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: Background & objectives: In May 2003, the Government of India had endorsed a comprehensive tobacco control law called the Cigarettes and other Tobacco Products Act 2003 (COTPA 2003) to reduce the use of tobacco by prohibiting the smoking of cigarettes and other tobacco products. The present study was undertaken to assess the Implementation and Compliance of anti-tobacco law in Visakhapatnam, South India. Methods: This is a community based descriptive, cross-sectional study conducted from 1st July 2022 to 31st August 2022 at 60 Public places, 60 Educational institutions and among 60 Vendors present in shops selling tobacco and tobacco‐related products each located within 10 km radius from the centre of the selected zones in Visakhapatnam city. Results: Majority of the public places visited were found to be compliant with the section 4 of COTPA Law and no active smoking was noted in 83% of the places visited. People were found smoking tobacco products in 10% of the educational institutions. Only 25% places visited had displayed ‘No Smoking Signage’ in the institutes. At the points of sale visited, most of the shops were found to be have an advertising board/poster displayed openly mentioning about the sale of tobacco and tobacco‑related products (90%), violating the section 5 of COTPA Act. Interpretation & conclusions: Visakhapatnam city being the largest and most populous metropolitan city of Andhra Pradesh, showed disturbing results with poor compliance with COTPA. It is recommended that a fully efficient tobacco control cell is established along with sensitization of the administration and empowering administrative officers to take care of the offences and impound fine. |
Tobacco use is known to be one of the major risk factors for cardiovascular diseases, cancer and other non-communicable diseases and is the single largest causative factor of preventable and premature mortality. [1, 2] In our country, tobacco products are consumed in a large variety of ways including smoking forms like cigarettes, bidis, chuttas, Hookah, dhumti, cigars, cheroots, and pipes and smokeless tobacco products in the form of khaini, ghutka, betel quid with tobacco and zarda. Tobacco industry has now flourished in a way that India tops as the second largest consumer and the third largest producer of tobacco products in the world. [3] Tobacco not only affects the health but also causes a massive economic burden. As per the reports in the year 2011, the economic cost credited to tobacco use leading to major diseases in India was amounted to be over INR 1044816 million (approximately 22.4 billion USD), which accounts for 1.16% of India’s Gross Domestic Product (GDP). [4] WHO quotes that “Tobacco epidemic is one of the biggest public health threats the world has ever faced” killing more than 8 million people a year. [5] According to the Global Adult Tobacco Survey 2017, nearly 29% of adults aged 15 years and above (approximately 267 million people) use some form of tobacco in India. [6] Even tobacco use among youth and minors have also been drastically increasing. Therefore, to achieve tobacco control amongst youth, In May 2003, the Government of India had endorsed a comprehensive tobacco control law called the Cigarettes and other Tobacco Products Act 2003 (COTPA 2003) (Prohibition of Advertisement and Regulation of trade and commerce, production, supply and distribution), to reduce the use of tobacco by prohibiting the smoking of cigarettes and other tobacco products. [7] This Act has various sections: a) Section 4, prohibition of smoking in public places; b) Section 5, prohibition of advertisement of cigarettes and other tobacco products; c) Section 6, prohibition of sale of cigarettes or other tobacco products to anyone below the age of 18 years and in a particular area; and d) Section 7, Prohibition on trade and commerce in production, supply, and distribution of cigarettes and other tobacco products. [8] On October 2, 2008, the central government’s Ministry of Health and Family Welfare expanded the Prohibition of Smoking in Public Places Rules to strengthen the existing COTPA legislation in order to protect individuals from the hazards of second-hand tobacco smoke. [9] While proclamation of law is usually a one-time process, its implementation is a continuous and more difficult process to ensure posing a big challenge for the success of the program. Even with the presence of laws and penalty for violation of laws, tobacco consumption seems to be increasing and there are a lot of violations against these legislations in many cities in India. In view of this, the present study was undertaken to assess the Implementation and Compliance of (COTPA) Cigarette and Other Tobacco Products Act (2003) in Visakhapatnam, which is one of the largest and most populous metropolitan cities in South India.
This is a community based descriptive, cross-sectional study conducted during 1st July 2022 to 31st August 2022. The entire geographical area of the Visakhapatnam city was divided into eight zones as per the Greater Visakhapatnam Municipal Corporation (GVMC), and using simple random sampling, 50% of the zones i.e., four zones were randomly selected. The sample size was calculated keeping in view the compliance rate to various sections of at different jurisdictions in India to be 85% as per the findings of Pradhan A et al, absolute error as 10%, and non-response rate as . Then, the minimum sample size was calculated to be 49 as per the given formula, which was rounded off to 60 places. A total of 15 places in each category were selected from each zone by convenient sampling and observed for any violations of laws.
