A cross sectional study is currently being conducted to evaluate the relation between viewing tobacco use in Bollywood movies and tobacco use among Indian youth. As an extension to the ongoing study, this longitudinal study will follow up participants with subsequent surveys to better assess the cause-and-effect relationship between exposure to and initiation of tobacco use. This research will be done primarily in HRIDAY, New Delhi, India as an extension of NIH Grant No. R01 TW007933-01 in collaboration with Prof. James D. Sargent (PI NIH Grant NO. R01 CA 077026). The overarching aim of this study is to provide an evidence base to support and influence policy change relating to depiction of tobacco use in Bollywood movies to reduce youth exposure to movie tobacco use. The proposed content analysis of newly released Bollywood movies will allow us to track trends in movie tobacco use over the duration of this study and assess the effect of any policy changes during that period. We propose to conduct a two year prospective cohort study among school going adolescents of grades 9 to 11 in 12 schools from New Delhi, India. The students from the ongoing cross-sectional study will be followed with surveys at the end of year 1 and year 2 for their tobacco use status as well as their level of exposure to tobacco use in Bollywood movies released during each interim period. The analysis of the surveys will be done to determine if there is a dose response relationship between exposure to tobacco use in movies seen by the participants and initiation and/or progression of tobacco use. The key outcome variables for this proposed study include initiation of use of tobacco products among those who were never-users and progression of use of tobacco products among those who were users of tobacco products. A longitudinal study allows us to effectively counter the argument of reverse causality by starting with never users and assessing the relation between baseline exposure and tobacco use onset. If an association is found between exposure to tobacco use in Bollywood movies and tobacco use onset among Indian youth, a strong argument can be made to revise existing legislation related to depiction of tobacco use in Bollywood movies. A stricter adult rating for movies with tobacco use would restrict youth access to this exposure. PUBLIC HEALTH RELEVANCE: Research in other countries has shown that exposure to tobacco use in movies results in early initiation and/or progression of tobacco use among adolescents. This research envisions establishing the relationship between exposure to tobacco use depictions in Hollywood movies and tobacco use among Indian youth to support and strengthen the provisions of the Tobacco Control Law in India, a policy that could help in reducing the enormous burden of tobacco use in India.