Compliance to Cigarettes and Other Tobacco Products Act(COTPA 2003) in public places of Bangalore urban district- Across-sectional study

Introduction

The tobacco epidemic is one of the biggest public health threats the world has ever faced, killing more than 70 lakhs people a year. More than 60 lakhs of those deaths are the result of direct tobacco use while around 9 lakhs are the result of nonsmokers being exposed to second-hand smoke. One person dies every 6 seconds due to tobacco. Up to half of current users will eventually die of a tobacco-related disease.¹ Nearly 80% of the smokers worldwide live in Low- and Middle- Income countries, where the burden of tobacco-related illness and death is heaviest. Tobacco users who die prematurely deprive their families of income, raise the cost of health care, and hinder economic development.The adverse effects of tobacco use, and exposure extends well beyond the health risks to individuals. For families, communities and governments, tobacco use and exposure to second hand smoke poses significant social and economic handicap, but also importantly contribute to the major risk factor in the looming epidemic of noncommunicable diseases that threatens to undo many of the global gains achieved with difficulty over the past 50 years.

Several countries have legislation restricting tobacco advertising, and regulating the sale and use tobacco products, and also, where people can smoke. One of the important legislations by Government of India, in 2003, to control tobacco use is the Cigarettes and Other tobacco products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act. The Act is applicable to all products containing tobacco in any form i.e. cigarettes, cigars, bidis, gutkha, pan masala, khaini, snuff etc. A target of 15% relative reduction in current tobacco use by 2020 and 30% by 2030 has been set by National health policy-2016.² The act contains 4 sections out of which section 4 of the Act deals Prohibition of smoking in public places and section 5 deals with Prohibition of direct and indirect advertisement of tobaccoproducts. However, even a decade after enacting this law, its implementation remains suboptimal and variable across the Indian states. A national survey (2009-10) revealed that 29% of adults were exposed to the second-hand smoke at public places.³

This survey has been undertaken to assess the compliance to COTPA sections 4, 5 in Bengaluru Urban district.

Materials and Methods

A cross-sectional study design was conducted to assess compliance to section 4, 5 of COTPA. The study was conducted at 1015 sites in Bangalore urban district.

The survey was conducted in educational institutes, bus or taxi stand/ mall/ market/ cinema theatre/ parks, eateries such as restaurant/ bars/dhaba/ tea stalls, offices, health care facilities, accommodation facilities, Point of Sales(PoS).

The survey was conducted in 1015 sites in Bangalore urban district using pretested (by piloting) app based semi structured questionnaire using smart phones running on android OS. Trained investigators who participated in the baseline survey were given a reorientation training. The 1015 sites were divided into 4 zones and each zone was assessed for compliance to section 4, 5of COTPA act.

Data entry, cleaning and recoding was done using MS Excel and was analysed using SPSS version 20.0.

Results

A total of 1015 sites were surveyed in the Bangalore Urban district. The compliance to the sections was tabulated according to zones.Majority of the surveyed sites were PoS. Other types of surveyed sites were eateries, educational institutions, bus/ taxi stands, offices, health care facilities and accommodation facilities.

A total of 435 public places were visited to assess compliance to section 4 of COTPA Act. The 5 parameters assessed under the section and the resulting compliance is mentioned in Table 1.

The overall compliance to Section 4 of COTPA Act was 61% in our study. In this study only 30% of public places had signages displayed.

580 sites of tobacco Shops or point of sale were visited for assessing the compliance to section 5 of COTPA Act. The overall compliance to section 5 of the Act was 95% shown in Table 2.

Discussion

Karnataka enacted the state law (the Karnataka Prohibition of Smoking and Protection of Health of Non-smokers Act, 2001) even before COTPA was enacted by the national government and is among a few states that have shown political will by taking steps towards COTPA implementation. Since 2007, several districts in Karnataka have declared themselves as highly compliant to COTPA. In our present study conducted in Bengaluru urban district showed only 30% of public places displayed signages prohibiting smoking in public places, but no active smoking was observed in 70% of the public places and overall compliance to section 4 was only 61%. This contrasts with study conducted by Goel s et al4in North India where 90% of public places had displayed signage, no active smoking was observed in 94.3% of places and overall compliance to section 4 was 92.3%.

The reason for lower compliance in our study maybe because the widespread nature of public places could lead to difficulty in enforcement of this section.

Our finding shows that 90% of the PoS did not display any kind of advertisements and overall compliance to sec 5 was 95%. This high level of compliance could be attributed to the possible reason that advertisements, being a permanent structure with respect to the PoS and being easily visible, violations are considerably lower than other sections.

Conclusion and recommendations

It has been more than a decade since the implementation of the COTPA Act and More than that since the implementation of the Karnataka Prohibition of Smoking and Protection of Health of Non-smokers Act, 2001, even though steps have been taken by the government. Our present study shows that the COTPA Act has not been well implemented and a co-ordinated effort is needed from all the stakeholders for the successful implementation of the same.

Limitations of the study

This study only studied the implementation of section 4 and 5 of the COTPA, Act, other sections were not assessed.

Conflict of interest:

None