Awareness about cigarettes and other tobacco products act and impact of health warnings on smokers in a North Indian city

Background: Tobacco use is a major preventable cause of morbidity as well as mortality worldwide. To combat the increasing trend of this problem, Government of India formulated the COTPA (Cigarettes and Other Tobacco Products Act) in 2003. The study aimed to assess the awareness about COTPA and impact of pictorial warnings among smokers attending outpatient services in a tertiary care hospital in Jammu.Method: The present study was conducted among 320 patients attending the outpatient department of Internal Medicine, Government Medical College, Jammu who happened to be cigarette smokers. The questionnaire was developed by authors with the help of literature review and pilot tested before its final use. Information was elicited about demographic details, awareness about COTPA and impact of pictorial warnings on quitting of smoking.Results: More than half of the respondents were in 30-50-year age group and were urban residents. Awareness about COTPA was good on some parameters but was relatively low on other parameters. Despite all, the respondents noticing pictorial warnings on tobacco packages, only 69.37% of them were contemplating to quit. About half of them were of the view that warning statements preferably be written in local languages.Conclusion: Health and pictorial warnings on tobacco packages remain an important pillar in filling the gap of knowledge and communicating the health risks of tobacco use to the consumers. Only 69.3% of the respondents were planning to quit and awareness levels about COTPA were mixed.

Compliance and awareness of Cigarettes and Other Tobacco Products Act among tobacco sellers in urban Ludhiana

Background: Tobacco use is one of the major preventable causes of deaths globally. Although India responded early to combat this global problem by implementing Cigarettes and Other Tobacco Products Act (COTPA), there is a need to evaluate its implementation. Objective: The objective of this study was to assess the compliance and awareness of the tobacco vendors to Section 5 (Point of sale advertisements of Cigarettes and Other Tobacco Products) and Section 6 (Prohibition on sale to minors and within 100 yards of educational institutes) of COTPA. Materials and Methods: The present study was a community-based cross-sectional study. All tobacco selling stores located within 100 yards distance from 58 educational institutes in urban Ludhiana were assessed for compliance to Section 5 and 6 provisions of COTPA. The study also assessed awareness regarding COTPA legislation among the tobacco vendors available in these tobacco selling stores. Data were collected using a semi-structured questionnaire. The questions were asked to determine the level of awareness of COTPA among the tobacco vendors. Results: Around 42.0% of the educational institutes had tobacco stores located within 100 yards and only around 25.0% of educational institutes had mandatory signage prohibiting ban on selling tobacco products displayed outside institutions. Most of the tobacco outlets (77.7%) were permanent, exclusive tobacco sellers (72%) and had displayed the products enabling easy access to minors. Majority (89%) of the vendors knew about an act regarding tobacco products. However, only 19.4% and 25% of vendors were aware of ban on selling tobacco products within the radius of 100 yards of educational institutions and to minors, respectively. Conclusion: Strict enforcement of the provisions of COTPA around educational institutes to reduce easy access of tobacco products to minors and strengthening awareness generation activities by involving key stakeholders is needed.

Assessment of implementation status of Cigarettes and Other Tobacco Products Act (COTPA) and its awareness among residents in a block of Haryana

Background: Legislative route is one of the known method to control behaviour of population. Cigarette and Other Tobacco Products Act is one of the laws enacted to control the use of tobacco in India lunched in the year 2003. Objective: The objective of this study was to find compliance of COTPA among tobacco stores and to find the knowledge of people regarding COTPA. Methods: All selected communities were studied by community audit. All stores selling tobacco products were assessed for its compliance to COTPA. Thirty participants from selected communities with in the age range of 18- 65 years were selected and interviewed for knowledge regarding COTPA. Results: A total of 218 stores were found to be selling tobacco. None of the stores were fully compliant to all COTPA clauses. Stores in rural areas were found to be more non-complaint than urban areas. 41% of stores were selling tobacco to minors, 10% were within 100 yards of schools.8% of schools have tobacco advertisement on fa鏰de and 24% displayed tobacco products openly. Around half of the participants (n-552) had heard about COTPA whereas only 4% were aware of all 4 provisions of COTPA. Conclusion: Although more than a decade passed since the law was enacted poor compliance and knowledge was found among participants.

