Tobacco-free policies in hospital campus reduce exposure to tobacco smoke; change the demeanour of the professionals, patients and people visiting hospitals towards tobacco use. A cross-sectional observational study was conducted within Government hospitals. Multistage random sampling was used to select 18 hospitals out of 39 hospitals from 5 zones. Hospital campuses were assessed by dividing them into zones like hospital buildings, office buildings, public places outside the hospital and residential areas. Signs of active tobacco use observed in

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Tobacco-free policies in hospital campus reduce exposure to tobacco smoke; change the demeanour of the professionals, patients and people visiting hospitals towards tobacco use. A cross-sectional observational study was conducted within Government hospitals. Multistage random sampling was used to select 18 hospitals out of 39 hospitals from 5 zones.

Hospital campuses were assessed by dividing them into zones like hospital buildings, office buildings, public places outside the hospital and residential areas.

Signs of active tobacco use observed in The study highlighted a lower compliance rate than expected which raises questions on law enforcement concerning tobacco. Hence necessary measures have to be used up for sustained awareness campaigns, backed by enforcement drives. Periodic compliance surveys will strengthen the implementation of tobacco free legislation in health care institutions.

However, Tobacco is the leading cause of preventable premature deaths across the world WHO, India is the 2nd largest consumer and producer of tobacco. It accounts for almost 1 million deaths of Indians per year. Health care facilities form the backbone of Health system of any society and Hospitals form a central role in dissipating preventive, curative and treatment services along with health promoting services which embraces the objective of health promotion, develops a health promoting organizational structure and civilization, including dynamic, participatory roles for patients and all members of staff.

Tobacco -free hospital campus is one path of doing so for commitment to sound health, reducing vulnerability to tobacco use, increases quit rates, change the behaviour of the healthcare professionals and patients visiting hospitals towards tobacco use Wheeler et al.

Although stringent health policies are in force in our country, notwithstanding there is lack of rigorous compliance to the health laws. It is a powerful global instrument that contains binding provisions on member states. It supplies a comprehensive direction for tobacco control at all levels covering more than India was the seventh nation in the world to ratify FCTC was also among the first nations to enact a strong national law for tobacco control in , i.

Section-5 of Tobacco Control Act, provides Prohibition of advertisement, promotion and sponsorship of all tobacco products. Section 6 b of Tobacco Control Act, provides; Prohibition on sale of tobacco products near educational institutions. In , Ministry of Health and Family Welfare, Government of India proposed the Prohibition of smoking in public place rules to strengthen the existing COTPA legislation by including public spaces that were omitted in the original legislation, and set terms such as smoking and non-smoking areas.

It also provides instructions related to enforcement, which includes inside information regarding the presentation of signage in public places and identification of focal points for putting through the law. MOHFW, Many such compliance studies have been conducted in public places like bars, pubs, restaurants, transportation settings and other public places across the world, but in health care institutions have not been explored so far specifically in Delhi. Against this background, the present study was designed to assess the compliance to Section-4, 5 and 6 of Cigarette and Other tobacco products Act in Public places in Delhi Government Hospitals.

A cross-sectional observational study was conducted to assess the compliance to Section-4, 5 and 6 of COTPA in public places within the hospital campus. A total of 39 government hospitals 18 tertiary and 21 secondary distributed in 5 zones of Delhi was considered for the subject area MOHFW, A multistage random sampling technique employed where 11 secondary and 7 tertiary hospitals were selected out of these hospitals as shown in Figure 1.

The public places within the Hospital campus were measured. These public place within the hospital campus are divided into four different zones like hospital buildings, office buildings public places outside the hospital and residential areas to get maximum response. Public places outside the hospitals included marketplaces, recreational spots such as greens, eating joints, schools, library, etc. Residential areas included staff quarters, hostels for doctors and nurses and homes for patients.

The trained field investigator visited these public places. The visits to the office buildings were drawn during the office hours, hospital buildings were seen during the busiest hours noon whereas, other public spaces and residential quarters were paid a visit during the evening hours.

The survey was held out from August October The average time spent at each location varied from 20 min to 30 min depending on the field covered.

The data regarding the location was recorded in the observation sheet. A total of public places within the hospital campus hospital buildings, office buildings- 20, public places outside the hospitals, and residential areas- 25 were visited during the study. The signs of active smoking were observed more in public places The name, designation and telephone no.

All these findings were shown in Table 1 and Figure 2. This survey was an effort to assess the compliance of Section-4, 5 and 6 of COTPA in various Government hospitals, both tertiary as well as secondary in Delhi. However, similar less significant compliance rates were observed in a survey done in tertiary care hospitals in smoke free city-Mohali, Punjab by Tripathy et al. Laws and its regulations are borne out of a need or efforts to curb issues or burden of disease which have a huge societal impact.

Further to ensure whether these laws have been implemented adequately or not, we need to assess compliance at every level from time to time. So there are multiple techniques available for evaluation and one way of doing so is by compliance surveys. The purpose of a compliance survey is to assess adherence, prevent deficiencies and violations, develop ways to address them Ponto, A survey performed in Cairo, Egypt, showed that smoke-free policies were poorly applied in great teaching hospitals.

Smoking by physicians, lax enforcement, a lack of penalties for violators and lack of cessation treatment were among the barriers reported by most of the interviewed staff Radwan et al.

Similar findings have been observed in a study Reddy et al. Well-implemented tobacco-free laws, not only protect common people and workers from exposure to second-hand smoke, but also increase public consciousness of the adverse health effects of smoking tobacco. In fact, longer the smoke free worksite policies are in place, the more pronounced their effects on smoking behavior could be.

