to calculate adjusted odds ratios for tobacco use, controlling for confounders. Overall, 73.6% (95% CI: 70.7–76.2%) of participants reported lifetime exposure to surrogate advertisements, with 19.8% (95% CI: 17.1–22.8%) of those exposed encountering them daily over the past 30 days. Current tobacco use was reported by 21.7% (95% CI: 19.2–24.3%) of the sample. In multivariable logistic regression adjusted for gender and educational status, participants reporting surrogate advertisement exposure daily (aOR = 3.56; 95% CI: 2.27–8.29; p < 0.001) and few days a week (aOR = 2.85; 95% CI: 1.72–4.94; p < 0.001) had significantly higher odds of current tobacco use compared with those reporting no exposure. Surrogate advertising is widely prevalent among young adults in Chennai and is significantly associated with tobacco use and attraction to promotional content. Strengthening regulatory enforcement and targeted health communication strategies may help limit the reach of surrogate advertising among young adults.