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Journal ArticleDOI

Assessing compliance to smoke-free legislation: results of a sub-national survey in Himachal Pradesh, India

01 Jan 2013-WHO South-East Asia Journal of Public Health (Medknow Publications)-Vol. 2, Iss: 1, pp 52-56
TL;DR: The compliance to ′Prohibition of Smoking in Public Places Rules, 2008′ was variable in various district headquarters of Himachal Pradesh, and at the state level, there was more than 80% compliance on at least three of the five indicators.
Abstract: Introduction: Exposure to second-hand smoke (SHS) is a serious public health concern. The Indian smoke-free legislation 'Prohibition of Smoking in Public Places Rules, 2008' prohibits smoking in public places, including workplaces. Objective: To measure the status of compliance to legal provisions that protects the public against harms of SHS exposure, identifies the potential areas of violations and informs policy makers for strengthening enforcement measures. Design: A cross-sectional survey in 1401 public places across 11 district headquarters in Himachal Pradesh, India, using a compliance guide developed by partners of the Bloomberg initiatives to reduce tobacco use. Results: In 1401 public places across 11 district headquarters, 42.8% public places had signage; in 84.2% public places, no smoking was observed and in 83.7%, there was absence of smoking accessories such as ashtray, matchbox and lighter . Tobacco litter like cigarette butts was absent in 64.7% of the public places. Overall, at the state level, there was more than 80% compliance on at least three of the five indicators. Among all categories of public places, educational institutions and offices demonstrated highest compliance, whereas most frequently visited public places, eateries and accommodation facilities had least compliance. Conclusions: The compliance to 'Prohibition of Smoking in Public Places Rules, 2008' was variable in various district headquarters of Himachal Pradesh. This study identified the potential areas of violations that need attention from enforcement agencies and policymakers.
Citations
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Journal Article
TL;DR: A Cochrane systematic review was undertaken to answer the question: "does legislation to ban or restrict tobacco smoking reduce exposure to secondhand smoke and smoking behaviour?"
Abstract: IntroductionA Cochrane systematic review was undertaken to answer the question: "does legislation to ban or restrict tobacco smoking reduce exposure to secondhand smoke and smoking behaviour?"Relevance for nursingSmoking bans are environmental, population-focused approaches that aim to rReducetion in both tobacco smoking behaviours and secondhand smoke exposure. through smoking bans impact the environment and hence population health. Often bans are accompanied by education regarding the need for the ban and support services thato help smokers use the opportunity to quit or reduce their tobacco consumption. Therefore, smoking bans can be associated with the 'settings approach' to health promotion derived from the World Health Organisation's Ottawa Charter (1986). Thise Charter supports population and individual health through integrated, coordinated and multi-dimensional interventions.Study characteristicsAThis was a Cochrane systematic review was undertaken thatwhich produced a 'narrative only' synthesis of 50 studies. Studies (with reported numbers of participants) had samples ranging from of 24 to 10413 subjects. No randomised controlled trials were identified that met review inclusion criteria., Nonethelesshowever, 13 non-randomised controlled studies (quasi-experimental designs) were included; of these 7, were located in a general or workplace setting and 6six related to hospital admissions. A further 37 studies which lacked a control group but recorded data from participants pre and post intervention were also included in the review. In total, In 16 16 of reviewed studies used random sampling was used to select participants from a target population, 11 employed convenience sampling, 5five used randomly selected clusters of bars/public houses; 5five sampling methods were unclear and 2two studies utilised mixed sampling methods.No age, gender or geographic limits were placed on study samples included in the review. ReviewedIncluded studies followed participants for a minimum of six months following the ban (except for 8 studies which measured exposure to second hand smoke). Eight study authors identified that small sample size or low statistical power limited the generalisability of their research findings. No age, gender or geographic limit was placed on participants in reviewed studies. A risk of bias summary table was not included in the review; however, the reviewers note that one source of bias (blinding participants to receipt of the intervention) was not possible in any study, due to the nature of the ban interventions. Eight study authors identified that small sample size or low statistical power was a limitation to the generalisability of their research findings.The most commonly reviewed intervention was a comprehensive legislative ban on indoor smoking that was comprehensive within indoor sites (a total ban in 40 studies). An additional 10Ten ?restriction' intervention studies were also included ; these permitted which the reviewers classified as 'restrictions' as they allowed smoking within a designated area. Twenty two of the reviewed studies were conducted in workplaces, most of these (19) targeted the health of hospitality workers in bars or restaurants. The reviewed studies included bans in 13 countries, mostly the USA (17) or Scotland (8). Exposure to secondhand smoke was collectedmeasured by participants' self-report recordingof either the 'duration of exposure' or 'percentage sample exposed'. Some researchers (mostly those conducting large population studies) also took biochemical samples e.g. of saliva, to validate self-reports. Measures such as: smoking prevalence, tobacco consumption, smoking cessation, and respiratory, cardiac or sensory health outcomes were also considered by the reviewers. …

