Assessment of compliance to the COTPA 2003 legislation in tertiary healthcare institutes of Shimla: a smoke free city in India

Anita Thakur, Ankit Chaudhary, Tripti Chauhan, Anmol Gupta, Anjali Mahajan, Vijay Barwal, Shaina Chamotra, Nidhi Chauhan


Background: Tobacco smoking is a pandemic affecting populations and contributing to global morbidity and mortality. It is well known that the second hand smoke is equally hazardous like first hand smoke. Cigarette and other tobacco products act 2003 is an effort put forth by Government of India in order to curb this menace and protect people from ill effects of second hand smoke.

Methods: The present study was conducted to assess the compliance to smoke free act in tertiary healthcare institutes in Shimla city, Himachal Pradesh. A total of 57 public places and 8 shops in five Tertiary healthcare institutes were evaluated for various provisions of the act. Compliance to different sections of the act was assessed using a structured observational checklist.

Results: Signage indicating ban on smoking was seen at 71.9% places. Active smoking was absent at 77.2% places. About 25% shops around the institutes were found selling tobacco products. Signage displaying ban on sale within 100 m of educational institution and sale to minors was not observed at any shop. Tobacco product vendor was seen around 80% of educational buildings. Tobacco free institution signage was seen at 60% of educational premises.

Conclusions: The study highlights that the level of compliance did not meet the standards laid down for a smoke free city. Timely and periodic assessment of the compliance must be conducted by the administrative authorities of the institutes for ensuring the adherence and strict implementation of the provisions of the act.



COTPA 2003, Tertiary healthcare institutions, Smoke free city

Full Text:



Mackay J, Eriksen M. The tobacco Atlas: World Health Organization; 2002. Available at: Accessed 01 December 2018.

WHO, WHO the global tobacco crisis. Available at: Accessed 01 December 2018.

Jha P, Jacob B, Gajalakshmi V, Gupta P, Dhingra N, Kumar R, et al. A nationally representative case–control study of smoking and death in India. New England J Med. 2008;358(11):1137–47.

Sinha D, Palipudi K, Gupta P, Singhal S, Ramasundarahettige C, Jha P, et al. Smokeless tobacco use: a meta-analysis of risk and attributable mortality estimates for India. Indian J Cancer. 2014;51(1):S73–7.

WHO Report on the Global Tobacco Epidemic 2008: The MPOWER package. Available at: Accessed 1 December 2018.

WHO Tobacco fact sheet March 2018. Available at: Accessed 1 December 2018.

WHO Framework Convention on Tobacco Control. Geneva: World Health Organization (WHO), 2005. Available at: handle/10665/42811/9241591013.pdf?sequence=1. Accessed 12 December 2018.

Cigarette and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) act-2003. New Delhi: Ministry of Health and Family Welfare, Government of India; 2003.

Tobacco free initiatives in Himachal Pradesh: Smoke free Shimla. Shimla: Department of Health and Family Welfare, Government of Himachal Pradesh, Department of Health and Family Welfare 2010. Available at: CaseStudySmokeFreeHimachal.pdf. Accessed 12 December 2018.

Gupta S, Gupta N. Journey from smoke free Himachal Pradesh to tobacco free to Eco-friendly hills of the adolescent state. Pediatric Education Res. 2014;2(1):5-13.

Goel S, Kumar R, Lal P, Singh R. How effective is tobacco control enforcement to protect minors: Results from subnational surveys across four districts in India. Int J Non-Commun Dis. 2016;1:116-21

Kumar R, Chauhan G, Satyanarayana S, Lal P, Singh R, Wilson N. Assessing compliance to smoke-free legislation: Results of a sub-national survey in Himachal Pradesh, India. South East Asia J Public Health. 2013;2:52-6.

Assessing compliance with smoke free laws, Second edition: A “how to” guide for conducting compliance studies. International Union against Tuberculosis and Lung Disease. 2014. Available at: Accessed 12 December 2018.

Guidelines for Law Enforcers for effective implementation of Tobacco Control Laws 2013. Ministry of Health and Family Welfare Government of India; 2013.

Sharma N, Chavan B. Compliance to tobacco-free guidelines (Cigarettes and Other Tobacco Products Act) in medical institute of North India. Indian J Soc Psychiatry. 2018;34:213-6.

Tripathy J, Goel S, Patro B. Compliance monitoring of prohibition of smoking (under section-4 of COTPA) at a tertiary health-care institution in a smoke-free city of India. Lung India. 2013;30:312-5.