Exposure to second hand smoke and its correlates in Northern State of India

Background: Second-hand smoke (SHS) has enormous adverse health impacts with grave health implications for the next generation. Section 4 of Indian legislation, Cigarettes and Other Tobacco Products Act, prohibits smoking at public places, thus protecting people from SHS. Objective: The objective of present study was to assess the exposure to SHS at home and working areas in Punjab, India. Methods: The present cross-sectional study was conducted from December 2015 to March 2016. A three-stage sampling technique was used for collecting data from three randomly selected districts representing three major regions of Punjab, India. A sample size of 510 individuals was divided equally into an urban and rural area with proportionate sampling on the basis of subsets of age groups and gender. The questionnaire based on tobacco questions for the survey, a subset of key questions from global adult tobacco survey was used. Results: At home, the odds of exposure to SHS exposure was higher (odds ratio [OR] = 2.2, 95% confidence interval [CI] = 0.6�3) in urban area, females, low educational status, and nongovernment employee as compared to their counterparts. At workplace, (OR = 3.9 and 95% CI = 1.11�.3) SHS exposure was higher in rural area, among males, primary and middle education and nongovernment or self-employed occupation. Conclusion: SHS exposure was low in Punjab, India especially in females as compared to other states of the country. The socio-economic disadvantaged groups and people with low education were more likely to experience exposure to SHS at workplace, which should be targeted to reduce tobacco consumption.

War against tobacco: Where do we stand?

India has launched war against tobacco epidemic for the past few decades but with partial success; hence, challenges are still there which need to be identified and addressed for winning the battle. Targeted approach directed at motivating smoking cessation of female smokers, frequent changing of pictorial warnings depicting variety of health consequences in cigarette packets and devoid of logos and colors in conjunction with plain packaging, and display of toll-free number for quitting are expected to dissuade tobacco consumers to quit and save themselves from the devastating health, social, environmental, and economic consequences of tobacco consumption. Online reporting system for violating legal enforcements can also be implemented easily. Moreover, guidance from success stories of countries/states who have achieved smoke-free status along with concerted efforts such as innovative anti-tobacco campaigns, involvement of religious leaders in anti-tobacco propaganda, strict legislations, and overall strong political commitment would further aid in winning the war.

Descriptive Evaluation of Cigarettes and Other Tobacco Products Act in a North Indian City.

Background: India is a signatory to Framework Convention on Tobacco Control and also enacted cigarettes and other tobacco products Act (COTPA) in 2003. Objectives: To undertake a comprehensive assessment (Section 4, 5, 6, 7, 8, and 9 under COTPA) of legislation against tobacco products in a North Indian city. Methods: An observational, crosssectional study was conducted at 108 public places which included educational institutions, offices, health institutes, transit sites, and hotels/restaurants. Structured checklists with compliance indicators for various sections under COTPA were used. Different brands of tobacco products were observed for pictorial warnings. Results: No active smoking was observed at 80.5% public places, while 54.6% places had displayed “No smoking” signage. About 68.5% public places were found free of evidence of smell/ashes of recent smoking, and 86.1% places had no smoking aids. Merely, one-third public places (36.1%) were complying with all Section 4 indicators. Around 42.3% point of sale had advertisements of tobacco products, and 73.1% had a display of tobacco products visible to minors. Around 60% educational institutions displayed signages as per Section 6b of COTPA, and 32.5% had tobacco shops being run within 100 yards of institution’s radius. There was minimal smoking activity within the campus. Health warnings were present in 80.8% of tobacco products, more with Indian brands as compared to foreign brands. Conclusion: The city of Chandigarh, which was declared the first smoke-free city of India, showed poor compliance with COTPA.

Compliance assessment of cigarette and other tobacco products act in public places of Alwar district of Rajasthan.

Background: The Government of India has taken various initiatives for tobacco control by enacting comprehensive tobacco control legislation (Cigarette and Other Tobacco Products Act [COTPA], 2003). Objectives: The aim of this study was to assess the level of compliance of Sections 4, 5, 6-a, and 6-b, and 7, 8, and 9 of COTPA with respect to public places, educational institutes, point of sale (PoS), and warning on packaging (COTPA) in public places of Alwar District of Rajasthan. Methods: A cross-sectional observational study was conducted in 2014 in Alwar city and four blocks of the district. The study was done around 365 public places for observing the compliance of Section 4 of COTPA, 357 educational institutions for observing the compliance of Section 6-b of COTPA, and 357 tobacco retailers for observing the compliance of Sections 5 and 6-a of COTPA. Results: The criteria for the evaluation (the core indicators) and decision criteria for a district to qualify for the "Smoke free" status include six parameters. From the total of 365 places visited, 90% places displayed the "No-smoking" signage and out of total 328 places, 99% were as per the COTPA specification. Alwar city, Ramgarh, Thanagaji, and Alwar rural block followed the compliance of Section 4. The PoS visited Alwar district displayed 93% (332) signage and all the displayed signage followed the COTPA compliance. In Alwar city, Thanagaji, Ramgarh, and Alwar rural block, the compliance of Section 6-a was above 90%. The compliance of Section 6-b was above 90% in Alwar city, Ramgarh, Thanagaji, and Alwar rural block. Ninety-three percent (332) of the PoS did not display tobacco advertisement in Alwar district, which is a positive sign of COTPA compliance. Conclusion: This finding suggest a high level of compliance of Section 4, Section 5, Section 6-a, and Section 6-b of COTPA at Alwar district.