305 citations

Journal ArticleDOI
TL;DR: Smoke-free compliance in public places in India was suboptimal and was mainly related to the absence of no-smoking signage, which warrants further pragmatic and innovative ways to improve the situation.

42 citations

Journal ArticleDOI
TL;DR: The city of Chandigarh, which was declared the first smoke-free city of India, showed poor compliance with COTPA, according to an observational study conducted at 108 public places.
Abstract: Background: India is a signatory to Framework Convention on Tobacco Control and also enacted cigarettes and other tobacco products Act (COTPA) in 2003. Objectives: To undertake a comprehensive assessment (Section 4, 5, 6, 7, 8, and 9 under COTPA) of legislation against tobacco products in a North Indian city. Methods: An observational, cross-sectional study was conducted at 108 public places which included educational institutions, offices, health institutes, transit sites, and hotels/restaurants. Structured checklists with compliance indicators for various sections under COTPA were used. Different brands of tobacco products were observed for pictorial warnings. Results: No active smoking was observed at 80.5% public places, while 54.6% places had displayed “No smoking” signage. About 68.5% public places were found free of evidence of smell/ashes of recent smoking, and 86.1% places had no smoking aids. Merely, one-third public places (36.1%) were complying with all Section 4 indicators. Around 42.3% point of sale had advertisements of tobacco products, and 73.1% had a display of tobacco products visible to minors. Around 60% educational institutions displayed signages as per Section 6b of COTPA, and 32.5% had tobacco shops being run within 100 yards of institution's radius. There was minimal smoking activity within the campus. Health warnings were present in 80.8% of tobacco products, more with Indian brands as compared to foreign brands. Conclusion: The city of Chandigarh, which was declared the first smoke-free city of India, showed poor compliance with COTPA.

16 citations

Journal ArticleDOI
TL;DR: More than 80% of the public places in a jurisdiction in north India were compliant with the smoke-free legislation of India, and ‘No smoking’ signages displayed as per legislation have an effect on curbing smoking behaviours at public places.
Abstract: Background Indian smoke-free legislation requires prohibition of smoking at public places and owners of public places to display ‘no smoking’ signages. Aims and objectives The study aims to assess the compliance of public places with smoke-free legislation and determine the factors associated with active smoking in public places. Methodology This was a cross-sectional analytic observational quantitative survey conducted by a team of trained field investigators using a structured observational checklist across 6875 public places in Punjab state of India. The study was carried out over a period of 3 years. Results A total of 6875 public places across 22 districts of Punjab were observed. The overall compliance to smoke-free law in Punjab was 83.8%. The highest overall compliance was observed in healthcare facilities (89.6%) and least in transit stations (78.8%). Less active smoking was observed in public places where display of ‘no smoking’ signage compliant with smoke-free law of India was present (adjusted OR 0.6). Further, there was a positive association between active smoking and places where the owner of public places smoked (OR 5.2, CI 2.5 to 11.1). Conclusion More than 80% of the public places in a jurisdiction in north India were compliant with the smoke-free legislation of India. ‘No smoking’ signages displayed as per legislation have an effect on curbing smoking behaviours at public places. It is recommended that policymakers should focus more on implementing the smoke-free law at transit sites and structured training sessions should be organised for owners of workplaces.

