Assessing compliance to smoke-free legislation: results of a sub-national survey in Himachal Pradesh, India.

Introduction: Exposure to second-hand smoke (SHS) is a serious public health concern. The Indian smoke-free legislation 'Prohibition of Smoking in Public Places Rules, 2008' prohibits smoking in public places, including workplaces. Objective: To measure the status of compliance to legal provisions that protects the public against harms of SHS exposure, identifies the potential areas of violations and informs policy makers for strengthening enforcement measures. Design: A cross-sectional survey in 1401 public places across 11 district headquarters in Himachal Pradesh, India, using a compliance guide developed by partners of the Bloomberg initiatives to reduce tobacco use. Results: In 1401 public places across 11 district headquarters, 42.8% public places had signage; in 84.2% public places, no smoking was observed and in 83.7%, there was absence of smoking accessories such as ashtray, matchbox and lighter . Tobacco litter like cigarette butts was absent in 64.7% of the public places. Overall, at the state level, there was more than 80% compliance on at least three of the five indicators. Among all categories of public places, educational institutions and offices demonstrated highest compliance, whereas most frequently visited public places, eateries and accommodation facilities had least compliance. Conclusions: The compliance to 'Prohibition of Smoking in Public Places Rules, 2008' was variable in various district headquarters of Himachal Pradesh. This study identified the potential areas of violations that need attention from enforcement agencies and policymakers.

Promoting tobacco cessation by integrating 'brief advice' in tuberculosis control programme.

Background: There is an enormous health burden caused by the co-prevalence of tuberculosis (TB) and tobacco use in India. This intervention study was undertaken in district Vadodara, Gujarat, India to promote tobacco cessation by integrating 'brief advice' for tobacco cessation in TB patients who were tobacco users and registered for treatment under TB control programme, based on the tested strategies advocated by World Health Organization (WHO) and the International Union against Tuberculosis and Lung Diseases (The Union). Materials and Methods: Brief advice for tobacco cessation based on five A's, advocated by the WHO and the UNION was incorporated into the on-going TB Control programme in India in the year 2010. The tools were developed for education, training and capturing data. All the registered TB patients receiving directly observed treatment short-course (DOTS) who used tobacco in any form were offered brief advice during routine interaction for treatment. Results: A total of 46.3% of TB patients, predominantly males (89.6% males and 10.3% females) were current users of tobacco; 39.1% used smokeless tobacco, 35.9% were smokers and 25% were dual users, that is, smoked as well as used smokeless tobacco. At the end of treatment, of the 67.3% patients who were offered brief advice, quit tobacco use, 18.2% re-lapsed while 14.5% were lost to follow-up. Conclusion: A significant numbers of TB patients use tobacco with adverse impact on TB control programmes. Our study shows that it is feasible to introduce 'brief advice' strategy as a cost effective intervention for tobacco cessation among TB patients with careful monitoring.

Second-hand Smoke: A neglected public health challenge.

Exposure to secondhand smoke (SHS) causes an estimated 5% of the global burden of disease, slightly higher than the burden from direct use of tobacco. This review highlights the urgent need to address this ignored public health issue by presenting the evidence and impact of SHS on those exposed using global studies including those from the South-East Asia Region. The burden of morbidity from SHS exposure is higher in low-income countries in Southeast Asia region compared to the rest of the world. SHS exposure affects those most vulnerable, especially women and children. While several countries in the region have enacted legislation which offer protection to those exposed to SHS, most measures are partial and inadequate. As a result, implementation and compliance at national and sub-national level within the countries of the Southeast Asia region is variable. Governments must ensure that legislation mandates comprehensive smoke-free environments in order to provide public health benefit which offers universal protection to everyone and everywhere. Where comprehensive legislation exists, stringent implementation and enforcement, along with awareness building, education and monitoring through regular compliance studies must be done to sustain smokefree status of public places within jurisdictions.