Understanding implementation gaps in tobacco control legislation: a mixed-methods study of COTPA compliance in urban India
6 affiliations
- 1Government Medical College and Hospital, Akola, Maharashtra, India.
- 2Dept of Community Medicine, Sant Sevalal Maharaj Government Medical College, Washim, Maharashtra, India.
- 3Dept of Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research Deemed to be University, Wardha, Maharshtra, India.
- 4School of Epidemiology and Public Health, Datta Meghe Institute of Higher Education and Research Deemed to be University, Wardha, Maharashtra, India.
- 5Faculty Member, Global Health Academy Nuvance Health, Danbury, Connecticut, USA.
- 6Public Health Department, Government of Maharashtra, Akola, Maharshtra, India.
Abstract
Background The Cigarettes and Other Tobacco Products Act (COTPA), 2003 is India’s key legislation to control tobacco use. This study aimed to assess compliance with Sections 4 and 6(b) of COTPA in an urban setting in western India and to explore institutional awareness and enforcement practices.Methods A mixed-methods cross-sectional study was conducted across 71 public places, including educational institutions, government offices, hospitals and informal public areas. Quantitative data were collected using structured observation checklists to assess signage, smoking activity and tobacco vendor presence. Qualitative data were obtained from semistructured interviews with 64 institutional heads, analysed thematically to explore awareness, enforcement and barriers to implementation.Results Compliance with Section 4 (prohibition of smoking in public places) was partial. Section 6(b) compliance was suboptimal: only 18 (39.1%) educational institutions displayed ‘Tobacco Free Institution’ signage at entrances, while 2 (4.3%) had tobacco vendors within 100 yards. Awareness of COTPA provisions among institutional heads was relatively high (82.6% in educational institutions, 92.9% in government offices, 75% in hospitals), but enforcement actions—such as warning shops or collecting fines—were infrequent. Thematic analysis revealed barriers including weak monitoring, manpower shortages, normalisation of tobacco use and limited institutional accountability. These findings indicate a significant policy-to-practice gap driven by system-level, institutional and sociocultural implementation barriers.Conclusions Although awareness of COTPA is high, compliance in urban settings remains partial, particularly regarding signage and tobacco sales near educational institutions. Weak enforcement and sociocultural acceptance of tobacco use undermine implementation. Addressing these implementation barriers through strengthened accountability systems, institutional governance and intersectoral coordination is essential to improve real-world effectiveness of tobacco control policies.
Related
- Assessment of Health Warning Label Compliance on Smokeless Tobacco Products in Bhubaneswar, India.
- Understanding the burden of smokeless tobacco use in rural India: patterns, motivations, and public health implications
- Infant Nutrition Protection in Bangladesh: An Assessment of the Implementation and Compliance of the Breast Milk Substitutes Act and Rules.
- Mapping the adoption and implementation of artificial intelligence (AI)-based conversational interface for tobacco cessation: a scoping review protocol.
- Codevelopment, Implementation, and Evaluation of an AI-powered Conversational Interface for Tobacco Cessation: Protocol for a Single-Group Pre-Post Study.
BibTeX
@article{shegokar2026understanding,
title = {{Understanding implementation gaps in tobacco control legislation: a mixed-methods study of COTPA compliance in urban India}},
author = {Niketan Shegokar and Umesh Kawalkar and Abhay Gaidhane and Priti Kogade and Amar Mankar and Zahiruddin Quazi Syed},
journal = {BMJ Public Health},
year = {2026},
month = oct,
doi = {10.1136/bmjph-2026-005596},
url = {https://doi.org/10.1136/bmjph-2026-005596},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Understanding implementation gaps in tobacco control legislation: a mixed-methods study of COTPA compliance in urban India
AU - Niketan Shegokar
AU - Umesh Kawalkar
AU - Abhay Gaidhane
AU - Priti Kogade
AU - Amar Mankar
AU - Zahiruddin Quazi Syed
PY - 2026
DA - 2026/10/23
JO - BMJ Public Health
DO - 10.1136/bmjph-2026-005596
UR - https://doi.org/10.1136/bmjph-2026-005596
AB - Background The Cigarettes and Other Tobacco Products Act (COTPA), 2003 is India’s key legislation to control tobacco use. This study aimed to assess compliance with Sections 4 and 6(b) of COTPA in an urban setting in western India and to explore institutional awareness and enforcement practices.Methods A mixed-methods cross-sectional study was conducted across 71 public places, including educational institutions, government offices, hospitals and informal public areas. Quantitative data were collected using structured observation checklists to assess signage, smoking activity and tobacco vendor presence. Qualitative data were obtained from semistructured interviews with 64 institutional heads, analysed thematically to explore awareness, enforcement and barriers to implementation.Results Compliance with Section 4 (prohibition of smoking in public places) was partial. Section 6(b) compliance was suboptimal: only 18 (39.1%) educational institutions displayed ‘Tobacco Free Institution’ signage at entrances, while 2 (4.3%) had tobacco vendors within 100 yards. Awareness of COTPA provisions among institutional heads was relatively high (82.6% in educational institutions, 92.9% in government offices, 75% in hospitals), but enforcement actions—such as warning shops or collecting fines—were infrequent. Thematic analysis revealed barriers including weak monitoring, manpower shortages, normalisation of tobacco use and limited institutional accountability. These findings indicate a significant policy-to-practice gap driven by system-level, institutional and sociocultural implementation barriers.Conclusions Although awareness of COTPA is high, compliance in urban settings remains partial, particularly regarding signage and tobacco sales near educational institutions. Weak enforcement and sociocultural acceptance of tobacco use undermine implementation. Addressing these implementation barriers through strengthened accountability systems, institutional governance and intersectoral coordination is essential to improve real-world effectiveness of tobacco control policies.
SN - 2753-4294
ER -