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| ORIGINAL ARTICLE |
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| Year : 2015 | Volume
: 13
| Issue : 4 | Page : 444-448 |
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Assessment of implementation of COTPA-2003 in Bengaluru city, India: A cross-sectional study
Shweta Gururaj Habbu1, Pushpanjali Krishnappa2
1 Department of Public Health Dentistry, Dr. HSRSM Dental College and Hospital, Hingoli, Maharashtra, India
2 Department of Public Health Dentistry, M.S. Ramaiah Dental College and Hospital, Bengaluru, Karnataka, India
| Date of Web Publication | 7-Dec-2015 |
Correspondence Address:
Shweta Gururaj Habbu
Department of Public Health Dentistry, Dr. HSRSM Dental College and Hospital, Hingoli, Maharashtra
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/2231-6027.171165
Introduction: Tobacco as a slow and modern epidemic remains a serious public health problem for the country. Despite the existence of a comprehensive law to reduce tobacco burden, India still faces the uphill task of its acceptance and successful implementation. Aim: To assess the implementation of Cigarettes and Other Tobacco Products Act 2003 (COTPA)-2003 (Section 4, 6b, and 7) in public places of Bengaluru city and to assess the awareness of the head of these institutions/offices regarding COTPA-2003 and its enforcement in their premises. Materials and Methods: A cross-sectional study was conducted in 175 public places selected as sources of data using cluster random sampling. The tool in the form of a checklist was prepared based on the sections of COTPA-2003 (Cigarettes and Other Tobacco Products' Act), and data were recorded through direct observation. A structured interview was conducted of the institutional heads regarding the implementation of COTPA-2003 in their premises. Informed consent was obtained from the institutional heads or in-charges of the public places. Results: Section 4 (Prohibition of smoking in public places) was not complied by 58%. Only 16.7% educational institutions complied with the Section 6b (Prohibition of sale of tobacco products near educational institutions). More than 50% of the head of the institutions were unaware of their role in the implementation of this law. Conclusion: Although the law has been drafted comprehensively, it is implemented only to a certain extent. Hence, all concerned departments and ministries responsible for meeting the framework convention on tobacco control objectives and enforcing COTPA, at central and state levels, should act urgently and in coordination. Keywords: COTPA-2003, implementation, smoking
How to cite this article:
Habbu SG, Krishnappa P. Assessment of implementation of COTPA-2003 in Bengaluru city, India: A cross-sectional study. J Indian Assoc Public Health Dent 2015;13:444-8 |
| Introduction | |  |
The flagrant misuse of tobacco has caused a colossal burden of disease and death in India and is responsible for the devastating health, social, economic, and environmental effects. The lugubrious prevalence and practices of tobacco consumption have been predicted to cause a rapid rise in disease burden, health care costs, and other fiscal losses.[1]
The tobacco epidemic is preventable. Leaders around the globe have begun to recognize that tobacco use is an epidemic that can and must be confronted and stopped. Some countries have started mobilizing resources to protect their citizens and their economies. To expand the fight against the tobacco epidemic, World Health Organization (WHO) has introduced the MPOWER package of six proven policies.[2]
Although the global tobacco epidemic threatens more lives than any infectious disease, the solution is not the discovery of a vaccine but implementation of proven public policies. Hence, almost all the countries and the WHO have policies and laws implemented to curb this global epidemic. In India, Cigarettes and other Tobacco products Act (COTPA)-2003 was formed and implemented from October 2008.
This law was intended to protect and promote public health, encompass evidence-based strategies to reduce tobacco consumption, and impose penalties to the violators. The chief provisions of the act were banning of direct and indirect advertisements of tobacco products, prohibition of smoking in public places, sale of tobacco to minors, and smoking within a radius of 100 yards of educational institutions.[3] The law intends to prevent the present and future generations from the adverse effects of tobacco use by forestalling youth.[2] The successful implementation of the law is an important strategy to prevent the tobacco related deaths and to improve the productivity of the country.
Thus, this study was conducted with two objectives, first being, to observe if the Section 4 (Prohibition Of Smoking In Public Places), 6b (Prohibition of sale of tobacco products near educational institutions), and 7 (Display of pictorial health warnings on all tobacco products packets) of the COTPA-2003 are implemented in Bengaluru city, and the second, to assess the knowledge of the head of these institutions/offices regarding COTPA-2003.
| Materials and Methods | | |
A cross-sectional study was undertaken in Bengaluru city during June 2012 to July 2012. Ethical consent was obtained from the Institutional Review Board. Sample size was statistically estimated to be 175 based on the single proportion formula with allowable error of 5%. The prevalence rate was used from the results of a pilot study conducted. Cluster random sampling was used to select the public places which included schools, bus stops, railway stations, government and private workplaces, restaurants, and shopping malls [Table 1].