In present survey, it was observed that there were no designated smoking areas, neither were the ashtrays or other smoking aids that were present at the indoor locations nor were there tobacco sale inside these premises.

This was a positive observation suggesting compliance with tobacco free laws at indoor locations and should be strengthened further to improve compliance. The variability in results after implementing smoking bans may also be due to differences across study jurisdictions e. Similar types of observation were also found in public places of Bengaluru city Habbu and Krishnappa, Such open accessibility to tobacco products near high risk areas like Hospitals, Schools etc. Further restricting access to tobacco products among adolescents has been viewed as an important strategy.

Display of boards to ban on sale of tobacco products and its ill effects posters were rarely found in these areas and need to be strengthened as visibility might positively reinforced and promote healthy practices or reduce the impact by creating awareness. Further it was observed that many people were found using tobacco products at outdoor areas in the hospital premises. This is a direct violation of the provision of the Act. This effort would surely take care of administrative intervention for immediate action.

The overall compliance to tobacco free laws was found to be higher in tertiary hospitals as compared to secondary centres. This gave an insight that better enforcement was seen in Tertiary setups as compared to Secondary setups. This could mostly be attributed to the fact that outpatient among secondary hospitals is high due to its nature or scope of services being a general hospital whereas tertiary care hospitals are specialized centres for referral cases. Tobacco is one of the leading causes of morbidity and mortality in India.

Tobacco control in India has come a long way. The various sections of COTPA help us to regulate sales to minors, pictorial health warnings, smoking at public places and advertisement of tobacco products.

Hence, to maintain the inviolability of these regulations it is necessary to evaluate various implementation strategies. Not only raising awareness would help changing the current scenario, but continuous compliance surveys for Tobacco control Legislations would aid in bringing a positive change.

Strict Health care Legislations form the backbone of Healthy society in any country. Compliance studies are one of the most uncomplicated and cost-effective instruments for measuring and shaping the progress of implementation.

The overall barriers to successful implementation of many tobacco control policies could be lack of inter-sectorial coordination, shortage of resources, low penalization of violators, lack of adequate and continuous monitoring and implementation of smoke free laws and above all low awareness among general public regarding health impact of tobacco and its related laws.

Some of the potential solution levers as suggested by many program managers include employing dedicated staff, regular training and health education drives for creating awareness, financial and non-financial awarding for best tobacco control officer incentives to raise their motivation and frequent up dation of penalities and annual collection of fine need to be accounted to check for effective implementation and enforcement.

The study is not without inherent limitations and needs to be considered with them. The study was a cross sectional study; considered only one time field assessment.

So in order to strengthen the information generated needs to be evaluated during timings of the day. The study only considered physical assessment of buildings; further interaction with tobacco control officers of respective hospitals would have given us better insight into the barriers of implementation.

Based on the findings above, we highly recommend several actions to enable us to move towards significant reductions in the growing tobacco burden. First, we encourage central and state public health organizations to establish stringent and pragmatic goals which will help reduce tobacco use especially at the district level.

At the same time, realistic planning needs to take into account existing capacity of the health system. An assessment of the health system implications and related resource costs will help in planning for proper implementation of tobacco control policy and program.

This will also facilitate integration of the tobacco control program into broader national health plans. While extensive scientific evidence exists on the tobacco epidemic, a lack of understanding of both policies and their implementation continues to hinder effective tobacco control. This is especially so in the context of developing countries such as India.

Understanding their perspectives can help strengthen the implementation and suggest midway corrections in the policies aiming to strengthen the diagonal integration of tobacco control in health system. Law enforcement forms the backbone of any Successful organization.

Compliance evaluation studies are an essential part of the MPOWER package since it is an equipment to screen tobacco control strategies and force bans. These are doable and replicable in any setting with nearby adjustment.

These studies are a straightforward for approving advancement in the implementation, actualizing sans smoke open spots and in recognizing the lacks. These should be done scientifically and must be illustrative of the locality substances or realities. In this manner outsider evaluations are urgent to make them substantial and worthy.

The conclusion of this study highlighted a lower compliance rate than expected which raises questions on law enforcement concerning tobacco. Realizing the pressing need to curtail the tobacco epidemic, the enforcement of the provisions of COTPA needs to be beefed up, particularly in academia, research and health care establishments.

As the second largest producer and consumer of tobacco in the world, there is a greater need to dissect the case for a comprehensive tobacco control program. This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

I would like to Thank Dr. Swati Jain and Vaibhav Singh for helping me in data management and analysis. National Center for Biotechnology Information , U. Asian Pac J Cancer Prev.


COTPA 2003 and Rules made thereunder

The questionnaire consisted of 21 questions which included the criteria related to tobacco-free provisions of Section 6 of COTPA Act In thirty five percent of schools at least one vendor was situated at within yards of school. The violation was seen at points of sale POS of tobacco products as well as around the EIs such as sale of tobacco products by minors 6. The schools and the local district health authorities should be made aware of the extent of non-compliance of COTPA Act and be made stakeholders to reduce tobacco use by Minors. Tobacco use is one of major preventable causes of premature death and disease worldwide.


Cigarettes and Other Tobacco Products Act

The Cigarettes and Other Tobacco Products Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution Act, or COTPA, is an Act of Parliament of India enacted in to prohibit advertisement of, and to provide for the regulation of trade and commerce in, and production, supply and distribution of cigarettes and other tobacco products in India. The Act was enacted by the Parliament to give effect to the Resolution passed by the 39th World Health Assembly , urging the member states to implement measures to provide non-smokers protection from involuntary exposure to tobacco smoke. From Wikipedia, the free encyclopedia. Long title.

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