16 citations

Journal ArticleDOI
TL;DR: Air quality monitoring can provide objective scientific data on SHS and air quality levels in venues to assess the effectiveness of SF laws and identify required improvements and suggests this is a viable method for improving knowledge about SHS exposure and can provide indicative data on compliance with SF legislation.
Abstract: INTRODUCTION Many low- and middle-income countries (LMICs) have enacted legislation banning smoking in public places, yet enforcement remains challenging. The aim of this study was to assess the feasibility of using a validated low-cost methodology (the Dylos DC1700) to provide objective evidence of smoke-free (SF) law compliance in hospitality venues in urban LMIC settings, where outdoor air pollution levels are generally high. METHODS Teams measured indoor fine particulate matter (PM2.5) concentrations and systematically observed smoking behavior and SF signage in a convenience sample of hospitality venues (bars, restaurants, cafes, and hotels) covered by existing SF legislation in Mexico, Pakistan, Indonesia, Chad, Bangladesh, and India. Outdoor air PM2.5 was also measured on each sampling day. RESULTS Data were collected from 626 venues. Smoking was observed during almost one-third of visits with substantial differences between countries-from 5% in India to 72% in Chad. After excluding venues where other combustion sources were observed, secondhand smoke (SHS) derived PM2.5 was calculated by subtracting outdoor ambient PM2.5 concentrations from indoor measurements and was, on average, 34 µg/m(3) in venues with observed smoking-compared to an average value of 0 µg/m(3) in venues where smoking was not observed (P < .001). In over one-quarter of venues where smoking was observed the difference between indoor and outdoor PM2.5 concentrations exceeded 64 µg/m(3). CONCLUSIONS This study suggests that low-cost air quality monitoring is a viable method for improving knowledge about environmental SHS and can provide indicative data on compliance with local and national SF legislation in hospitality venues in LMICs. IMPLICATIONS Air quality monitoring can provide objective scientific data on SHS and air quality levels in venues to assess the effectiveness of SF laws and identify required improvements. Equipment costs and high outdoor air pollution levels have hitherto limited application in LMICs. This study tested the feasibility of using a validated low-cost methodology in hospitality venues in six LMIC urban settings and suggests this is a viable method for improving knowledge about SHS exposure and can provide indicative data on compliance with SF legislation.

14 citations

References
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Journal ArticleDOI
TL;DR: Estimates of worldwide burden of disease attributable to second-hand smoke suggest that substantial health gains could be made by extending effective public health and clinical interventions to reduce passive smoking worldwide.

1,555 citations


"Assessing compliance to smoke-free ..." refers background in this paper

  • ...Every year, exposure to SHS causes over 600 000 premature deaths worldwide.[3]...

    [...]

Journal ArticleDOI
TL;DR: Assessment of the effects of legislative smoking bans on morbidity and mortality from exposure to secondhand smoke, and smoking prevalence and tobacco consumption provides more robust support for the previous conclusions that the introduction of a legislative smoking ban does lead to improved health outcomes through reduction in SHS.
Abstract: Smoking bans have been implemented in a variety of settings, as well as being part of policy in many jurisdictions to protect the public and employees from the harmful effects of secondhand smoke (SHS). They also offer the potential to influence social norms and the smoking behaviour of those populations they affect. Since the first version of this review in 2010, more countries have introduced national smoking legislation banning indoor smoking.

574 citations

Journal ArticleDOI
TL;DR: Age-specific mortality from smoking among men in urban and in rural India was assessed, finding that ever smokers are three times as likely as never smokers to report a history of tuberculosis, corresponding to a higher rate of progression of chronic subclinical infection to clinical disease.

465 citations


"Assessing compliance to smoke-free ..." refers background in this paper

  • ...Epidemiological overview of hIV/aIdS in thailand UNAIDS estimates that there are around 490 000 [450 000‐550 000] people living with HIV in Thailand....

    [...]

  • ...[15] WHO also estimated 45% reduction in diarrhoea morbidity from household water treatment[13] and 65....

    [...]

  • ...Source: Reference[13]; DALY ‐ Disability‐adjusted life year...

    [...]

  • ...[13] Conventional source‐based interventions have a mean cost per disability‐adjusted life year (DALY) averted of about twice that of chlorination and solar disinfection....

    [...]