Various subsections of the Section 4 (Prohibition of smoking in Public Places) and 6b (Prohibition of sale of tobacco products in the radius of 100 m around educational institutions) were studied, and a checklist [Table 2] was prepared to observe the public place. Permission was sought from the Institutional Head to conduct the study in their institutional premises. Then the institution or the workplace was observed for the compliance of the law. The presence or absence of the particular subsection was marked in the checklist. This was followed by a structured interview for the Institutional Heads regarding their knowledge of COTPA-2003 and also their responsibilities in its implementation [Table 3]. | Table 3: Checklist for view of the institutional heads in implementation of "no smoking in public places" law
Click here to view |
The various Indian brands of smoked and smokeless forms of tobacco were studied for the adherence to law. A similar kind of checklist was made based on the subsections of the Section 7 of COTPA-2003 [Table 4]. It was used to assess the brands available (12 smokeless forms of tobacco products and 12 smoked (cigarettes and bidis) in Bengaluru. | Table 4: Checklist for display of pictorial health warning on all tobacco products
Click here to view |
The results were analyzed using IBM Statistical Package for Social Sciences (SPSS) Version 16. The enforcement of the law in the public places was presented as descriptive statistics.
| Results | | |
We observed that the law of COTPA-2003 (Section 4, 6b, and 7) was not implemented in the Bengaluru city to the fullest extent.
Display of the board
The "No Smoking Area–Smoking Here is An Offence" boards were seldom (10.3%) placed at the entrance/exit, and specified locations recommended under the COTPA-2003. The boards with warning message "No Smoking" were seen at most of the public places (41.4%). Such boards were found at places inside the buildings (24%) e.g., written or pasted on the walls. On the buildings of more than one floor, the boards were observed on the ground floor in most of these buildings. In the public transport, the text warning message "no smoking" was pasted. About 93.1% of the public places had "no smoking" boards which were smaller in size than the specified size of 60 cm by 30 cm under the rules. These did not comply with the color specifications (80.6%), and also the boards were not visible at the entry of the public place (66.3%) as per the recommendations of the law.
Complaint mechanism
Most of the public places did not have any complaint mechanism in the form of a notice placed at a visible position. These boards were displayed only in 4.6% locations. Only one board that we observed had displayed the telephone number of complaint officer along with his/her designation.
Educational institutions
These boards as mandated under the law were placed at very few educational institutions. The boards placed were of variable sizes, even when the size of display has been specified strictly by the government. Only 28.2% educational institutions displayed such a board at a noticeable place outside the institution [Table 5]. The sale of tobacco products outside educational institution was quite commonly observed. About 80% of these shops were fixed. We saw that an alarming 76.2% of the educational institutions had shops selling tobacco products within a radius of 100 mm.
Interview with the institutional heads
Based on the interview of the institutional heads, it was seen that 91% of them were aware of the law being present. However, only 25% of them were aware that they as institutional heads are empowered to collect penalty from the people who violate the law. None of them had collected fine from anyone.
Display of pictorial health warnings
Based on the observation of the various smoked and smokeless forms of tobacco, we observed that though 100% of them had a label as specified by the law; it did not follow all the specifications. Only 58.3% had the label in both the languages, that is, English and the local language (Kannada). Only 79.2% of the brands had it specified covering 40% of the front panel. Pictorial warning was seen on almost all (95%) the tobacco packets.
| Discussion | | |
The present cross-sectional study gave a very grim situation of the implementation of the COTPA-2003 in Bengaluru city, India. As per our knowledge, this is one among the few studies conducted to observe the implementation of COTPA-2003 in India.