Compliance to Gutka ban and other provisons of COTPA in Mumbai.

BACKGROUND: Cigarettes and other tobacco products act 2003 (COTPA) is the principal law governing tobacco control in India. Government of Maharashtra in one of its landmark decisions also banned manufacturing, sale and distribution of gutka and pan masala since July 2012. The desired impact and level of enforcement of the COTPA legislation and the gutka and pan masala ban in Maharashtra State, however, needs assessment. Among the many provisions within COTPA, the present study seeks to assess compliance to implementation and enforcement of Section 5 and 6 of COTPA including compliance to gutka and pan masala ban in Mumbai, India. METHODOLOGY: Six educational institutes (EI) within the Mumbai metropolitan region were selected in a two stage random sampling process. Area around each EI was manually mapped and all the tobacco products selling outlets with in the 100 yards distance were listed by trained Field Social Investigators and were observed to determine compliance for Section 5 and Section 6 of the COTPA legislation and for gutka and pan masala ban. The vendors/shop owners manning these outlets were also interviewed for their personal sociodemographic details, self‑tobacco use, awareness and perception about ill‑effects of tobacco and existing tobacco control legislation in the country. RESULTS: A total of 222 tobacco retail outlets were listed within 100 yards of the EI in violation to the provisions of Section 6 of COTPA, of which 72 (32.4%) were selling tobacco products on mobile structures. About 53.2% of the tobacco vendors were also users of some form of tobacco. Whereas, nearly 217 (97.7%) vendors were aware about the gutka and pan masala ban in the State, only 48.2% were aware about the existence of COTPA legislation. None of the EI had a display board prohibiting the sale of tobacco products within a radius of 100 yards of their EI. Only 56.3% tobacco outlets had complied with the mandatory warning display boards indicating tobacco products will not be sold to people below 18 years of age. With regards to point of sale advertisement only 25.2% compliance was noted for display of health warning boards at the point of sale. Nearly 48.6% tobacco outlets exhibited >2 display boards and another 43.2% exhibited hoardings with brand pack photo, brand name in violation to the provision under Section 5. Violation by visible stacking and open display of tobacco products for sale was observed at 51.3% of tobacco outlets. While 41% of tobacco outlets were found displaying gutka and pan masala packets in violation to the ban. CONCLUSIONS: Enacting of the law without robust measures for enforcement has led to widespread noncompliance to the provisions with in the tobacco control legislation in the metropolitan city of Mumbai. Strong and sustainable measures needs to be incorporated both by civic administration and public health departments for its forceful implementation.

Public opinion about smoking and smoke free legislation in a district of North India.

Context: A growing number of cities, districts, counties and states across the globe are going smoke-free. While an Indian national law namely Cigarettes and Other Tobacco Products Act (COTPA) exists since 2003 and aims at protecting all the people in our country; people still smoke in public places. Aim: This study assessed knowledge and perceptions about smoking, SHS and their support for Smoke-free laws among people residing in Mohali district, Punjab. Materials and Methods: This cross-sectional study was conducted in Mohali district of Punjab, India. A sample size of 1600 people was obtained. Probability Proportional to Size technique was used for selecting the number of individuals to be interviewed from each block and also from urban and rural population. Statistical Analysis Used: We estimated proportions and tested for significant differences by residence, smoking status, literacy level and employment level by means of the chi-square statistics. Statistical software SPSS for Windows version 20 was used for analysing data . Results: The overall prevalence of current smoking among study participants was 25%. Around 96% were aware of the fact that smoking is harmful to health, 45% viewed second-hand smoke to be equally harmful as active smoking, 84.2% knew that smoking is prohibited in public places and 88.3% wanted the government to take strict actions to control the menace of public smoking. Multivariate logistic regression analysis showed that people aged 20 years and above, unemployed, urban, literate and non-smokers had significantly better perception towards harms of smoking. The knowledge about smoke free provisions of COTPA was significantly better among males, employed individuals, urban residents, and literate people. Conclusions: There was high knowledge about deleterious multi-dimensional effects of smoking among residents and a high support for implementation of COTPA. Efforts should be taken to make Mohali a "smoke-free district".

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.

Overview on the implementation of smoke-free educational institutions in Tamilnadu, India.

'The Cigarettes and Other Tobacco Products (Prohibition of Advertisement and Regulation Trade and Commerce, Production, Supply and Distribution) Act, 2003,' known as COTPA in short, was enacted by the Government of India to control the tobacco menace. One of the successful strategies adopted by the government of Tamilnadu for implementing this Tobacco Control Act was the concept of 'Smoke-free educational institutions'. The process for having smoke-free educational institutions was started by the NGOs motivating the school authorities, to ensure that the set of guidelines, which were devised based the COPTA Act, was followed. The institution was later certified as a smoke-free institution, after verification by the government. The role of the stakeholders and the challenges we faced are discussed in this article.