Journal ArticleDOI
TL;DR: Higher taxes, regulations on smoking and information for consumers could avoid at least 115 million smoking-associated deaths in the next few decades, including around 25 million cancer deaths.
Abstract: On the basis of current consumption patterns, approximately 450 million adults will be killed by smoking between 2000 and 2050. At least half of these adults will die between 30 and 69 years of age, losing decades of productive life. Cancer and the total deaths due to smoking have fallen sharply in men in high-income countries but will rise globally unless current smokers, most of whom live in low- and middle-income countries, stop smoking before or during middle age. Tripling the taxes on tobacco could rapidly raise cessation rates and deter the initiation of smoking. Higher taxes, regulations on smoking and information for consumers could avoid at least 115 million smoking-associated deaths in the next few decades, including around 25 million cancer deaths.

462 citations


"Assessing compliance to smoke-free ..." refers background in this paper

  • ...[1] More than 80% of the world’s smokers live in low‐ and middle‐income countries.[2] It is now unequivocally established that exposure to SHS is as harmful as active smoking and causes death, disease and disability....

    [...]

Journal Article
TL;DR: A Cochrane systematic review was undertaken to answer the question: "does legislation to ban or restrict tobacco smoking reduce exposure to secondhand smoke and smoking behaviour?"
Abstract: IntroductionA Cochrane systematic review was undertaken to answer the question: "does legislation to ban or restrict tobacco smoking reduce exposure to secondhand smoke and smoking behaviour?"Relevance for nursingSmoking bans are environmental, population-focused approaches that aim to rReducetion in both tobacco smoking behaviours and secondhand smoke exposure. through smoking bans impact the environment and hence population health. Often bans are accompanied by education regarding the need for the ban and support services thato help smokers use the opportunity to quit or reduce their tobacco consumption. Therefore, smoking bans can be associated with the 'settings approach' to health promotion derived from the World Health Organisation's Ottawa Charter (1986). Thise Charter supports population and individual health through integrated, coordinated and multi-dimensional interventions.Study characteristicsAThis was a Cochrane systematic review was undertaken thatwhich produced a 'narrative only' synthesis of 50 studies. Studies (with reported numbers of participants) had samples ranging from of 24 to 10413 subjects. No randomised controlled trials were identified that met review inclusion criteria., Nonethelesshowever, 13 non-randomised controlled studies (quasi-experimental designs) were included; of these 7, were located in a general or workplace setting and 6six related to hospital admissions. A further 37 studies which lacked a control group but recorded data from participants pre and post intervention were also included in the review. In total, In 16 16 of reviewed studies used random sampling was used to select participants from a target population, 11 employed convenience sampling, 5five used randomly selected clusters of bars/public houses; 5five sampling methods were unclear and 2two studies utilised mixed sampling methods.No age, gender or geographic limits were placed on study samples included in the review. ReviewedIncluded studies followed participants for a minimum of six months following the ban (except for 8 studies which measured exposure to second hand smoke). Eight study authors identified that small sample size or low statistical power limited the generalisability of their research findings. No age, gender or geographic limit was placed on participants in reviewed studies. A risk of bias summary table was not included in the review; however, the reviewers note that one source of bias (blinding participants to receipt of the intervention) was not possible in any study, due to the nature of the ban interventions. Eight study authors identified that small sample size or low statistical power was a limitation to the generalisability of their research findings.The most commonly reviewed intervention was a comprehensive legislative ban on indoor smoking that was comprehensive within indoor sites (a total ban in 40 studies). An additional 10Ten ?restriction' intervention studies were also included ; these permitted which the reviewers classified as 'restrictions' as they allowed smoking within a designated area. Twenty two of the reviewed studies were conducted in workplaces, most of these (19) targeted the health of hospitality workers in bars or restaurants. The reviewed studies included bans in 13 countries, mostly the USA (17) or Scotland (8). Exposure to secondhand smoke was collectedmeasured by participants' self-report recordingof either the 'duration of exposure' or 'percentage sample exposed'. Some researchers (mostly those conducting large population studies) also took biochemical samples e.g. of saliva, to validate self-reports. Measures such as: smoking prevalence, tobacco consumption, smoking cessation, and respiratory, cardiac or sensory health outcomes were also considered by the reviewers. …

305 citations


"Assessing compliance to smoke-free ..." refers background in this paper

  • ...A Cochrane Review of 50 studies from developed countries confirms that legislation when enforced can effectively reduce SHS exposure, especially at workplaces and public places.[6]...

    [...]

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The compliance to ′Prohibition of Smoking in Public Places Rules, 2008′ was variable in various district headquarters of Himachal Pradesh.