In this study, we observed that 89.7% of the public places did not display the "no-smoking-smoking here is an offence" signage at any of their entrance (s). A similar kind of study was conducted by Hriday Organisation in 2 states of India–Delhi and Tamil Nadu, and they reported similar results. Overall, 89% of the public places did not display the "no-smoking-smoking here is an offence" signage at any of their entrance (s). Only 6% of the public places had complaint mechanism in the form of a visible notice placed at the public place, whereas, in our study, we saw that only 4.6% had the complaint mechanism mentioned.[4]
Although in Bengaluru, 91% of the institutional heads were aware of the law being present; none of them had collected the penalty from the violators. Nearly 3 years after the new regulations under the Control of Tobacco Products Act (COTPA), 2004, were passed, there are still problems with their enforcement in the State. Both the Bruhat Bangalore Mahanagara Palike (BBMP) and the State Government lack funds and are short of staff when it comes to making the ban on smoking in public places completely effective.[5] Under COTPA, 2004, new rules were passed on May 30, 2008, which prohibits smoking in hotels, restaurants, coffee houses, pubs, shopping malls, cinema halls, hospitals, amusement centers, railway stations, etc., The Health Department of BBMP confirms that the corporation is short of staff and lacks funds when it comes to patrolling and conducting raids.[5]
Breslau et al. in their cohort study, reported that persons who smoked their first cigarette at 14–16 years of age were 1.6 times more likely to become dependent than those who initiated smoking at an older age.[6] Hence, the law has strict regulations for the sale of tobacco products in near the educational institutions. In our study, we saw that boards were displayed outside the schools, but there were fixed shops (76%) selling tobacco products in the radius of 100 mm of the school. Furthermore in the WHO based health promoting schools framework, ban on use of tobacco forms a component of healthy school environment.[7] The government of Tamil Nadu has taken many initiatives in the implementation of this act, which has proved to be a successful model for the entire country. One of the strategies adopted is, "smoke-free educational institutions," which is impressive, visible, and sustainable, and can be replicated.[8] In another study conducted in schools of West Bengal, 80% of the school personnel reported that there was no policy on prohibiting tobacco use for students.[9]
The evidence indicates that the effect of health warnings depends on their size and obscure text-only warnings appear to have little effect on minds of people. The evidence also indicates that comprehensive warnings are effective among youth and may help to prevent smoking initiation. Pictorial health warnings that elicit strong emotional reactions are significantly more effective.[10] None of the studies conducted hitherto in regard to pictorial health warnings have assessed the implementation of the law. In our study, we observed that though 100% of them had a label as specified by the law, only 58.3% had it in both languages and 79.2% had had it specified covering 40% of the front panel.
A study was conducted in Mumbai, India, reported that the mandated pictorial warnings did not serve the desired purpose since they were not properly understood. The symbol of scorpion in the health warning becomes associated with the product in a nonscientific manner. The study also showed that X-ray of lung were hardly understood by anybody, and pictures of diseased lungs were not used by tobacco manufacturers.[11]
Another study conducted in India in five states showed that 64.47% of participants expressed that the current health warnings are inadequate to convey health impact of tobacco, and over half of participants felt that these warnings would neither motivate tobacco users to quit nor prevent nonusers from initiating.[12] Thus, even though the warnings are present on the tobacco products, they are not field tested, and strategies need to be implemented in making them more effective.
Studies have shown that smoke-free laws that ban smoking in public places such as bars and restaurants help to improve the health of workers.[13],[14],[15] In one of the systematic reviews conducted on the legislative smoking bans, two studies showed no significant change in support pre- and post-ban. One study showed ≥70% support post ban with greater support among smokers who had stopped or tried to stop smoking. Four studies reported full compliance in no smoking hospitality venues; three others reported significant decrease in observed smoking or smoking in the workplace. Only one study reported that 31% of smokers reported no change post ban or seeing more smoking after implementation of ban.[16]
The limitation of this study is that it was not practically feasible to assess the Section 6a (prohibition of sale of tobacco products to a person below age of 18 years).
Recommendations
The implementation of the other sections of COTPA-2003 should be assessed, and only then it can be concluded whether the law is being implemented to the fullest extent. Implementation of the law across all the major cities should be checked, and a fool-proof strategy to overcome the pitfalls should be formulated. Future surveys to monitor tobacco use in developing countries need to focus on preferred smoking sites that can provide evidence to tailor smoke-free policies at the national level. Indoor smoking bans as implemented in many developed countries may not protect a large proportion of the population from second-hand smoke in India.[17]
| Conclusion | | |
Overall, this cross-sectional study showed that COTPA-2003 (Sections 4, 6b, and 7) is not being implemented to its fullest extent in Bengaluru city, India. It is considered that an effective realization of this goal would require a coordinated effort from all stakeholders from public and private institutions. Besides sensitization and capacity building of all the notified enforcement officers to effectively enforce the law, there is need for creating larger public awareness about the harmful effects of second-hand smoke so that there is more voluntary compliance with the regulations. Furthermore, the structure of the law should be re-structured so that the enforcement is feasible [Table 6].
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]
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