Compliance to Cigarettes and Other Tobacco Products Act(COTPA 2003) by Educational institutions of BangaloreUrban District- A cross-sectional study

Introduction

Noncommunicable diseases (NCDs) contribute to 71% of deaths globally and a common and very important risk factor for eight leading cases such as cancer, heart disease, asthma and other illness is Tobacco.¹ Tobacco leads to 8 million deaths every year out of which 1.2 million deaths are from exposure to tobacco smoke or second hand smoke.

Tobacco in all its forms and levels of exposure are dangerous to health. Cigarette smoking is the most common form of tobacco use. Other tobacco products include waterpipe tobacco, various smokeless tobacco products, cigars, cigarillos, roll-your-own tobacco, pipe tobacco, bidis and kreteks.

Tobacco use leads to heavy economic cost especially in poor households as priorities get shifted from their basic needs to tobacco. Due to its effects on health it also leads to significant health care costs and lost human capital due to its morbidity and mortality.²

According to the The Global Adult Tobacco Survey (GATS) India, 2009–2010, current prevalence of adult tobacco smoking is 24.3% among males and 14% for both sexes. India is one of the five focus countries selected to be part of the Bloomberg Initiative to Reduce Tobacco Use (BI) and has a very high burden of tobacco.³

The National Tobacco Control Program (NTCP) was launched by Ministry of Health and Family Welfare, Government of India in 2007- 08 to bring about greater awareness about the harmful effects of tobacco use and to facilitate effective implementation of the tobacco Control Laws. The National Tobacco Control Cell (NTCC) is responsible for overall policy formulation, planning, monitoring and evaluation of the various activities. Cigarettes and Other tobacco products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act is an important legislation by Government of India, in 2003, to control tobacco use. It includes 4 sections out of which Section 6(a) deals with prohibition on the sale of tobacco products to and by minors, Section 6(b) deals with prohibition on the sale of tobacco products within 100 yards of educational institutions; and Section 7 deals with display of pictorial health warnings on tobacco products.⁴ Which are three important sections as majority of users begin smoking before the age of 18years.⁵ Studies have shown that such laws may also reduce smoking initiation among youth.⁶ Hence the current study was conducted to assess the compliance to COTPA Section 6(a), Section 6(b) and Section 7 in Bengaluru Urban district.

Materials and Methods

A cross-sectional study design was conducted to assess compliance to Section 6(a), 6(b) and Section 7 of COTPA. The study was conducted at 780 sites in Bengaluru urban district.

The survey was conducted in educational institutes and Point of Sales (PoS).

The survey was conducted in 780 sites in Bengaluru 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 780 sites were divided into 4 zones and each zone was assessed for compliance to section 6(a) and 6(b) of COTPA act.

To assess compliance to Section 7, 12 cigarette packs, 4 Beedi products and 6 tobacco chewing products were observed for 3 key indicators.

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

Results

A compliance survey was conducted in 780 sites. Majority of the sites were PoS for section 6(a) and educational institutions were surveyed for section 6(b). 580 PoS or tobacco shops were surveyed to assess for compliance to Section 6 (a) and the overall compliance was found to be 70% as shown in Table 1. But only 17% were displaying signage regarding Section (a).

In this study 200 education institutions were surveyed to assess compliance to Section 6 (b) and only 29% of the institutions had displaying signage and only 65% had no tobacco sale within 100 yards of its boundaries. The overall compliance by institutions was only 65% as shown in Table 2.

In this study, 83% of cigarette packs, 42% of beedi products and 83% of tobacco chewing products were compliant to Section 7 as shown in Table 3, 4 and 5.

Discussion

In our present study 18% of the PoS or tobacco outlets had displayed signage as per section 6(a) that is tobacco products will not be sold to individuals below 18 years of age. Which is very low when compared to study conducted by S Pimple et al where 56.3% had complied to section 6(a).⁷ In our study 93% of the purchasers were not below the age of 18 years and the overall compliance in our study was only 70%, which is worrisome. Other studies conducted in north India show no purchasers that were minors.^7,8

The overall compliance by the Educational institutions in Bengaluru urban district was a mere 65% which is a very low, but higher than 16.7% found in study conducted by Habbu et al in Bengaluru city in 2012.⁹ Which shows that there has been some improvement in compliance over the past few years.

The compliance to section 7 at 83% for cigarette packs, 43% for Beedi products and 83% for tobacco chewing products also depicts a very poor compliance. This is in contrast to study conducted by Jain M et al who observed 1245 brands and found 100% compliance to this section on all tobacco prosucts.¹⁰

Conclusion and Recommendations

Our study showed a very poor compliance of only 65% by educational institutions which is very worrying as according to the Global Youth Tobacco Survey conducted in 2009 in India showed that 14.6% of students currently use any form of tobacco, out of which 4.4% currently smoke cigarettes and 12.5% currently use some other form of tobacco. Therefore, it is very important that educational Institutions take initiative and ensure stricter compliance to the law.

Limitations of the study

This study only studied the implementation of section 6 and 7 of the COTPA, Act, other sections were not assessed.  

Conflict of interest: None