The term “public place” was defined according to “As places which have public access, whether as of right or not and includes auditorium, hospital buildings railway waiting rooms, restaurants, court buildings, educational institutions, public offices, cinema halls, workplaces.” The investigators visited and observed about 15 places each from the three categories of public places, educational establishments and tobacco selling shops in each selected zone separately. The visits were done at unannounced timings with an average duration of stay at each location being 20–30 min. However, for the public places like workplaces, government buildings, healthcare institutions and educational institutions, visits were made during the office timings, hospital visiting hours and school hours respectively. The observations at the transit sites were made during the busiest hours. The public places and educational institutions were manually mapped before the visit. A radial distance of approximately 100 yards from the educational institution’s entrances/exits is measured by the data collector, wherever possible, using Google Maps and shops selling tobacco products were observed for any violation of laws. The observations were also recorded photographically. No personnel of the educational institutions or any authority outside the institutions are interviewed or informed about the study. A structured observational checklist was designed in English based on the sections of specifications and guidelines. Approval was obtained from the Institutional Ethics Committee before commencement of the study Data was entered in Microsoft Excel worksheet 2013 and Analysis was performed using SPSS software A descriptive statistical analysis was performed to report the data. Categorical variables were represented as proportions/percentages.
Among the eight zones divided by Greater Visakhapatnam Municipal Corporation (GVMC), using simple random sampling, 50% zones were randomly selected i.e., four zones. They are Zone 2 (Madhurawada), Zone 3 (Asilmetta), Zone 4 (Suryabagh) and Zone 6 (Gajuwaka).
Public places
Out of the 60 public places visited, 13.33% were accommodation facilities/restaurants, 20% were offices and workplaces, 25% were healthcare facilities, 25% were most frequently visited places, and 16.67% were public transport facilities (Table 1). No active smoking was found in majority of the public places visited (83%) while ‘No Smoking Signage’ was displayed at 75% of the places and 53% of the public places were free from recent smell of tobacco/smoke. (Table 2) Half of the places visited were devoid of any smoking aids whereas the other half of the places had evidences of Cigarette butts/smoked beedi ends/tobacco sachets/ashtrays. (Figure 1)
Educational institutions
Among the educational institutions visited, it was observed that majority of the places visited were found to be compliant (90%) with no active smoking and ‘No Smoking Signage’ was displayed in 25% of the institutes. Signboard showing the prohibition of the sale of tobacco within radius of 100 yards was not displayed anywhere either on main gate / boundary of the educational institutions. (Figure 2) Tobacco vendors were found selling tobacco products within radius of 100 yards of the educational institutions in majority of the institutes (95%). (Table 3)
In spite of the stringent laws against use of tobacco and penalty for violations, enforcement and compliance of smoke-free laws in many countries around the world is still a challenge. The compliance is even more difficult in low and middle-income countries like India in comparison to high-income Western countries due to poor monitoring and regulatory infrastructure and mechanisms. As per the section 4 of COTPA Law, smoking is prohibited in public places and no person shall use tobacco in the open public places. In the current study, majority of the places visited were found to be compliant and no active smoking was noted in 83% of the places visited. This is quite consistent with the study findings of Goel S et al and reports of Sharma N and Chavan BS. In contrast, the recent study in Bengaluru has reported very high rates of active smoking as 61% by Khargekar NC et al which is against Section 4 of COTPA. Regarding the display of ‘No Smoking Signage’ in public places, three-fourth of the places visited were found to be compliant the present study. These results were relatively far better than the study findings at comparable settings where authors reported the display of ‘No Smoking signage’ at 28% 42.76% and 36.9% [15] of the public places visited. Reasons for the poor compliance may be due to lack of awareness or knowledge about the law amongst owners and persons in charge of public places and lastly, lack of enforcement of smoke-free legislation. More than half of the public places visited were found to be free from evidence of recent smell of tobacco/smoke (53%). In contrast to this, studies by Jain ML et al [16] stated that 8% of the public places observed had recent smell of tobacco smoke. Regarding the smoking aids, half of the public places observed in the present study were devoid of smoking aids, which is consistent with the study findings in the neighboring state of Karnataka by Koppad R and Nagendra K which stated that 42.5% of the public places observed were devoid of any smoking aids. The wide variations in compliance to the COTPA Act could be attributed to various cultural and social factors but more so can be the result of strong administrative will by following strict enforcement of the law policies.
Visakhapatnam city being the largest and most populous metropolitan city of Andhra Pradesh, showed disturbing results with poor compliance with COTPA. It is, therefore, recommended that a fully efficient tobacco control cell should be established. Adequate funds need to be spent for Information Education and Communication (IEC) activities for wide publicity along with operational research on tobacco control.
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