Public health researchers on Tuesday asserted the need for the Union health ministry to enforce anti-tobacco rules on over-the-top (OTT) streaming content, challenging a claim by a policy consulting firm that OTT content does not influence smoking habits in India.

The researchers said the enforcement of health warnings for tobacco scenes in OTT content would be a critical public health step towards curbing tobacco use, amid abundant evidence that exposure to tobacco imagery influences smoking behaviour, particularly among the young.

India is the only country that has since 2012 implemented rules requiring anti-tobacco warning messages to be scrolled during tobacco imagery on television and cinema screens. And the health ministry had earlier this year consulted with public health experts on options to impose the rules on OTT content as well, raising expectations that a notification to cover OTT is imminent.

“OTT platforms are renormalising smoking behaviour and glamourising smokeless tobacco use,” Monika Arora, the director of health promotion and tobacco control division at the Public Health Foundation of India, New Delhi, a research and training institute.

OTT platforms, Arora said, are “reversing” the effects of a decade of anti-tobacco warnings scrolled on TV and cinema screens during tobacco use imagery.

“There is no evidence to show that the impact of tobacco imagery shown in movies or TV serials would be any different when shown in cinema theatres, TV, or on OTT platforms,” Arora told The Telegraph. Any tobacco use imagery has the potential to influence and increase adolescent tobacco use, she said.

The researchers have also challenged a claim made on Tuesday by a policy consulting firm based on a nationwide survey that two-thirds of respondents “remained indifferent to the depiction of smoking on OTT content.”

The New Delhi-based firm, Koan Advisory Group, also said its online survey based on 1,896 respondents -- most of them men aged between 18 and 35 years -- from 350 locations across the country, has shown that OTT content “does not influence smoking habits in India.”

The firm said the survey found that factors such as peer pressure, the influence of friends, and mental stress were more significant drivers of smoking habits in India. It said the survey found that users “feel” that depiction of smoking on TV or OTT had “insignificant” impact on smoking uptake.

Health researchers have said the survey lacks scientific rigour, largely depends on the feelings and the perceptions of OTT viewers, and appears timed to influence any decision on imposing the anti-tobacco warnings on OTT content.

“The survey report lacks reporting research methodology and the results are not peer-reviewed or published in a scientific journal,” said Mansi Chopra, a research scientist with HRIDAY, a non-government organisation focused on health promotion among youth.

Impact assessment studies, Chopra said, must have at least two measurement points to correctly report, for instance, the impact of tobacco exposure on tobacco use behaviour. The survey provides a percentage distribution based on sample perceptions using a single measurement.

An email query from this newspaper requesting Koan Advisory Group to respond to the questions raised by the health researchers has evoked no response.

A study by Arora and her colleagues, published in a research journal three years ago, had assessed tobacco imagery in 10 online serials on OTT platforms and found that 70 per cent of the serials had portrayed use of tobacco.