Document Type : Original Article


International Union Against Tuberculosis and Lung Disease (The Union), South‑East Asia Office, New Delhi, India


BACKGROUND: Tobacco is one of the biggest threats to the public health. Tobacco harms not only
human health but also the environment. The Cigarette and Other Tobacco Products Act (COTPA) was
implemented in India in 2003. Compliance of these laws in public places is mandatory. This study
presents an innovative model to make hospitals tobacco‑free. The aim is to assess the effectiveness
of implementation of tobacco‑free hospitals among security guards, tobacco users, and key observers
visiting a tertiary care dental hospital through a comprehensive strategy.
MATERIALS AND METHODS: An exploratory study was conducted in three phases. Structured
training was organized for all security guards (n = 25) along with pre‑ and post‑assessment using
a validated questionnaire. All the patients and attendants entering the hospital were screened
for tobacco products by security guards. Those patients who were carrying tobacco products
to the hospital (n = 107) were interviewed using a validated questionnaire. Opinions of key
observers (n = 223) who witnessed the event were also recorded. Descriptive statistics (means,
frequency distribution) and inferential statistics (Chi‑square test) were calculated.
RESULTS: At the baseline, only 20% security guards were aware about tobacco legislations, whereas
after 1 month, more than 80% security guards were aware about the laws. Around two‑third of study
participants of both the groups were aware of COTPA Section 4. Approximately 33.6% of tobacco
users and 58.4% of key observers were aware of COTPA Section 6b. Forty tobacco users in the
study availed tobacco cessation services of the hospital.
CONCLUSION: Every staff should be a torch bearer of tobacco control. The study highlights
a comprehensive approach of integrating hospital staff and linking vital cessation services by
implementing Sections of COTPA.


  1. Gats‑2 Global Adult Tobacco Survey Fact Sheet India. 2016–2017.
    Available from:
    GATS‑2 FactSheet.pdf. [Last accessed on 2019 Oct 10].
    2. World Health Organization. Tobacco and Its Environmental
    Impact: An Overview. 2017.
    3. Swaach Bharat Abhiyan. Available from: https://www.pmindia.‑bharat‑abhiyan/. [Last
    accessed on 2019 Oct 10].
    4. WHO framework convention on tobacco control (FCTC). Geneva:
    World Health Organisation, 2003.
    5. Ministry of Law, Government of India, the Cigarettes and
    Other Tobacco Products Bill, 2003 (as passed by the Houses of
    Parliament). Available from:
    [Last accessed on 2019 Oct 09].
    6. Usha S, Sindhu R. Awareness of smoke‑free legislation (Section
    4 of COTPA) among owners or person in‑charge of the public
    places in Ramanagara City. Indian J Public Health Res Dev
    7. Rath R, Krishnan A, Nongkynrih B, Misra P. Assessment of
    implementation status of Cigarettes and Other Tobacco Products
    Act (COTPA) and its awareness among residents in a block of
    Haryana. Indian J Public Health 2018;62:100‑3.
    8. Rijhwani K, Mohanty VR, Balappanavar AY, Hashmi S.
    Compliance assessment of cigarette and other tobacco products
    act in public places in Delhi government hospitals. Asian Pac J
    Cancer Prev 2018;19:2097‑102.
  2. 9. Kayakalp revised booklet august 2016. Kayakalp ‑ Swacchta
    Guidelines for Public Health Facilities | National Health Portal Of
    India. 2019. Available from:
    pg. [Last accessed on 2019 Oct 10].
    10. WheelerJG, Pulley L, Felix HC, BursacZ, Siddiqui NJ, StewartMK,
    et al. Impact of a smoke‑free hospital campus policy on employee
    and consumer behavior. Public Health Rep 2007;122:744‑52.
    11. Sharma R, Saini NK. A critical appraisal of Kuppuswamy’s
    socioeconomic status scale in the present scenario. J Family Med
    Prim Care 2014;3:3‑4.
    12. Ministry of Health and Family Welfare, Government of
    India, National Health Mission. National Tobacco Control
    Programme, [Internet]. Accessed from:
    [Last accessed on 2020 Sep 10].
    13. Athuluru D, Reddy C, Sudhir KM, Kumar K, Gomasani S,
    Nagarakanti S. Cognizance and social attitudes regarding tobacco
    control laws in and around educational institutions of Nellore
    city, India. J Educ Health Promot 2018;7:125.
    14. Tripathy JP, Goel S, Patro BK. 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
    15. Goel S, Ravindra K, Singh RJ, Sharma D. Effective smoke‑free
    policies in achieving a high level of compliance with smoke‑free
    law: Experiences from a district of North India. Tob Control
    16. Goel S, Sharma D, Gupta R, Mahajan V. Compliance with
    smoke‑free legislation and smoking behaviour: Observational
    field study from Punjab, India. Tob Control 2018;27:407‑13.
    17. Sobhan SM, Quader R, Quddus MR, Alam SM, Chowdhury I.
    Investment and getting back the reward: Training different
    government agencies to implement the tobacco control law in
    Bangladesh. Tob Induc Dis 2018;16(Suppl 1):A657.
    18. Sucakli MH, Ozer A, Celik M, Kahraman H, Ekerbicer HC.
    Religious officials’ knowledge, attitude, and behavior towards
    smoking and the new tobacco law in Kahramanmaras, Turkey.
    BMC Public Health 2011;11:1‑7.